SOMATOFORM DISORDER
Introduction
The Somatoform disorder is a group of mental disturbances placed in a common category
on the basis of their external symptoms. These disorders are characterized by physical
complaints that appear to be medical in origin but that can not be explained in terms of
physical disease. In order to meet the criteria for a somatoform disorder, the physical
symptoms must be serious enough to interfere with the patient’s employment or
relationships, and must be symptoms that are not under the patient’s voluntary control.
People with somatoform disorder have a number of different symptoms that typically last
for several years, medical test results are either normal or don’t explain the person’s
symptoms. People who have this disorder often become very worried about their health
because they do not know what is causing their health problems. The symptoms of
somatoform disorder are similar to the symptoms of other illnesses. People with this
disorder may have several medical evaluations and tests to be sure that they do not have
another illness.
The psychological disorders are often difficult to approach and complex to understand.
They present with unexplained physical symptoms that are not intentional or under
voluntary control but they are understood by the patient and family as having a medical
cause. They can be confused with disorders that have situations in which patients are
intentionally stimulating or creating the problems.
The term malingering is used when the patient has a specific goal in mind when creating
the symptoms. Examples are the child’s Monday morning, “Sore Throat” before school
or the shy girl’s, “sudden weakness” before the school prom.
TYPES OF SOMATOFORM DISORDER
1.
2.
3.
4.
5.
Somatization disorder
Conversion disorder
Pain disorder
Hypochondriasis
Body dysmorphic disorder
SOMATIZATION DISORDER
Definition


Somatization disorder is a psychiatric condition marked by multiple medically
unexplained physical, or somatic, symptoms.
In order to qualify for the diagnosis of Somatization disorder, somatic complaints
must be serious enough to interfere significantly with a person's ability to perform
important activities, such as work, school or family and social responsibilities, or
lead the person experiencing the symptoms to seek medical treatment.
1
Symptoms



Gastrointestinal (GI) complaints, such as nausea, bloating, diarrhea, and
sensitivities to certain foods are common, and at least two different GI symptoms
are required for the diagnosis.
Sexual or reproductive symptoms, including pain during intercourse, menstrual
problems, and erectile dysfunction are also necessary features for a diagnosis for
Somatization disorder. Other frequent symptoms are headaches, pain in the back
or joints, difficulty swallowing or speaking, and urinary retention.
To qualify for the diagnosis, at least one symptom must resemble a neurological
disorder, such as seizures, problems with coordination or balance, or paralysis.
CONVERSION DISORDER
Definition




Conversion disorder is defined by the DSM-IV-TR as a mental disorder whose
central feature is the appearance of symptoms affecting the patient's senses or
voluntary movements that suggest a neurological or general medical disease or
condition.
Previously known as hysteria.
May include seizures or numbness.
Somatoform disorders are marked by persistent physical symptoms that cannot be
fully explained by a medical condition, substance abuse, or other mental disorder,
and seem to stem from psychological issues or conflicts.
Symptoms

In general, symptoms of conversion disorder are not under the patient's conscious
control, and are frequently mysterious and frightening to the patient. The
symptoms usually have an acute onset, but sometimes worsen gradually.
PAIN DISORDER
Definition



The term "somatoform" means that symptoms are physical but are not entirely
understood as a consequence of a general medical condition or as direct effects of
a substance, such as a drug.
Pain in one or more anatomical sites is the predominant complaint and is severe
enough to require medical or therapeutic intervention.
Pain disorder is classified as a mental disorder because psychological factors play
an important role in the onset, severity, worsening, or maintenance of pain.
2
Symptoms
Symptoms vary depending on the site of pain and are treated medically. However, there
are common symptoms associated with pain disorder regardless of the site:






negative or distorted cognition, such as feeling helpless or hopeless with respect
to pain and its management
inactivity, passivity, and/or disability
increased pain requiring clinical intervention
insomnia and fatigue
disrupted social relationships at home, work, or school
depression and/or anxiety
HYPOCHONDRIASIS
Definition




The primary feature of hypochondriasis is excessive fear of having a serious
disease.
These fears are not relieved when a medical examination finds no evidence of
disease.
People with hypochondriasis are often able to acknowledge that their fears are
unrealistic, but this intellectual realization is not enough to reduce their anxiety.
In order to qualify for a diagnosis of hypochondriasis, preoccupation with fear of
disease must cause a great deal of distress or interfere with a person's ability to
perform important activities, such as work, school activities, or family and social
responsibilities.
Symptoms




The primary symptom of hypochondriasis is preoccupation with fears of serious
physical illness or injury.
The fears of persons with hypochondriasis have an obsessive quality; they find
thoughts about illness intrusive and difficult to dismiss, even when they recognize
that their fears are unrealistic. In order to relieve the anxiety that arises from their
thoughts, people with hypochondriasis may act on their fears by talking about
their symptoms; by seeking information about feared diseases in books or on the
Internet; or by "doctor-shopping," going from one specialist to another for a
consultation.
Others may deal with their fears through avoidance, staying away from anything
that might remind them of illness or death. Persons with hypochondriasis vary in
their insight into their disorder.
Some recognize themselves as "hypochondriacs," but suffer anxiety in spite of
their recognition. Others are unable to see that their concerns are unreasonable or
exaggerated.
3
BODY DYSMORPHIC DISORDER
Definition


In body dysmorphic a preoccupation with a perceived defect in appearance results
in significant distress or impaired functioning.
People with body dysmorphic disorder believe they have a defect in appearance
that in reality is nonexistent or slight. The disorder usually begins in adolescence
and is believed to occur in men and women equally.
Symptoms
 Many people with this disorder become fixated on mirrors. They frequently check
their presumed ugly feature to see if any change has taken place. Others avoid
mirrors to an almost phobic extent.
 Quite understandably, suicidal ideation, suicide attempts, and suicide itself are
frequent consequences of this disorder (Phillips, 1991; Zimmerman & Mattia,
1998).
 People with BDD also have “ideas of reference”, which means they think
everything that goes on in their world somehow is related to them – in this case,
to their imagined defect. This disorder can cause considerable disruption in the
patient’s life. Many patients with severe cases become house bound for fear of
showing themselves to other people.
4