Somatoform disorders

T. Omidvar,MD

• The key characteristic of somatoform disorders:

• preoccupation with physical symptoms

• without explanation of any medical conditions

• leading to significant stress

• not intentionally produced

Definition

• Somatization disorder

• Conversion disorder

• Pain disorder

• Hypochondriasis

• Body dysmorphic disorder

• Somatoform disorder nos

• Undifferentiated somatoform disorder

Somatoform disorders in DSMIV

Epidemiology

• very common in all countries and cultures

• physical symptom the most common presentation

• idiopathic physical symptoms: no organic cause

• finding 20%-80%

• co-occuring with psychiatric disorders

Etiology

• Using a biopsychosocial model

• biological vulnerability

• early traumatic experience

• learning factors

• Leading to focus on the somatic and difficulty

expressing emotions (alexythymia)

Course and prognosis

• Chronic course associating with personality and

cognitive style

• Inconsistency in symptom presentation

• With these symptoms psychiatric disorders becoming

more severe

Treatment

• Establishing an alliance

• Taking the history

• Reassurance

• Physical versus psychological focus

• General therapeutic approach

SOMATIZATION DISORDER

Definition:

• a polysymptomatic syndrome

• physical symptoms coming from several organs

• causing significant stress

• severe reluctancy to accept psychological etiology

Somatization disorder

DSMIV criteria

four pain sites or functions (back, chest,..)

• two non pain GI symptoms(nausea, bloating)

• one non pain sexual symptom(loss of libido)

• one pseudoneurological symptom (aphonia, ..)

Epidemiology

• More common among females

• Individuals from lower socioeconomic states

• Having comorbidity with depression and anxiety

• Some biological factors :

– violence in biological fathers of the woman with

somatization

Etiology

Treatment

• General considerations

• Pharmacotherapy

• Reassurance and supportive therapy

• psychotherapy

PAIN DISORDER

Pain disorder

• Pain : one of the most complaints in medical practice

• Associating with psychological stress

• Deciding that the pain is psychogenic

can be difficult

Definition

• Complaints of severe, persistent pain in one or more

areas

• Warrant clinical attention

• Cause significant impairment in function

• Relatedness of severity , exacerbation and

maintenance of symptoms with psychological factors

Treatment

• Approaching the patient

• Pharmacological management

• Psychotherapy

Thanks for your attention

Any Question?