Download somatoform disorders

SOMATOFORM DISORDERS
BERFİN GİZEM USLU
• Somatoform disorders are a group of illnesses,
each of which is marked by physical symptoms
that are not explained by a general medical
condition.
Somatic symptoms and related disorders
in DSM-5
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Somatic symptom disorder
Illness anxiety
Conversion disorder
Psychological factors affecting other medical
conditions
• Factitious disorder
• Somatoform disorders common to the
American Psychiatric Association's
Diagnostic and Statistical Manual, Fourth
Edition, Text Revision (DSM-IV-TR)
• Somatization disorder
• Conversion disorder
• Pain disorder
• Hypochondriasis
• Body dysmorphic disorder
• Undifferentiated somatoform disorder
• Somatoform disorder not otherwise specified
• The somatoform disorders category includes the
following diagnoses:
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Somatization disorder
Conversion
Hypochondriasis
Body dysmorphic disorder
Factitious disorder
SOMATIZATION DISORDER
(Briquet’s Syndrome)
• In Briquet’s syndrome, first described
by Paul Briquet in 1859, patients feel
that they have been sickly most of
their lives and complain of a multitude
of symptoms referable to numerous
different organ systems. This
conviction of illness persists despite
repeatedly negative and unrevealing
consultations, hospitalizations, and
diagnostic procedures, and patients
continue to seek medical care, to take
prescription medicines, and to submit
to needless diagnostic procedures.
• EPIDEMIOLOGY — Somatization is common in
the general population. More than 50 percent of
patients presenting to outpatient medical clinics
with a physical complaint do not have a medical
condition.
Risk factors for somatization include:
• ●Female sex
• ●Fewer years of education
• ●Minority ethnic status
• ●Low socioeconomic status
DSM-IV-TR diagnostic criteria for
somatization disorder
1.A history of many physical complaints that begin
before age 30, occur over a period of several years,
and lead to seeking treatment or to significant
impairment in occupational, social, or other
important areas of functioning.
2.Each of the following criteria must have been met,
with individual symptoms occurring at any time
during the course of the disturbance:
Four pain symtoms
Two gastrointestinal symptoms
One sexual symptom
One pseudoneurological symptom
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• 1. Four pain symptoms: a history of pain related to at least four
different sites or functions (eg, head, abdomen, back, joints,
extremities, chest, rectum, during menstruation, during sexual
intercourse, or during urination)
• 2. Two gastrointestinal symptoms: a history of at least two
gastrointestinal symptoms other than pain (eg, nausea, bloating,
vomiting other than during pregnancy, diarrhea, or intolerance of
several different foods)
• 3. One sexual symptom: a history of at least one sexual or
reproductive symptom other than pain (eg, sexual indifference,
erectile or ejaculatory dysfunction, irregular menses, excessive
menstrual bleeding, vomiting throughout pregnancy)
• 4. One pseudoneurological symptom: a history of at least one
symptom or deficit suggesting a neurological condition not limited to
pain (conversion symptoms such as impaired coordination or
balance, paralysis or localized weakness, difficulty swallowing or
lump in throat, aphonia, urinary retention, hallucinations, loss of
touch or pain sensation, double vision, blindness, deafness, seizures;
dissociative symptoms such as amnesia; or loss of consciousness
other than fainting)
3.Either (1) or (2): 1. After appropriate investigation,
each of the symptoms in criterion B cannot be fully
explained by a known general medical condition or
the direct effects of a substance (eg, a drug of
abuse, a medication) 2. When there is a related
general medical condition, the physical complaints
or resulting social or occupational impairment are
in excess of what would be expected from the
history, physical examination, or laboratory
findings
4.The symptoms are not intentionally produced or
feigned (as in Factitious Disorder or Malingering).
CLINICAL PRESENTATION
• Pain symptoms, including headache, back pain,
dysuria, joint pain, diffuse pain, and extremity pain
• ●Gastrointestinal symptoms, including nausea,
vomiting, abdominal pain, bloating, gas, and diarrhea
• ●Cardiopulmonary symptoms, including chest pain,
dizziness, shortness of breath, and palpitations
• ●Neurologic symptoms, including fainting,
pseudoseizures, amnesia, muscle weakness,
dysphagia, double or blurred vision, difficulty
walking, difficulty urinating, deafness, and
hoarseness or aphonia
• ●Reproductive organ symptoms, including
dyspareunia, dysmenorrhea, and burning in sex
organs
CONVERSION
Conversion disorder (functional neurologic
symptom disorder) is characterized by neurologic
symptoms (eg, weakness, abnormal movements, or
nonepileptic seizures) that are inconsistent with a
neurologic disease, but nevertheless are genuine,
cause distress and/or psychosocial impairment.
A DSM-5 diagnosis of conversion disorder
requires each of the following criteria
1.One or more symptoms of altered voluntary motor or
sensory function
2.Clinical findings that demonstrate incompatibility
between the symptom and recognized neurologic or
general medical conditions (eg, Hoover's sign of
functional limb weakness or a positive entrainment test
for functional tremor)
3.The symptom or deficit is not better explained by
another medical or mental disorder
4.The symptom or deficit causes significant distress,
psychosocial impairment, or warrants medical
evaluation
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Conversion disorder can present with :
●Nonepileptic seizures
●Weakness and paralysis
●Movement disorders
●Speech disturbances
●Globus sensation
●Sensory complaints
●Visual symptoms
●Cognitive symptoms
Hypochondriasis
• Preoccupations with fear of having a serious
disease with misinterpretation of bodily
symptoms. Persists despite appropriate medical
evaluation and reassurance.Lasts at least 6
months.
DSM-IV-TR diagnostic criteria for
hypochondriasis
• A. Preoccupation with fears of having, or the idea that one has, a serious
disease based on the person's misinterpretation of bodily symptoms.
• B. The preoccupation persists despite appropriate medical evaluation and
reassurance.
• C. The belief in Criterion A is not of delusional intensity (as in delusional
disorder, somatic type) and is not restricted to a circumscribed concern
about appearance (as in body dysmorphic disorder)
• D. The preoccupation causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
• E. The duration of the disturbance is at least six months.
• F. The preoccupation is not better accounted for by generalized anxiety
disorder, obsessive-compulsive disorder, panic disorder, a major depressive
episode, separation anxiety, or another somatoform disorder.
• Choosing treatment — We suggest that acute
treatment of illness anxiety disorder proceed
according to the sequence described in the
subsections below. Patients initially receive first
line therapy and progress through each step
until they respond:
• ●First line – Cognitive-behavioral therapy
• ●Second line – A different psychotherapy
• ●Third line – Antidepressant medication
Body dysmorphic disorder
• Body dysmorphic disorder (BDD) is
characterized by preoccupation with nonexistent
or slight defects in physical appearance, such
that patients believe that they look abnormal,
unattractive, ugly, or deformed, when in reality
they look normal. The preoccupation with
perceived flaws leads to repetitive behaviors (eg,
checking their appearance in mirrors), which are
difficult to control and are not pleasurable.
DSM-5 diagnostic criteria for body
dysmorphic disorder
• A. Preoccupation with one or more perceived defects or flaws
in physical appearance that are not observable or appear
slight to others.
• B. At some point during the course of the disorder, the
individual has performed repetitive behaviors (eg, mirror
checking, excessive grooming, skin picking, reassurance
seeking) or mental acts (eg, comparing his or her appearance
with that of others) in response to the appearance concerns.
• C. The preoccupation causes clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.
• D. The appearance preoccupation is not better explained by
concerns with body fat or weight in an individual whose
symptoms meet diagnostic criteria for an eating disorder.
Factitious disorder
(Munchausen syndrome)
• Factitious disorder imposed on self is characterized by
falsified general medical or psychiatric symptoms.
• Patients deceptively misrepresent, simulate, or cause
symptoms of an illness and/or injury in themselves,
even in the absence of obvious external rewards such
as financial gain, housing, or medications.
• Factitious disorder imposed on self is distinguished
from factitious disorder imposed on another, such as a
child or older adult.
• Diagnostic criteria — We suggest diagnosing
factitious disorder imposed on self according to the
criteria in DSM-5, which require each of the
following:
• ●Falsification of physical or psychological signs or
symptoms, or induction of injury or disease,
associated with identified deception
• ●The individual presents himself or herself to others
as ill, impaired, or injured
• ●The deceptive behavior is evident even in the
absence of obvious external rewards
• ●The behavior is not better explained by another
mental disorder, such as delusional disorder or
another psychotic disorder