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Transcript
Somatization and Traumatic Stress Somatoform Disorders (DSM -IV) • • • • Somatization Disorder Undifferentiated Somatoform Disorder Conversion Disorder Pain Disorder (1.With psychological factors; 2. With both psychological factors and medical condition) • Hypochondriasis • Body Dysmorphic Disorder • Somatoform Disorder, NOS Somatization in Clinical Practice (Noyes, Holt, Kathol 1995) • Patients with multiple unexplained complaints (somatizers) • Patients excessively worried about serious illness (hypochondriasis) • Patients with psychiatric disorders with somatic symptoms (depression; anxiety) Somatization (Noyes, R., Holt, C., Kathol, R. 1995) • Abnormal illness behavior (i.e., failure to respond to treatment; unusual side effects) • Psychological distress (a mixture of psychosocial stressors -- trauma and symptoms of anxiety and depression) Treatment Guidelines Somatization • Empathic Interview-- one hour (validate patient, present treatment options) • Primary Physician in Charge-- regular visits • Trial of Psychotherapy-- cognitive, supportive, 4-6 sessions • Choose Medications-- at lowest dose, monotherapy, monitor side effects, prefer SSRI’s, Bupropion, Venlafaxine; if necessary, mood stabalizers + boosters. Somatization and Trauma • In PTSD memories are stored as non-verbal emotions. • Rauch et al.-- PET studies in PTSD. When exposed to reminders of trauma: a) Increase of perfusion in right hemisphere; b)Decrease in oxygen consumption in the left inferior frontal cortex , i.e., Broca’s Area. Thus, trauma may lead to speechless terror. Somatization and Trauma (cont’d) Alexithymia • A) Inability to translate somatic sensations into basic feelings, e.g., anger, happiness, fear. • B) Such somatic states are not translated into words or symbols, and therefore, emotions are expressed as physical problems. In one study, 65% of patients with dissociative disorder also met criteria for somatization disorder (Saxe et al. 1994). For additional information regarding this subject, please contact Dr. Novac at [email protected]
