Download SOMATOFORM AND CONVERSION DISORDERS

SOMATOFORM AND CONVERSION
DISORDERS
Walid Michel NASSIF MD
DEFINITION (DSM IV)
• Somatoform Disorders: : Group of
disorders characterized by physical
symptoms suggesting medical disease,
with associated excessive thoughts,
feelings and illness behaviors [without
(sufficient) organic pathology or
known pathophysiological mechanism]
DIFFERENTIAL
VOLUNTARY
CONTROL
UNCONSCIOUS
GAIN
_
CONSCIOUS
GAIN
+
MALINGERING
+
FACTITIOUS
+
+/-
-/+
SOMATOFORM
-
+
-/+
GENUINE ILLNESS
-
-/+
-/+
INCL. MUNCHAUSEN
S0MATOFORM DISORDERS/SOMATIC
SYMPTOM DISORDER
(DSM IV/V)
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Somatization disorder (Somatic Symptom Disorder)
Hypochondriasis (Illness Anxiety Disorder)
Somatoform pain disorder (Pain Disorder, SSD with
predominant pain)
Conversion disorder (Functional Neurologic SD)
Body dysmorphic disorder (OCD spectrum)
Psychological Factors Affecting other (known)
Medical Conditions
Undifferentiated SD (other SSD)
SD NOS (unspecified SSD)
CONVERSION DISORDER



Loss of, or alteration in physical
functioning suggesting a physical
disorder
Most commonly pseudoneurological
DSM IV: Typically preceded by
conflicts or stressors, and not
intentionally produced
EPIDEMIOLOGY
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Frequent
Female preponderance
Onset teens to young adults
? Lower socioeconomic groups
PHENOMENOLOGY
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“Traditional”: Mutism, deafness,
blindness, syncope, seizures, amnesia,
paralysis, anesthesia…
Subtle, sophisticated, more
diagnostically challenging
presentations
Plasticity of symptoms
Symbolism vs identification and
imitation
COMORBIDITY


Neurologic
Psychiatric: Psychosis
Depression
Personality Disorders
Other somatoform
symptoms
WORK-UP
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Medical and neurologic history
Correlation with
conscious/unconscious emotions
Primary and secondary gain
Psychiatric profile/family assessment
WORK-UP
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
(CONT.)
History of abuse
Presence of a model
Other unexplained medical symptoms
PRESENTING THE
DIAGNOSIS
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Team approach
Insistence on unconscious nature of
symptoms
Highlighting positives
"Normalization"
Assurance of ongoing medical treatment
Reinforcing the necessity and benefit of
psychiatric treatment (individual and family)
CONFUSING ELEMENTS
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History of documented organic
pathology
Present organic findings
Absence of overt psychopathology
Absence of previous somatization
Absence of “la belle indifference”
Sex/Age
AVOID!
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“It’s stress” (if chronic)
“It’s depression”
Indiscriminate use of antidepressants
Assuming conversion disorder is
always benign
TREATMENT
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Spontaneous remission
Support, reassurance, suggestion
Invasive diagnostic/therapeutic procedures
only for objective evidence of disease
Hypnosis, placebo procedures
Resolution of underlying conflict
Individual, family psychological intervention
Physical, psychiatric rehabilitation