SOMATOFORM DISORDERS
Dr Sayuri Perera
MBBS, MD, MRCPsych(UK)
Senior Lecturer in Psychiatry
USS Xray Blood tests CT External injuries
Refer to specialist unit
• Appendicitis/Cystitis
• Migraine/SDH
• Shoulder dislocation/contusion
NO DIAGNOSIS
OR
SYMPTOMS ARE IN EXCESS OF THE ILLNESS
Patient has been reassured theres no physical problem with them
But still continues to have symptoms
Patient now starts to worry excessively about the symptoms
Thinks theres some illness which the doctor has missed
Gets more tests/invasive procedures
Sees another doctor
Negative emotions
These are the patients who qualify for the diagnosis of
Somatoform Disorder
DIAGNOSIS
“presence of physical symptoms which suggest a general
medical condition and are not fully explained by general
medical condition, substance use or another mental
disorder”.
Symptoms are not intentional (contrasting it with
factitious disorder or malingering)
Unexplained physical symptoms
Produces clinically significant distress or
impairment in
social
occupational
other important areas of functioning.
They excessively seek medical help and
reassurance, but have difficulties accepting the
nonpathological results in medical
examinations
SOMATOFORM DISORDER
IS AN UMBRELLA TERM
Somatization disorder
Hypochondriacal disorder
Conversion disorder
Somatization Disorder (Briquet's syndrome)
Multiple, recurrent, and frequently changing physical symptoms
A definite diagnosis requires the presence of all of the following:
(a)at least 2 years of multiple and variable physical symptoms for which no
adequate physical explanation has been found
(b)persistent refusal to accept the advice or reassurance of several doctors that
there is no physical explanation for the symptoms
(c)some degree of impairment of social and family functioning
including at least
• two gastrointestinal complaints
• four pain symptoms
• one pseudoneurologic problem
• and one sexual symptom
Hypochondriacal disorder ( Illness Anxiety Disorder)
The essential feature is a persistent preoccupation with the possibility of
having one or more serious and progressive physical disorders
For a definite diagnosis, both of the following should be present:
(a)persistent belief in the presence of at least one serious physical illness
underlying the presenting symptom or symptoms, even though repeated
investigations and examinations have identified no adequate physical
explanation, or a persistent preoccupation with a presumed deformity or
disfigurement
(b)persistent refusal to accept the advice and reassurance of several different
doctors that there is no physical illness or abnormality underlying the symptoms
SOMATIZATION HYPOCHONDRIACAL
Focus is on having a serious illness
•Focus is on the physical symptoms Refuses medications and worries of the side
•Requests medications to relieve effects
symptoms More emphasis on investigations to find the
illness
CONVERSION DISORDER
involves a single symptom related to voluntary motor or sensory functioning
suggesting a neurologic condition and referred to as pseudoneurologic
typically do not conform to known anatomic pathways or physiologic
mechanisms
may present in a dramatic fashion or show a lack of concern for their
symptom.
more common in rural populations, persons of lower socioeconomic
status, and those with minimal medical or psychological knowledge
Two related disorders, factitious disorder and malingering, must be
excluded before diagnosing a somatoform disorder
In factitious disorder, patients adopt physical symptoms for unconscious
internal gain (i.e., the patient desires to take on the role of being sick)
In malingering there is purposeful feigning of physical symptoms for
external gain (e.g., financial or legal benefit, avoidance of undesirable
situations).
In somatoform disorders, there are no
obvious gains or incentives for the patient,
and the physical symptoms are not willfully
adopted or feigned; rather, anxiety and fear
facilitate the initiation, exacerbation, and
maintenance of these disorders.
Managing somatoform disorders
The main aim is to stop the pathological cycle of interventions and ‘doctor-shopping'
and the resulting somatic ‘overtreatment’ and improve the functioning than ‘cure’
The delivery of the diagnosis may be the most important treatment step
Build a therapeutic alliance with the patient. This can be partially achieved by
acknowledging the patient's discomfort with his or her unexplained physical symptoms
and maintaining a high degree of empathy toward the patient during all encounters
The patient made understand that he/she is taken seriously
Explain them that the symptoms have emotional component as well. Not to say ‘it is
all in your mind’
Come to an agreement about investigations and consultations
Once the diagnosis is made and the patient
accepts the diagnosis and treatment goals, you
start to treat any psychiatric comorbidities
Co morbidities- Clinically significant depressive
disorder, anxiety disorder, personality disorder,
and substance abuse disorder
Antidepressants are commonly used to treat
depressive or anxiety disorders and may be part of
the approach to treating the comorbidities of
somatoform disorders
CBT
Effective treatment
Focuses on
• cognitive distortions
• unrealistic beliefs
• Worry
• behaviors that maintain health anxiety and somatic symptoms
Benefits of cognitive behavior therapy include reduced frequency and
intensity of symptoms and cost of care, and improved patient functioning
best results - psychotherapy lasting longer than 12
sessions.
positive effects lasted from three months to one year
group therapy contributed most to minimizing
somatic symptoms, while individual psychotherapy
was most effective in reducing signs of depression
and anxiety
