Somatic Disorders

1
Somatic Disorders

• Elizabeth Harris
• PSYC 2621H - Spring 2007

2
Overview

• soma body
• somatic relating to the soma
• Pathological concerns with the appearance or
  functioning of the body, usually in the absence
  of any identifiable medical condition

3
Overview (continued)

• Formerly known as hysterical neurosis
• thought to be found primarily in women since the
  time of the Ancient Greeks Egyptians
• Freud suggested conversion hysteria
• due to the process of unconscious emotional
  conflicts being converted into physical
  symptoms

4
Hypochrondriasis

• Current Diagnostic Criteria
• preoccupation with fears of having a serious
  disease
• preoccupation persists despite appropriate
  medical evaluation and reassurance
• preoccupation is not of a delusional intensity
  and is not restricted to concern over physical
  appearance
• clinically significant distress or impairment
  because of preoccupation
• duration of at least 6 months

5
Hypochrondriasis (cont.)

• Etiology / Causes / Risk Factors
• hypersensitivity to normal situations/changes
• inability to accept non-findings
• tends to run in families, possible learned
  behaviors (sick role)
• can begin in reaction to a stressful life event
• comorbidity with anxiety depression is high
• Prevalence / Incidence Rates
• no gender difference in occurrence rates seen
• studies show 1 - 14 prevalence, rates higher in
  older population
• cultural effects must be considered

6
Hypochrondriasis (cont)

• Course / Prognosis
• chronic due to nature of not accepting results
  showing nothing wrong
• acute onset, mild symptoms, identifiable general
  medical condition and no comorbid condition are
  indicators for full recovery
• Patients tend to move from provider to provider
  to seek answers/support
• patients tend to have a higher than average
  appraisal of risk than non-affected
• Current Issues in regards to DSM V development
• suggestions to wider the scope of diagnosis, that
  current is too narrow
• time requirement may be limiting
• patients get set in their ways by the 6 month
  point

7
Somatization Disorder

• Current Diagnostic Criteria
• History of many physical complaints beginning
  before the age of 30 that occur over years and
  result in treatment being sought or significant
  impairment in important areas of functioning
• each of the following
• Four pain symptoms
• two gastrointestinal symptoms other than pain
• one sexual symptom
• one pseudoneurologic symptom
• physical complains cannot be fully explained by
• a known general medical condition
• the effects of a substance
• or where there is a general medical condition,
  the physical complains or impairment are in
  excess of what would be expected
• complaints or impairment are not intentionally
  produced or feigned
• Rule out factitious disorder and malingering
  disorder

8
Somatization Disorder (cont)

• Etiology / Causes / Risk Factors
• Evidence of biological and psychosocial
  contributions
• Freud assumed a constitutional diathesis
  existed in patients
• Family patterns are possible, as well as history
  of illness in patient/family member
• comorbidity with anxiety and depression common
• also some Personality Disorders are sometimes
  present (anti-social, histrionic, borderline)
• Prevalence / Incidence Rates
• Dutch study found a prevalence of .5 in general
  practice patients, rose to 13
• for undifferentiated somatization disorder,
  American rates between 4.4 20
• prevalence rates rise as age factors in
• gender differences are high, studies put female
  male ratio between 32 and 31
• cultural differences in prevalence are great

9
Somatization Disorder (cont)

• Course / Prognosis
• chronic, rarely remits
• stressful events may heighten symptoms
• unconscious defenses block experience of anxiety,
  expression only comes in the form of physical
  symptoms
• Current Issues in regards to DSM V development
  other
• looking at number of symptoms required for
  diagnosis,
• possible difference for women and men

10
Pain Disorder

• Diagnostic Criteria Current
• presence of serious pain in one or more
  anatomical sites
• pain causes clinically significant distress or
  impairment in functioning
• psychological factors judged to play primary role
  in onset, severity, exacerbation or maintenance
  of the pain
• pain is not feigned or intentionally produced

11
Pain Disorder (cont)

• Etiology / Causes / Risk Factors
• pain may be a learned behavior from a medical
  condition, previous or current
• physical and psychosocial factors may be involved
  (neurotransmitter pathways may become keyed and
  react during stress)
• Prevalence / Incidence Rates
• back pain is cause of 10-15 of disability
  claims, roughly 50 have no physically
  identifiable reason
• abdominal pain presents in 75 of general medical
  practice patients,
• 75 of these (50 overall) have no physically
  identifiable reason (this is most common
  complaint in children strong reaction to stress)

12
Pain Disorder (cont)

• Course / Prognosis
• If duration is less than 6 months, recovery
  chances are great, chronicity sets in past that
  point
• site/location of pain is another factor
• comorbidity with additional psychological
  syndrome will also negatively affect recovery
  chances

13
Conversion Disorder

• Diagnostic Criteria Current
• one or more conditions affecting voluntary motor
  or sensory function that suggest a neurological
  or general medical condition
• psychological factors are judged to be associated
  with the condition because of preceding conflicts
  or other stressors
• condition cannot otherwise be explained by
• a general medical condition,
• effects of a substance or
• as a culturally sanctioned behavior or experience
• clinically significant distress or impairment
  caused by condition

14
Conversion Disorder (cont)

• Etiology / Causes / Risk Factors
• childhood trauma, family illness behaviors,
  stressful events (unconscious converts anxiety
  into physical symptoms)
• the less medical knowledge of the patient, the
  less plausible are the symptoms more
  sophisticated knowledge will present more
  detailed symptoms
• Prevalence / Incidence Rates
• Rates range from 1-24, depending on comorbid
  syndromes, physical symptoms presented

15
Conversion Disorder (cont)

• Course / Prognosis
• normally chronic when adult onset
• children/adolescents see high rate of recovery
• if remission is probable, normally happens within
  days/weeks of onset
• interpersonal relationships, dealing with
  stressors is key to recovery
• Comorbidity factors lessen chances for favorable
  outcome

16
Treatment options

• Treatment of all somatoform disorders should be
  undertaken by a single or communicating group of
  physicians
• lessen repeated gains through repetitive tests
  and treatment plans
• Reassurance seems to work
• it requires time be spent that many doctors dont
  have to spend
• goal to provide patient with insight into
  validity of symptoms to control unnecessary
  tests, hospital/doctor visits

17
Treatment options (cont)

• Absence of secondary gain important to recovery
  efforts
• lessen gains gathered by assuming sick role
• improving skills in interpersonal relationships
  to make physical symptoms less of a focus for
  attention gathering, reducing maladaptive
  attachment style
• Cognitive-behavioral training to focus on stress
  management
• avoid misinterpretation of stress reactions as
  symptoms
• Course is for management, not curative in nature
• techniques to lessen pain-related behavior
• encourage increased activity level
• avoid pain medication reliance