Somatoform Disorders

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Somatoform Disorders

An Outline: Psy 530

Carolyn R. Fallahi, Ph. D.

Somatoform disorders: persons who are overly preoccupied with their health or body. All of these disorders share one thing in common = no identifiable medical condition causing the physical complaints.

Hypochondriasis: physical complaints without a clear cause; anxiety focused on the possibility of having a serious disease.

· Shares many features with panic disorder

· Essential problem anxiety, but the expression is different from anxiety disorders

· Reassurance from a medical professional not lasting

· Differs in many ways from illness phobia

· Prevalence estimates

DSM-IV common features of Somatoform Disorders

· Presence of physical symptoms that suggest a general medical condition

· Symptoms not fully explained by medical condition

· Not due to substances or other mental disorders

Somatoform Disorders can be clustered into 2 larger categories:

· Classical hysterical disorders – somatization disorder, CD, pain disorder

· Preoccupation disorders – hypochondriasis, BDD

Issues related to Somatoform Disorders

· No reliable information about prevalence rates

· Lobo et al (1996) 9.4% of a large primary care sample = somatizers

· Low base rate in the general population

· Ethnicity understudied; Farooq et al (1995) Asian patients

· Etiology: onset & risk factors obscure; systematic knowledge lacking

· Preliminary thoughts: parental rearing, childhood development, stressful life events, personality, and communication & relationship with professionals

Research Studies:

· Torgerson (1986) genetic twin study – transmission environmental, esp sexual abuse.

Somatization Disorder

· Multiple physical complaints without clear/known physical causes

· Condition can last years

· 4 pain symptoms (back, abdomen, joints)

· 2 gastrointestinal symptoms (diarrhea, food intolerance)

· 1 sexual symptom (irregular menses, indifference to sexual activity)

· 1 pseudoneurological symptom (poor balance, numbness, paralysis)

· before the age of 30

· frequent and multiple medical consultations

· alters the person’s lifestyle

· full-blown somatization disorder rare - .2% men; .2 to 2.0% women; lifetime 0.1% in general population.

· Historical explanations: ancient Greeks – wandering uterus; 19th C Briquet polysymptomatic somatic condition = Briquet’s syndrome; Guze & Perley (1963) “somatization disorder”.

· Contemporary Thoughts: small subset of patients; functional symptoms; what happens?

· Somatosensory amplification

· Maintenance of the disorder

· Prognosis

Conversion Disorder

· Symptoms look neurological, e.g. glove anesthesia.

· 4 subtypes: motor symptoms or deficits; seizures or convulsions; sensory symptoms or deficits; mixed presentation

· important requirement: temporal relation between symptoms & psychological stressor.

· Distress or la belle indifference

· Prevalence unknown, but estimates .001 and .3% population.

· Historical explanations: “neuroses”; Charcot & hysterical conversions under hypnosis; defense mechanisms; Freud’s explanation.

· Contemporary Theories: Ullman & Krasner (1975) learned via behaviorism; Folks, Ford, & Regan (1984) sociocultural influences; Kellner (1991) neurophysiological studies show patients with CD do not habituate in the same ways as other patients; the role of emotional arousal.

· Onset late childhood or early adulthood.

· Grief & sexual trauma often involved.

· Mace & Trimble (1996) 10 year follow-up.

Pain Disorder

· Severe acute or chronic pain in one or more body parts is not entirely or adequately explained by a known medical condition

· Psychological factors involved.

· Acute versus chronic

· Prevalence unknown – relatively common

· Historical explanations: Aristotle; Descartes; Epicetus; Religious leaders; unidimensionality of pain.

· After 20th C, integrated explanations that were organic & psychological.

· Fordyce (1976) behaviorist explanations

· Cognitive-behavioral explanations.

· High frequency trauma & personality disturbance.

· Engle (1959) pain-prone personality

· Occupational factors important

Hypochondriasis: unjustified fears or convictions that one has a serious/fatal illness.

· 6 months & not of delusional intensity

· 3 to 14% medical patients (Kenyon, 1976); 16% general population illness phobia (Agras et al, 1969); 10% general practice (Palson, 1988); patients with increased exposure to medical settings

· Historical explanations: “Below the cartilage” – excess of black bile; 17thC Thomas Sydenham = equivalent to hysteria; Freud

· Contemporary Theories: behavioral theories; learned disorder; cognitive explanations; somatosensory amplification.

· Chronic condition.

· Children’s symptoms versus adult’s symptoms.

· Sexual trauma

Body Dysmorphic Disorder

· Preoccupation with an imagined or exaggerated body disfigurement/excessive concern that there is something wrong with the shape/appearance of body parts.

· Examples.

· Cognitive features.

· Typical behaviors.

· Prevalence unknown, but…. Rosen (1995) & Connolly & Gipson (1978)

· Not equal to unhappiness about one’s appearance.

· Historical explanations: 19th C Enrico Morselli – sudden onset & persistence of an idea that the body is deformed with severe anxiety. Morselli – obsessive nature. Recent views = no to phobic anxiety.

· Core problem: perception of abnormality.

· Contemporary theories: Rosen (1995) cognitive-behavioral explanation.

· Gradual / sudden onset; course continuous & chronic.

· Only anecdotal evidence.

· Beings in adolescence.

· Sociocultural factors. Perfectioinstic features.

Factitious Disorder

· Physical symptoms produced or feigned intentionally to assume the sick role.

· Eager to undergo extensive medical procedures.

· Pathological compulsion to deceive medical professionals = pseudologia phantastica.

· Different from malingering.

· Munchhausen Syndrome; munchhausen-by-proxy.

· Historical explanation: Munchhausen syndrome coined by Asher (1951) to describe patients who sought hospitalization at different hospitals under often dramatic circumstances for self-induced or simulated illnesses.

· Etiology not well understood, many authors feel it is the patient’s need for being taken care of.

· Trauma & abuse early in life.

· Early experiences with medical procedures & grudge against medical profession.

· Onset adulthood & chronic.

· Poor prognosis if patient goes from hospital to hospital.

· Severe personality disorders associated with this diagnosis.

Issues of differential diagnosis & comorbidity