Somatoform Disorders

SOMATOFORM DISORDERS

• Typically present with physical symptoms which cannot be explained by any known medical condition.
• Patients persistently request for investigations despite repeated negative findings & doctors reassurances.

Features:

• Significantly distressing symptoms.
• Impairment in social & occupational functioning.

Types:

1. Somatization disorder:

• Main feature – Presence of multiple physical symptoms.
• No ascertained medical causes.
• Patient usually refuses to accept advice or doctors reassurance of nil physical cause for symptoms. 
• Onset & progression of symptoms bear a close relationship to unpleasant life events & psychological stressors.

Diagnosis:

According to DSM-IV:

• Following symptoms should be present: 
• Four pain symptoms – Pain at 4 different sites.
  • Two gastrointestinal symptoms (nausea, vomiting, belching).
  • One sexual symptom (erectile/ejaculatory dysfunction).
  • One pseudo-neurological symptom (weakness, visual disturbance).

Treatment:

• Psychotherapy.
  • Creating patient’s awareness that physical symptoms are expression of underlying emotions.
  • Helped to cope with symptoms & underlying emotions.

2. Undifferentiated somatoform disorder:

• Multiple physical symptoms present.

3. Hypochondriasis:

• Characterized by preoccupation with “fear of having”/”idea of having serious physical illness”.
• Preoccupation persists despite normal investigation & doctors’ reassurances.

Differential diagnosis:

Somatization disorder:

• Emphasis in hypochondriasis – On diagnosis; emphasis in somatization disorder – On symptoms.

Delusional disorder (somatic type): 

• Hypochondriatic patients – Doubtful belief; delusional disorder – fixed & totally unshakeable belief

4. Body dysmorphic disorder:

• Characterized by preoccupation with an imagined defect in body appearance.

5. Somatoform autonomic dysfunction:

• Characterized by specific & unexplained autonomic symptoms (palpitations, tremors, sweating, belching).

6. Persistent somatoform pain disorder: 

7. Pseudocyesis: Patient with false belief that she is pregnant.

Don’t Forget to Solve all the previous Year Question asked on SOMATOFORM DISORDERS