Somatoform Disorders

Hypochondriasis is defined by DSM-IV as a persistent fear, despite medical reassurance, that one has a serious physical illness. The patient’s beliefs are based on misinterpretation of benign bodily symptoms. The belief is not of delusional proportions, and the condition must persist for 6 months for this diagnosis to be made. It is estimated that from 3 to 14% of patients seen in a general medical practice may suffer from hypochondriasis.

In Hypochondriasis, patients are preoccupied with the fear of having a serious disease based on misinterpretation of bodily signs and sensations. This fear persists even in the presence of evidence to the contrary and physician’s reassurance or evidence from investigations.

Ref: Current Medical Diagnosis and Treatment : Psychiatry 2nd edition chapter 22.

A i.e. Somatisation disorder

IBS, chronic fatigue syndrome & fibromyalgia all are specific (named) somatoform disorders, whereas somatization disorder is (unnamed) somatoform disorder which require 4 pain, 2G1, 1 sexual & 1 pseudoneurological symptoms for diagnosisQ.

Somatoform Disorders

Somatoform disorders (coined by American nosologist Robert spitzer) meaning somatic like is a generic term first used in DSM III for a group of disorders charactrized by physical symptoms that are not explained by organic factors (i.e. for syndromes of presumed psychological origin). A more appropriate term from a language (semantic) point of view would have been somatomorph disorders.

Categories of somatoform disorders include

So conversion disorder & body dismorphic disorder exist in DSM IV (but not in ICD-10), whereas neurasthenia, somatoform autonomic dysfunction & dissociative disorder exist in ICD-10 (but not in DSM­

Functional (Specific) Somatic Syndromes

These includes clusters of idiopathic physical symptoms legitimately used in many specialities but their association with psychopathology & psychological distress suggest that many of them would fall in somatofom disorders.

These includes

– Chronic fatigue syndrome, fibromyalgiaQ, fibrositis, chronic

low back pain, herniated disc, carpel tunnel syndrome, reptitive strain injury (orthopaedics)

–  Tension headache, pseudoseizures, chronic whiplash syndrome (neurology)

– Irritable bowel syndrome (IBS)Q, nonulcer dyspepsia, food allergies (gastroenterology)

– Temporomandibular joint syndrome, atypical facial pain (dental)

–  Tinnitus, dizziness, globus syndrome (ENT)

–  Dyspnea, habbit cough, laryngeal dysfunction, hyper ventilation syndrome (pulmonary medicine); multiple chemical sensitivity , sick building syndrome (occupational medicine); chronic Lyme disease, candidiasis hypersensitivity, chronic candidiasis, hypoglycemia, total allergy syndrome, systemic yeast infection (internal medicine); Gulf war syndrome, insomnia (military medicine)

Premenstrual syndrome, chronic pelvic pain (Obs-Gyne); silicone breast implant effects / associated connective tissue disease (plastic surgery); interstitial cystitis (urology); atypical chest pain, non cardiac pain, mitral valve prolapse (cardiology).

B i.e. Hypochondriasis

D i.e. Abnormal preoccupation with normal body function

Hypochondriasis is persistent preoccupation with fear or belief of having serious disease based on person’s own interpretation of normal body function ie Hypochondriasis is abnormal preoccupation about normal body functionQ.

C i.e. Hypochondriasis

C i.e. Delusional disorder 

In Delusional dysmorphophobia (delusional disorder) patient feels his body part or body ugly or mishappen.

Ans. D: Hypochondriasis

Hypochondriasis, hypochondria refers to excessive preoccupation or worry about having a serious illness. An individual suffering from hypochondriasis is known as a hypochondriac.

Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, the concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue.

Ans. Hypochondriasis

Ans. Hypochondriasis

Ans. is ‘d’ i.e., All of above

Functional Neurological Disorder

• Transformation of inner psychological conflict into physical symptoms

Two types

• Somatoform
• Dissociative

Somatoform disorder include‑

• Conversion
• Somatization
• Pain disorder
• Hypochondriasis
• Body dysmorphic disorder

Dissociative disorder – include‑

• Dissociative amnesia
• Fugue
• They are often associated with co-morbid mood & anxiehg disorder

Ans. is ‘c’ i.e., Hypochondriasis

Hvpochondriasis (hypochondriacal disorder)

• The primary feature of hypochondriasis is persistent preoccupation with excessive fear of a serious (e.g., cancer) or incurable (e.g., AIDS) disease, which is based on person’s own interpretation of physical symptoms or sensation, i.e., misinterpretation of physical symptoms or sensations, for example an occasional change in heart rate will lead a person with hypochondriasis to fear of heart disease. Therefore, Hypochondriasis is abnormal preoccupation about normal body function, i.e., body functioning is normal but patient thinks it as abnormal.
• The preoccupation with the presence of a feared illness persists inspite of normal medical assessment and investigations. Patient goes from one doctor to another for a consultation.
• People with hypochondriasis are able to acknowledge that their fears are unrealistic (insight is present), but this intellectual realization is not enough to reduce their anxiety.
• Two important facts differentiate hypochondriasis from somatization disorder : –

1. Patient with hypochondriasis is preoccupied with illness, on the other hand patient with somatization disorder is occupied with symptoms.
2. Hypochondriasis patient is preoccupied with one illness (usually) while patient with somatization disorder has many (at least 8 or more) symptoms.

Ans–b. Fibromyalgia (Ref Harrison 19/e p2238. 18/e p122. 2849: Kaplan and Sada’ock!s Synopsis of Psychiatry 10/e p276; Niraj Ahuja 7/e p104-105)

• Fibromyalgia is not a specific somatoform disorder, it has organic basis behind its pathology
• somatic like is a generic term first used in DSM III for a group of disorders charactrized by physical symptoms that are not explained by organic factors (i.e. for syndromes of presumed psychological origin).”

Ans. (A) There are physical symptoms without physical basis (B) Somatization disorder is characterized by multiple physical symptoms (D) Hypochondriasis is a somatoform disorder (E) There are pain and GI symptoms in somatization disorders

ACCORDING TO DSM -TV CLASSIFICATION:

•  Somatoform disorders are characterized by repeated presentation with physical symptoms but without any physical basis.
• Somatoform disorders are: – (i) Somatization disorder, (ii) Conversion disorder, (iii) Hypochondriac, (iv) Body dysmorphic disorder ft) Somatization pain disorder.

Somatization disorder:

• Multiple recurrent somatic symptoms of long duration caused by psychological basis and no physical illness.

Diagnostic criteria:

• Four pain symptoms – Pain in Head (headache), abdomen, back, joint, extremities,
• chest, rectum, during menstruation or sexual intercourse or urination.
• Two gastrointestinal symptoms – Nausea, bloating, vomiting, diarrhea.
• One sexual symptom – Erectile dysfunction (Impotence), ejaculatory dysfunction.
• One pseudoneurological symptom – Mainly glove & stocking anesthesia, Paresthesia,

SOMATIC SYMPTOMS & RELATED DISORDERS (DSM-V):

• DSM-5 has replaced somatoform disorders (of DSM-IV) with somatic symPtoms and related disorders.

Important disorders in this group are :-

1. Somatic symptom disorder (complex somatic symptom disorder)
2. Illness anxiety disorder
3. Conversion disorder (functional neurological disorder )
4. Factitious disorders
5. Other specified somatic symptoms & related disorders (e.g’ Pseudocyesis)

Note: Body dysmorphic disorder is replaced along with OCD & related disorder,