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.

• 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).

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