somatization disorders

8/2/2019 Somatization Disorders

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Are group of psychiatric disorders

whose symptoms are severe enoughto cause global impairment or

functioning. Typically, clients

presents with recurrent, multiple,clinically significant somatic

complaints. The complaints are

colourful and exaggerated, but lack

specific factual information to

support the diagnosis.


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It is the conversion of

emotional or mental states

into body symptoms

Anxiety, stress and

frustrations areinternalized

Internal conflicts are

expressed in physical

symptoms instead of direct

confrontation


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Patients dont feign their

symptoms (as in malingering)

There is failure to recognizesomatisation leading to the

tendency to go from one

physician to another in searchfor diagnosis and treatment.

Numerous tests always fails to

identify organic disease


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Two distinct phenomena

present:Physical symptoms

suggesting that a medical

condition exist

The symptoms are not

readily defined by a medicalcondition


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a.Personality disorders (strong rel

between physical illness and

personality traits)

b. Depressive and anxiety disorder

Panic and agora phobia arecommon with somatisation

Depression is common with pain

disorderObsessive personality is common

among Body Dysmorphic


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A. Psychodynamic Theories:

a.a. Psychoanalytic theory explains

that the symptoms presented by

clients represent a substitution

for repressed instinctual impulses

and are best depicted by the

concept of hysteria (madness)

Symptoms are physical

manifestations of the repressed

material


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a. b. Freud focused his work onhysteria and postulated that egodefense of conversion representedhgysteria. It is the conversion ofpsychic energy to physicalmanifestations

Paul Briquet (1859) Firstrecognized the syndromecharacterized by multipledramatic medical complaints in

the absence of a physiologicalbasis. Thus this condition wascalled Briquets syndrome andlater somatisation disorders


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a. c. Conversion stems from the

premise that the personsphysical manifestations depict a

symbolic resolution of an

unconscious psychologicalconflict, reducing anxiety and

serving to hide the conflict from

awareness.


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a. d. Pain is likewise linked to

unmet childhood issues. The

psychoanalytic meaning of paininvolves fulfilling an

unconscious need for guilt or

masochism


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B. Psychosocial and Stress

Factors somatisation is

associated with emotional

distress expressing

underlying anxiety,depression and stress-

related disorders

a. Females are more likelyto report ill health than

males


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C. Attachment Theory -

somatisation behaviours may

result from complex childhoodexperiences of illness and the

response of the persons social

system to the behaviour

c.a. Early life experiences

serve as diatheses, governing

illness behaviour and results

in maladaptive coping or

personality traits


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c. b. The premise is, health

seeking behaviour is synonymous

with attachment behaviour and

assist in procuring closeness toanother person for the purpose of

receiving care

c. c. Physical symptoms thatcannot be explained by underlying

medical condition are coping

mechanism that enables theclient to respond to stressors


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D. Cognitive Behavioral There is

intimate relationship betweenbrain and physiological process

and there is dysregulation in

perception of an event andsubsequent exaggerated

physiological response owing to

cognitive distortion insomatoform


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E. Neurobiological :

Bain imaging studies reveal

alterations in neuroanatomical

structures and regional brainperfusion

Gate theory explains the role of the

dorsal horn of the spinal cord thatmodulates afferent pain signals. The

dorsal horn is the gate through

which pain impulses travel from the

periphery to the central nervoussystem. Activation of this gate

results in transmission and

experience of pain


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F. Neurotransmitters likeserotonin play roles in opening

and closing the gate of painful

sensations. A closed gatedecreases stimulation of trigger

cells, decreases transmission

impulses and thus decreasingpain perception.


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(1) Somatization Disorder (Briquets

Syndrome or hysteria) - It refers to

disorder whose primary symptoms

are progressive, recurrent, andsomatic complaints of pain, sexual,

gastrointestinal and

pseudoneurological manifestations.The symptoms produce significant

distress, and global disability.


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Descriptive Characteristics of

Somatization:

1. The symptoms presentedhave no physical basis and are

multiple and vague

2. Symptoms usually worsen

after job loss, death of close

relative or some other losses

and intensify with stress


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3. History of client will reveal

chaos, impulsiveness,

manipulative behaviours, suicidal

threats, unstable occupation andturbulent interpersonal

relationships. History reveals

impairment in occupation, socialand other functioning.

4. Some clients may present

Factitious Disorder which involvesfeigning or deliberately injecting

a disease to oneself (the client

has severe personality disorder)


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Criteria: Somatization

A. History of many physical

complaints before age 30

occuring over a period of several

years resulting in treatment

being sought or significant

impairment in important

functioning areas

h f h f ll


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B. Each of the following

criteria must have been met,

with symptoms occurring atany time during the course

of the disturbance:

1. Four pain symptoms(head, abdomen, back,

joints, extremities, chest,

rectum, duringmenstruation, during sexual

intercourse or during

urination


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2. Two gastrointestinal

symptoms (nausea, bloating,

vomiting other than duringpregnancy, diarrhea,

intolerance of several foods

3. One sexual symptom orreproductive (sexual

indifference, erectile or

ejaculatory dysfunction,

irregular menses, excessive

menstrual bleeding, vomiting

throughout pregnancy

4 O d l i l t


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4. One pseudoneurological symptom

(conversion symptom such as

impaired coordination or balance,

paralysis or localized weakness,difficulty swallowing, lump in the

throat, aphonia ( ), hallucinations,

loss of touch or pain sensation,urinary retention, double vision,

blindness, deafness, seizures,

dissociative symptoms such asamnesia, loss of consciousness other

than fainting


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C. The symptoms in B

cannot be fully explained

by known general medicalcondition


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Comprehensive assessment

approach: Identify the illness what does the client

think is wrong

Cause what does the client believe is the

basis of her symptoms (physical or

psychosocial) Duration how long does the client believe

present symptom will last (acute or

chronic)

Consequences what effects will thesymptoms have on the clients ability to

function

Recovery and self efficacy what are the

clients prospects of recovering?


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somatization disorders

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