Somatoform Disorders•Also know as Hysteria (Freud)•Conditions involving physical complaints or disabilities that occur without physical pathology

•NOT psychosomatic disorders…

–Somatization Disorder –Conversion Disorder–Pain Disorder–Hypochondriasis–Body Dysmorphic Disorder

Somatization disorderSomatization disorder1. Previously known as “hysteria”2. Usually strikes before the age of 303. Commonly develop more symptoms during

times of emotional distress4. Generally history of vague symptoms related to

specific body systems--cause him/her to see variety of physicians

5. Often self-rate their health as very poor even lower than people with chronic medical conditions

6. Significant social, occupational, and/or other impairment

7. Most common symptoms related to gastrointestinal, sexual/reproductive and neurologic body systems

8. Symptoms not intentionally produced

In the not too distant past, conditions like asthma were thought to be somatoform disorders.

QUESTION:

Are the somatoform disorders, as defined by DSM IV (THX), purely psychological, or do you believe that they are biological and it is a matter of time until doctors identify the etiology?

Conversion Disorder•Conversion of emotional difficulties into the persistent loss of a physiological function

•Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness

•Not faking a physical problem•Cannot be explained physically

Conversion disorder1. Only one symptom (whereas a person with

somatization disorder has several) which can appear at any age

2. Sensorimotor disturbance of bodily functionsa. range of sensory symptoms: paresthesia

(abnormal sensations, such as tingling, numbness, or heightened sensation), and anesthesia (loss of feeling) to blindness and deafness

b. range of motor symptoms: tics to seizures to paralysis

3. Sometimes precipitated by a severe trauma such as rape, deep anger and frustration, disaster, war, etc.

4. Typically begins/ends abruptly relapsing within 5 yrs

Conversion disorder…cont.5. Affected body part sometimes related to

inner psychological conflict person is experiencinga. Example: A husband, who is denying his anger and

growing dislike towards his spouse, may be experiencing a deep unconscious hatred and desire to hurt his wife.

b. He could experience paralysis of his dominant arm and not know why.

6. Contracture may occur after disorder ends if there is long-term paralysis.

7. Tends to be strong denial against possible psychological explanations

8. Prognosis generally good with only 20% of patients relapsing within 5 years

Pain disorder1. Patient consistently preoccupied with

unexplained pain for period of over 6 months2. Frequently prevents individual from

attending work or school3. Frequent medication use and relationship

problems4. Contributes to work disability in about 10 to

15 % of the population5. Pain often leads to depression, suicide,

social isolation and results in expenditure of many resources trying to find a cure

6. Treatment might include use of nerve blocks, and carefully controlled pain medications

Hypochondriasis1. Preoccupation with fears of heaving

serious disease or chronic belief that one has a serious illness

2. Hyperawareness of normal bodily sensations such as heartbeat or breathing

3. Do not want to be referred to psychiatrists

4. Most treated by family physicians with physicals and reassurance that they do not have serious ailment

5. 6+ mos.

Hippocrates used the term hypochondrium in the 4th century BC to refer to the anatomic area below the ribs.

Later, the term hypochondriasis emerged to refer to the ill effects upon the psyche and soma of humors or fluids that emanate from the hypochondrium and cause disease.

The term hypochondria is from the Greek - literally 'below the cartilage', referring to the lower ribs and the underlying spleen and liver.

Its application to mental states comes from the theory of humours, relating moods to the liver and spleen.

Similarly depression was called melancholia, literally black bile.

The Four Humors - Ancient Greeks (~2000 BC - 0 AD)

Ancient Greek philosophers such as Hippocrates 400 BC and Galen, 140/150 AD classified 4 "humors" in people. 

Each type was believed to be due to an excess of one of four bodily fluids, corresponding to their character. 

The personalities were termed "humors"

Character Humor Fluid Corresponding Type

Irritable Choleric yellow bile Ruling type

DepressedMelancholic black bile Avoiding type

Optimistic Sanguine blood Socially useful type Openness to experience

Calm Phlegmatic phlegm Leaning type/Neuroticism

BBody DDysmorphic DDisorder1. Normal-appearingNormal-appearing person is

preoccupied with imagined or minor physical defect

2. Pervasive feeling of uglinessPervasive feeling of ugliness despite a normal appearance

3. Body parts that are often thought to be inferior – face, hair, breasts and face, hair, breasts and genitaliagenitalia

4. Average ageAverage age of patient is 3030 years—some as early as five.

5. Patients maymay appear shy, narcissistic and/or obsessive, and will seek plastic surgery as a definitive cure

Body Dysmorphic disorder BBody DDysmorphic DDisorder (BDD)

was recognized formally in 1997 in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) under the somatoform disorders.

BDD is defined as “…a preoccupation with an imagined a preoccupation with an imagined or or slight defect in appearance. This slight defect in appearance. This preoccupation causes significant preoccupation causes significant distress distress or impairment in social, or impairment in social, occupational, or occupational, or other areas of other areas of functioning in the functioning in the person's person's life.”life.”

BBody DDysmorphic DDisorderBackground: EuropeEurope: more than 100 years ago, : more than 100 years ago, EnricoEnrico MorselliMorselli, , a a

psychiatrist in Italypsychiatrist in Italy described persons described persons with a with a subjective feeling of ugliness or with a slight subjective feeling of ugliness or with a slight physical defect considered abnormal by the patient physical defect considered abnormal by the patient but undetectable by others.but undetectable by others.

He stated that these people felt miserable, were He stated that these people felt miserable, were tormented by their imagined defect, and were tormented by their imagined defect, and were consumed by thoughts of this defect in any consumed by thoughts of this defect in any situation. situation.

The term The term dysmorphobia dysmorphobia was coined by him.was coined by him.

BBody DDysmorphic DDisorder Many are dissatisfied with their appearance in some Many are dissatisfied with their appearance in some

way, so does everyone have BDD?way, so does everyone have BDD?No. Individuals with BDD usually dislike every aspect of

themselves to the point of total self hatred. Will spend hours a day thinking about everything from Will spend hours a day thinking about everything from

appearanceappearance, to , to communicationcommunication, to , to mistakesmistakes they've they've made.made.

Often perform rituals, looking at themselves in Often perform rituals, looking at themselves in reflective surfaces repeatedly, or ask for constant reflective surfaces repeatedly, or ask for constant reassurancereassurance.

Additionally, co-morbid with depression Additionally, co-morbid with depression For an diagnosis, appearance concerns must meet the For an diagnosis, appearance concerns must meet the

3 Ds.3 Ds.

BBody DDysmorphic DDisorder True incidence of BDD is unknown, due to the

secrecy of the disorder ~many ~many people with BDD have Social Phobia and are afraid people with BDD have Social Phobia and are afraid of visiting the doctorof visiting the doctor

BDD affects ~1-2%1-2% of the general population; However, this is thought to be an underestimate However, this is thought to be an underestimate because BDD frequently is underdiagnosed.because BDD frequently is underdiagnosed.

Patients are ashamed of their problem and do not Patients are ashamed of their problem and do not report it to their physicians.report it to their physicians.

BBody DDysmorphic DDisorderBackgroundBackground:

>> The The facial areafacial area, including the , including the skinskin, , hairhair, or , or nosenose, are the , are the most common areasmost common areas of concern of concern for for many patients. many patients. >> ManyMany patients affected with BDD have patients affected with BDD have co-morbidco-morbid conditions, such as conditions, such as obsessive-obsessive- compulsive compulsive disorder (OCD)disorder (OCD), , major major depressiondepression, , delusionsdelusions, or , or social social phobiaphobia. . >> Of those with a primary diagnosis of BDD, Of those with a primary diagnosis of BDD, 30% 30% meet criteria for OCD. meet criteria for OCD. >> Approximately 2-7% of patients who undergo Approximately 2-7% of patients who undergo plastic surgery have BDDplastic surgery have BDD..

Patients who undergo plastic surgery generally arePatients who undergo plastic surgery generally areunhappy with the results and find another part of theunhappy with the results and find another part of thebody with which to be concerned or continue to be body with which to be concerned or continue to be consumed with thoughts about the postoperative site.consumed with thoughts about the postoperative site.