Somatoform Disorders

When Inner Conflict Leads to the Unconscious production of

Physical Symptoms

Somatoform Disorders

Somatization DisorderConversion DisorderPain DisorderHypochondriasisBody Dysmorphic Disorder

What is Somatization?

Experiencing physical distress/symptoms in response to mental/emotional conflict

Seeking medical attention for that physical distress

Somatization Disorder: DSM-IV Criteria

Seeking treatment for many physical complaints, with onset before age 30

Four pain symptoms Two gastrointestinal symptoms One sexual symptom One pseudoneurological symptom The symptoms are NOT intentionally

produced

Conversion Disorder: DSM-IV Criteria

One or more symptoms affecting voluntary motor or sensory function

Resembles neurological or medical disease

Psychological factors must be involved

The symptoms are NOT intentionally produced

Where does the concept of “Conversion” come from?

Freudian term

Patients noted to “convert” psychic conflict into bodily symptoms as a defense mechanism

Commonly association with trauma

Examples of Conversion Symptoms

Sensory– Double vision

(diplopia)– Blindness – Deafness– Numbness

Motor– Paralysis– Difficulty

swallowing (dysphagia)

– Difficulty walking (ataxia)

– Tremor– Inability to talk

(aphonia)– Seizures

(Pseudoseizures)

Pain Disorder: DSM-IV Criteria

One or more sites of pain as primary focus

Pain causes significant impairment

Psychological factors are felt to have an important role in the pain

The symptom is NOT intentionally produced

Hypochondriasis: DSM-IV Criteria

Preoccupation with fears of having a serious disease based on misinterpretation of bodily sensations

Preoccupation goes on despite medical evaluation and reassurance (poor insight)

Duration is at least six months

Hypochondriasis: Associated Features

Serious childhood illnesses and past experience with illness in a family member are common

“Doctor-shopping” and costly medical work-ups are common

Appears equally common in men and women

Body Dysmorphic Disorder: DSM-IV Criteria

Preoccupation with an imagined defect in appearance

If the individual already has a mild physical “flaw,” the concern surrounding it is excessive

Body Dysmorphic Disorder: Associated Features

Frequent inspection of the “defect” can consume many hours a day, lead to suicidal thoughts

Insight is often poor- can become delusional

Medical and surgical treatments are often pursued

High prevalence in cosmetic surgery and dermatology clinics

Factitious Disorder

“I know I’m producing my symptoms, but I don’t

understand why”

Factitious Disorder: DSM-IV Criteria

Intentional production of physical or psychological signs and symptoms

The motivation for the behavior is to assume the sick role (primary gain)

External incentives (such as economic gain, or avoiding responsibilities) are absent (ie, no secondary gain)

Examples of methods to produce Factitious symptoms

Factitious Disorder: Associated Features

Often involves multiple hospitalizations at multiple sites

Invasive procedures and surgery

Usually have few visitors while in the hospital

Patients often have extensive knowledge of medical terminology (health care workers, etc.)

Munchausen Syndrome?

Another term for Factitious Disorder Baron Von Munchausen was a fictional

eighteenth-century character known for story-telling, exaggeration and frequent travel

Munchausen by Proxy

Parent induces illness in a child (most common)

The child is repeatedly hospitalized as a result

This is abuse (a crime, NOT a mental illness)

Malingering

“I’m faking it, I know it, and I’m getting something out of

it”

Malingering

Intentional production of false or exaggerated physical or psychological symptoms

The malingerer is aware that he is producing the symptoms for gain (secondary gain)

In Summary…