somatoform disorders

Somatoform disorders are characterized by the presence of physical symptoms that cannot be fully explained by a medical condition, leading to significant distress and impairment in daily functioning. Common types include somatization disorder, hypochondriasis, and conversion disorder.

an overview of somatoform disorders

common elements

• preoccupation with health or appearance

• physical symptoms or complaints that have no physiological basis

• symptom are not under voluntary or conscious control

complex somatic symptom disorder with somatization features:

• used to be called somatization disorder: prior to that was called hysteria(def leppard song)

  • DSM5 → complaints of many bodily symptoms with no physical basis

  • DSM 4 diagnosis criteria

    • 4 pain symptoms

    • 2 gastrointestinal symptoms

    • 1 sexual symptoms

    • 1 pseudo neurological symptom

  • symptoms=identity

    • 2% of females and 0.2% in males(men tend to be less likely to admit the problems)

• basic types of somatoform disorders

  • complex somatic symptom disorder with somatization features (somatization disorder)

    • previously called somatization disorder, and prior to that, hysteria

    • individuals often deny psychological issues

    • DSM-5 criteria

      • multiple body complaints with no physical basis

      • change from DSM4 criteria

        • at least 4 pain symptoms

        • 2 gastrointenstinal symptoms

        • 1 sexual symptom

        • 1 psuedo-neurological symptom

    • symptoms become part of the individuals identity

    • prevalence: 2% females, 0.2% males

  • complex somatic symptom disorder with pain features (pain disorder)

    • similar to complex somatic symptom disorder but primarily focused on pain

    • key elements

      • no physiological/neurological basis for pain

      • pain persists longer than expected after an actual injury

      • chronic pain classification: the pain may be real, affects 30% of US population

      • emphasis on avoiding untreated pain

    • illness anxiety disorder (hypochondriasis)

      • previously known as hypochondriasis

      • clinical description:

        • anxiety or fear of having a serious illness

        • characterized by cognitive disortions

          • focus on bodily symptoms

          • seeking medical reassurance

          • strong conviction of disease

          • misinterpretation of symptoms

          • checking behaviors

          • high levels of trait anxiety

    • functional neurological symptom disorder (conversion disorder)

      • example: during pearl harbor, some soldiers lost their vision before kamikaze missions. sudden and completely unexpected loss of sight with no physical abnormalities

      • clinical description:

        • physical malfunctioning without structural abnormalities

        • no physical or organic pathology, lack of awareness of the symptoms

        • symptoms range:

          • anesthesia: loss of feeling in body parts

          • conversion blindness: inability to see despite navigating spaces

          • conversion deafness: hearing loss but orientation upon heading own name

            • aphonia: a speech-related conversation

          • La Belle indifference: no reason to the new symptoms

  • Key characteristics of somatoform disorders

    • preoccupation with health or appearance

    • physical complaints about physiological basis

    • symptoms are not under voluntary or conscious control

  • physiological factors in the development of somatoform disorders

    • psychodynamic factors:

      • freud and breuer: unconscious intrpsychic conflict leads to “conversion” into somatic symptoms

      • primary gain: reduces anxiety

      • secondary gain: avoidance of painful emotions and dependency needs

  • congitive behavioral perspective

    • focus on the “sick role” and reinforcement of behaviors

      • barksy (1991) and the cognitive behavioral cycle:

        • external/internal triggers increase perception of bodily changes

        • worry about diseas arises

        • body sensations are amplified

        • catastrophic thoughts about sensations intensify

    • conversion symptoms(speech and sensations):

      • aphonia: speech disturbance

      • globus: lump-in-throat sensations

      • seizures: no EEG abnormalities or memory issues

  • common elements in somatoform disorders

    • social and sociocultural influences

      • family dynamics: parenting, observational learning, reinforcement

      • family history of recent illness

      • cultural factors dictate the display and acceptance of emotions