Somatoform Disorders

Somatoform Disorders

  • Definition: Disorders characterized by excessive concerns about body functioning.

  • Included Disorders:

    • Somatic Symptom Disorder

    • Illness Anxiety Disorder (formerly hypochondriasis)

    • Conversion Disorder

Illness Anxiety Disorder (IAD)

  • Overview:

    • Preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms.

    • Preoccupation persists despite appropriate medical evaluation and reassurance.

    • Duration: At least 6 months.

Associated Features of IAD

  • "Doctor-shopping": Frequent changing of doctors due to dissatisfaction.

  • Relationship Issues: Poor relationships with healthcare providers, causing frustration for clients and physicians.

  • Family History: History of serious illness within the family.

Prevalence of IAD

  • Statistics: Prevalence varies between 1% and 5%.

  • Demographics: Somewhat more common in women.

  • Nature of Condition: Usually chronic condition; symptoms may wax and wane over time.

Etiology of IAD

  • Similar causes to anxiety disorders with potential genetic contributions.

  • Misinterpretation of harmless bodily symptoms causing increased anxiety.

  • Higher likelihood of focusing on illness-related information.

  • Disproportionate incidence of disease in their family during upbringing.

  • Social benefits from playing the "sick" role (perks).

Treatment of IAD

  • Cognitive Behavioral Therapy (CBT):

    • Identifying and challenging illness-related misinterpretations of symptoms.

    • Modest results; many patients refuse psychological intervention believing symptoms stem from biological causes.

Somatic Symptom Disorder (SSD)

  • Definition: Physical complaints persisting for at least 6 months, including the following:

    • Persistent thoughts about the seriousness of one’s symptoms.

    • Excessive time and energy spent on symptoms.

    • High levels of health-related anxiety.

Characteristics of SSD

  • Symptoms often cannot be fully explained by a known medical condition or substances.

  • Physical complaints or impairment exceed what is expected based on medical evaluation.

  • Symptoms are not intentionally produced or faked; this distinguishes SSD from Factitious Disorder or malingering.

Treatment of SSD

  • CBT Techniques: Limited success in teaching healthy interpersonal skills.

  • Focus on reassurance, stress reduction, and curtailing help-seeking behaviors.

  • SSRIs: Some promise noted, although side effects are a concern.

Conversion Disorder (CD)

  • Criteria: Symptoms/deficits affecting voluntary motor or sensory function, suggesting a neurological condition.

  • Symptoms or deficits cannot be explained by medical conditions after investigation.

  • Cause significant impairment or distress.

Characteristics of CD

  • Symptoms are not intentionally produced or faked.

  • Common Manifestations:

    • Motor deficits (e.g., paralysis)

    • Sensory deficits (e.g., blindness)

    • Seizures or convulsions (non-epileptic)

Associated Features of CD

  • Symptoms do not conform to known anatomical and physiological mechanisms.

  • Higher prevalence in rural and less educated populations.

  • More frequent in women than men, with reported ratios of 2:1 to 10:1.

Treatment of CD

  • Consideration of (repressed) trauma; addressing feelings associated with traumatic events.

  • Reducing supportive consequences of the disorder: Patients often receive greater attention and sympathy which can reinforce the symptoms (secondary gain).