2. A group of disorders in which people
experience significant physical symptoms for
which there is no apparent organic cause
Symptoms are often inconsistent with possible
physiological processes
People do not consciously produce or control
the symptoms but truly experience the
symptoms
Symptoms pass only when the psychological
factors that led to the symptoms are resolved
3. Conversion disorder Loss of functioning in some part of the body for
psychological rather than physical reasons
Somatization
disorder
History of complaints about physical symptoms,
affecting many different areas of the body, for
which medical attention has been sought but no
physical cause found
Pain disorder History of complaints about pain, for which
medical attention has been sought but that
appears to have no physical cause
Hypchondriasis Chronic worry that one has a physical disease in
the absence of evidence that one does; frequently
seek medical attention
Body dysmorphic
disorder
Excessive preoccupation with some part of the
body the person believes is defective
4. Somatoform and
Pain Disorders
Subjective experience of many
physical symptoms, with no organic
causes
Psychosomatic
Disorders
Actual physical illness present and
psychological factors seem to be
contributing to the illness
Malingering Deliberate faking of physical
symptoms to avoid an unpleasant
situation, such as military duty
Factitious
Disorder
Deliberate faking of physical illness
to gain medical attention
5. Somatoform disorders are problems that
appear to be medical but are due to
psychosocial factors
◦ Unlike psychophysiological disorders, in
which psychosocial factors interact with
physical ailments, somatoform disorders
are psychological disorders masquerading
as physical problems
6. Dissociative disorders are patterns of memory
loss and identity change that are caused
almost entirely by psychosocial factors rather
than physical ones
7. When a physical ailment has no apparent medical
cause, physicians may suspect a somatoform
disorder
People with a somatoform disorder do not
consciously want, or purposely produce, their
symptoms
◦ They believe their problems are genuinely medical
There are two main types of somatoform disorders:
◦ Hysterical somatoform disorders
◦ Preoccupation somatoform disorders
8. People with hysterical somatoform
disorders suffer actual changes in their
physical functioning
◦ These disorders are often hard to distinguish
from genuine medical problems
◦ It is always possible that a diagnosis of hysterical
disorder is a mistake and that the patient’s
problem has an undetected organic cause
10. Recognized since the time of ancient Egypt.
An early name for somatization disorder
was hysteria, a condition incorrectly
thought to affect only women. (The word
hysteria is derived from the Greek word for
uterus, hystera.)
In the 17th century, Thomas Sydenham
recognized that psychological factors,
which he called antecedent sorrows, were
involved in the pathogenesis of the
symptoms.
11. In 1859, Paul Briquet, a French physician,
observed the multiplicity of the symptoms
and the affected organ systems and
commented on the usually chronic course
of the disorder.
The disorder was called Briquet's syndrome
for a time, although the term somatization
disorder became the standard in the United
States when the third edition of DSM (DSM-III)
was introduced in 1980.
12. Somatization is “the tendency to experience
and communicate somatic distress and
symptoms unaccounted by pathological
findings.”
Can coincide with another illness.
13. Prevalance- 0.2% to 2% among women and is
less than 0.2% in men
Usually begins in the teenage and young
adulthood years.
Onset after 30 years is extremely rare
More common in less educated and lower
socioeconomic groups
14. Observed in 10% to 20% of female first-degree
relatives.
Male relatives of women with somatization
disorder have an increased risk of antisocial
personality, substance abuse disorders, and
somatization disorder.
15. Psychosocial Factors
◦ interpretations of the symptoms as social communication
avoid obligations
express emotions
symbolize a feeling or a belief
◦ the symptoms substitute for repressed instinctual impulses
◦ A behavioral perspective
Biological Factors
◦ characteristic attention and cognitive impairments
◦ decreased metabolism in the frontal lobes and in the
nondominant hemisphere
◦ genetic components
◦ Research into cytokines
16. Patients with somatization disorder have the
tendency to react to psychosocial distress
and environmental stressors with physical
bodily symptoms.
Can be vague and dramatic in reporting their
medical history.
Frequently move abruptly from complaining
of one symptom to another symptom.
17. Usually present with numerous symptoms,
such as headaches, back pain, persistent lack
of sleep, stomach upset, and chronic
tiredness
Without demonstrable medical causes
Have a persistent conviction of being ill,
despite repeated negative results on
laboratory tests, diagnostic tests,
consultations with specialists, and recurrent
hospitalizations
18.
19. Has impaired social/work/personal functioning
Symptoms may be exacerbated by stress
No element of feigning symptoms to occupy sick
role (Facititious Disorder) or for material gain
(Malingerer)
20. Physical examination is normal
May reveal some skin lesions or scars that
resulted from previously performed surgeries
Affects the patient’s perception of wellness
Patient begins to believe that she or he is
physically disabled and unable to work
Characteristically deny the influences of
psychosocial distress in producing the
symptoms,resist psychiatric referral
21. Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV) diagnostic
criteria
22.
23.
24.
25. Medical conditions - multiple sclerosis, brain
tumour, hyperparathyroidism, hyperthyroidism,
lupus erythematosus
Affective (depressive) and anxiety disorders-
1or2 symptoms of acute onset and short
duration
Hypochondriasis - patient´s focus is on fear of
disease not focus on symptoms
Panic disorder - somatic symptoms during
panic episode only
26. Conversion disorder - only one or two
Pain disorder - one or two unexplained pain
complaints, not a lifetime history of
multiple complaints
Delusional disorders - schizophrenia with
somatic delusions or depressive disorder
with hypochondriac delusions, bizzare,
psychotic sy.
Undifferentiated somatization disorder -
short duration (e.g. less than 2 years) and
less striking symptoms
27. The major importance for successful
management
Trusting relationship between the patient and
one (if possible) primary care physician
Frequent changes of doctors are frustrating and
countertherapeutic.
Regularly scheduled visits every 4 or 6 weeks.
Brief outpatient visits - performance of at least
partial physical examination during each visit
directed at the organ system of complaint.
28. Explain to the patient and family
relationship between psych and somatic
Empathic attitude
Avoid more diagnostic tests, laboratory
evaluations and operative procedures
unless clearly indicated
Treatment of underlying depression and
anxiety.
Potentially addicting medications should be
avoided
29. Psychotherapy, both individual and group
◦ decreases personal health care expenditures
(50%)
◦ decreasing their rates of hospitalization.
◦ helped to cope with their symptoms
◦ to express underlying emotions
◦ to develop alternative strategies for expressing
their feelings
30. • Increased Activity Involvement
–Combats stress
–Improves overall mood
–Provides Distraction from somatic
symptoms
–Pain perception has a subjective
component—improved mood and
distraction reduce the experience of pain
–Exercise has physiological effects that
combat somatization and stress
31. • Directly acts on physical symptoms, given its
effects on breathing, heart rate, muscle
tension, etc.
• Patients report benefit soon upon learning
the technique
• Helps with stress management
• Includes Diaphragmatic Breathing,
Progressive Muscle Relaxation, Biofeedback
32. – Establish consistent sleep patterns (same bedtime and
waketime everyday)
– Go to bed only when sleepy (stimulus control)
– If not asleep within 20-30 minutes leave bed and return
when sleep again (stimulus control)
– Comfortable sleep environment
– Avoid alcohol/caffeine during 6 hours before bedtime
– Exercise regularly, but not within 4 hours of bedtime
33. • Much like CBT for depression
– Looking for adaptability of thoughts
– Eliminating distortions
• Use somatic symptoms as anchors for examining
thoughts
• Look for variations in adaptability of thoughts and
discuss their effect
• Patients are likely to have difficulty identifying
thoughts/emotions.
35. Somatization Disorders:Diagnosis, Treatment,
and Prognosis;Psychosocial: vol 32no2 Feb
2011
Somatisation in neurological practice;J Neurol
Neurosurg Psychiatry. Oct 2004; 57(10):
1161–1164.
Somatization A Debilitating Syndrome in
Primary Care; Psychosomatics 42:1, January-
February 2001
Kaplans and Sadocks textbook of psychiatry
