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Somatoform disorders

Somatoform disorders

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Published by Niva Lieberman Azuz

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Published by: Niva Lieberman Azuz on Apr 13, 2011
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02/06/2013

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Somatoform disorders

(Am Fam Physician 2007;76:1333±8. Copyright © 2007 American Academy of Family Physicians)

7 subtypes:

personality disorders. . eating disorders.Epidemiology ‡ Up to 50 percent of primary care patients (symptoms that cannot be explained) ‡ Most do not meet the strict psychiatric diagnostic criteria ± but have ³somatic preoccupation. and psychotic disorders).´ ‡ familial aggregation ‡ comorbidities with mental health disorders (such as mood disorders. anxiety disorders.

‡ The unexplained symptoms of somatoform disorders often lead to: ‡ strong. often negative emotions toward the physician or office staff ‡ noncompliance with diagnosis or treatment .

Diagnosis ‡ lack of any physical or laboratory findings prompts the diagnosis. ± symptoms are caused and maintained by anxiety .have no obvious gains or incentives ± symptoms are not willfully adopted or feigned. ‡ factitious disorder (internal gain) and malingering (external gain) must be excluded: ± somatoform.

Diagnosis ‡ should be considered early in the process of evaluating unexplained symptoms. ‡ over-evaluation and unnecessary testing should be avoided .

Patient Health Questionnaire .

or other functioning. cause significant impairment in social. . occupational. 2. another mental disorder. 3. cannot be fully explained by a general medical condition. or the effects of a substance. are not the result of factitious disorder or malingering.Criteria 3 criteria common to all somatoform disorders: 1.

neck. multiple imaging and laboratory tests. <0. numerous referrals Subthreshold somatization disorder a prevalence up to 100 times. 4 pain symptoms (shoulder. frequent clinical visits. . Familial patterns. F>M (prevalence: 0. diarrhea etc).2% in M) lasting several years.2-2% in F. Include at least: 2 GI complaints (cramping. low back. 1 pseudoneurologic problem (ringing in the ears).SOMATIZATION DISORDER ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ beginning before 30 years of age. 10 -20 % incidence in 1st-degree female relatives. 1 sexual symptom (eg anorgasmia) that have been thoroughly evaluated but have no identified cause. and legs).

.

SOMATOFORM DISORDER (undifferentiated) ‡ Less specific than somatization disorder ‡ 6 month of 1 or more unexplained physical complaints ‡ Chronic fatigue -is a typical symptom. ‡ Epidemiology: ± more in young women ± of low socioeconomic status. .

a hemiparesis that does not follow known corticospinal-tract pathways or without changes in reflexes or muscle tone). ‡ Epidemiology: ± ± ± ± Onset usually age 10 .35 years. ‡ Patients may present in: ± a dramatic fashion or ± show a lack of concern for their symptom. minimal medical or psychological knowledge . more common in rural populations.CONVERSION DISORDER ‡ a single pseudoneurologic symptom (voluntary motor or sensory) ‡ Do not conform to : ± known anatomic pathways ± or physiologic mechanisms. lower socioeconomic status. (e..g.

anxiety. ‡ use the health care system frequently. ‡ associated with psychological factors at its onset BUT may also be associated with a general medical condition. or family. ‡ make substantial use of medication. or a substance-related disorder . ‡ psychological factors play the primary role in the perception of pain. work.PAIN DISORDER ‡ fairly common. ‡ have relational problems in marriage. . ‡ Pain may lead to inactivity and social isolation. ‡ often associated with comorbid depression.

‡ 6 months a nondelusional preoccupation with their symptoms ‡ Prevalence: is 2 . .. ‡ The predominant characteristic: ± fear when discussing their symptoms (e. an exaggerated fear of having acquired HIV despite reassurance to the contrary).HYPOCHONDRIASIS ‡ fixate on the fear of having a lifethreatening medical condition.g.7 % in the primary care ‡ not consistent differences with age. sex. ‡ This fear is pathognomonic for hypochondriasis. or cultural factors.

‡ defect is usually slight but the patient's concern is excessive. flat keloid on the shoulder may be so self-conscious of it that she never wears clothing that would reveal it. (For example. avoids all social situations in which it may be seen) ‡ F=M . a woman with a small. real or imagined.BODY DYSMORPHIC DISORDER ‡ debilitating preoccupation with a physical defect.

oligomenorrhea. expanding abdomen without eversion of the umbilicus.SOMATOFORM DISORDER NOT OTHERWISE SPECIFIED ‡ do not meet the full criteria ‡ physical symptoms that are misinterpreted or exaggerated with resultant impairment.g. ‡ eg: pseudocyesis. ‡ A variety of conditions come under this diagnosis.. the mistaken belief of being pregnant based on actual signs of pregnancy (e. amenorrhea. nausea. breast changes. . feeling fetal movement. labor pains).

Treatment .

. .. . " . . . ‡ ‡ . .

‡ . . . . . ‡ ‡ ‡ . . .‡ . . .

. . .(1) ‡ . . .

. BDD ± . ) ‡ . ( . .(2) ‡ .

‡ CBT ‡ ‡ . . . . .(3) . CBT.

" . DD " CBT . . . . . . ‡ . . " ‡ ‡ .

. .‡ .reassurance ‡ . ‡ . .

.2 . .3 . . . .1 .(1) .4 .

5 . .7 .10 .9 . 5) . . ." . .( .8 .6 . .(2) .

BDD .

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