SOMATOFORM DISORDERS

Somatoform disorders are characterized by physical symptoms suggesting medical disease but without
demonstrable organic pathology or known pathophysiological mechanism to account for them.

Somatization: It refers to all those mechanisms by which anxiety is translated into physical illness or bodily
complaints.

Types
 Somatization Disorder
 Pain disorder
 Hypochondriasis
 Conversion Disorder or Somatoform Autonomic Dysfunction
 Body Dysmorphic disorder

Incidence:
 Life time prevalence: 0.2 to 2%
 Hypochondriasis: 1 to 5% of general population
 More common in women than in men, with the exception of hypochondriasis, which affects women
and men equally.
 Are more common in the poorly educated, in rural areas, and in individuals from the lower
socioeconomic groups

1. Somatization Disorder

Is a syndrome of multiple somatic symptoms that cannot be explained medically and are associated
with psychosocial distress and long seeking of assistance form healthcare professionals.

Is chronic, with symptoms beginning before age 30.

The symptoms may be:

 Pain (in at least four different sites)

Gastrointestinal (Nausea, vomiting, diarrhea)

Sexual symptoms ( Irregular menses, erectile dysfunctions etc)

Neurological symptoms (Paralysis, blindness, deafness)

 Anxiety and depression, suicidal threats and attempts

 The disorder usually runs a fluctuating course, with periods of remission and exacerbation.
 Clients receive medical care from several physicians, sometimes concurrently, leading to the possibility of
dangerous combinations of treatments.
 Tendency to seek relief through overmedication with prescribed analgesics or antianxiety agents.
 Drug abuse and dependence are common complications

2. Pain Disorder
 Is characterized by severe and prolonged pain that causes clinically significant distress or impairment in
social, occupational or other important areas of functioning.
 There is a correlation of a stressful situation with the onset of the symptoms.
 Frequent visits to physicians in an effort to obtain relief, excessive use of analgesics and requests for
surgery.
 Depression and addiction of substances

3. Hypochondriasis
Is defined as a person’s preoccupation with the fear of contracting, or the belief of having a serious disease.

The fear becomes disabling and persists despite appropriate reassurance that no organic pathology can be
detected.

Occasionally medical disease may be present, but in the individual with hypochondriasis, the symptoms are
excessive in relation to the extent of pahtology.

Preoccupation may be with-

 A specific organ or disease (Cardiac disease)

 With bodily functions (peristalsis, heartbeat)
 Or minor physical alterations ( Smal sore, occasional cough)

They are profoundly preoccupied with their bodies and are aware of even the slightest change in feeling or
sensation.

Long history of “Doctor shopping” and are convinced that they are not receiving proper treatment.

Anxiety and depression are common

4. Conversion Disorder
 Is a loss of or change in body function resulting from a psychological conflict.
 Clients are unaware of the psychological basis and are therefore unable to control their symptoms.
 It affect voluntary motor or sensory functioning suggestive of neurological disease
(Pseudoneurological)
 Ex- Paralysis, aphonia, seizures, coordination disturbance, difficulty swallowing, urinary retention,
akinesia, blindness, deafness, double vision, loss of pain sensation and hallucinations etc.
 The symptoms usually occurs after a situation that produces extreme psychological stress for the
individual.
  Most conversion symptoms resolve within a few days or weeks.
 75% complete recovery and 25% experience additional episodes during periods of stress.

5. Body dysmorphic disorder

 Is formerly called Dysmorphophobia
 Is characterized by the exaggerated belief that the body is deformed or defective in some specific way.
 Common complaints include-
 Defect in face, thinning of hair, acne, wrinkles, scars, facial swelling or assymmetry, excessive facial hair
etc
 History reflect numerous visits to plastic surgeons and dermatologists in and drive to correct the imagined
defect.
 May undergo unnecessry surgical procedures.

Etiology
Genetic

Biochemical: Decrease level of serotonin and endorphins

Psychodyanmic: is ego defense mechanism. Physical complaints are expression of low self esteem and feeling
of worthlessness, Defense against guilt.

Family Dynamics

Learning theories:

 Reinforcement mechanisms
 Primary gain: Relieve from duties
 Secondary gain: Gets attention of others
 Tertaiary gain: relieves conflict

Treatment:
Individual Psychotherapy: Helping the clients develop healthy and adaptive behaviors

Group Psychotherapy: It provides a setting where clients can share their experiences of illness, learn to
verbalize thoughts and feelings.

Behavior therapy: it focuses on teaching these individuals to reward the clients autonomy and independence.

Psychopharmacology:
  Antidepressnats

Tricyclic: amitriptyline, nortriptyline, imipramine etc

SSRI: Paroxetine, fluoxetine, sertraline etc

Anticonvulsants: Phenytoin, carbamazepine, clonazepam

 Antianxiety Drugs:

Nursing Diagnosis:
 Ineffective coping related to repressed anxiety as evidenced by verbalization of numerous physical
complaints in the absence of any pathophysiology.
 Chronic pain related to repressed anxiety or learned maladaptive coping skills as evidenced by verbal
complaints of pain.
 Fear of having serious disease related to past experience with life threatening illness of self as
evidenced by preoccupation with bodily signs and symptoms.
 Disturbed body image related to repressed anxiety as evidenced by preoccupation with imagined defect.
 PSYCHOPHYSIOLOGICAL DISORDERS
Certain psychological factors can influence the development or exacerbation of, or delayed recovery
from, various medical conditions these disorders are known as Psychophysiological disorders.

Psychological factors include-

 Mental illness

 Psychological symptoms

 Personality traits ( denial for medical care)

 Maladaptive health behavior (Alcoholism, smoking)

 Stress

Common psychophysiological disorders

 Acne

 Amenorrhea

 Angina pectoris

 Asthma

 Cancer

 Coronary heart disease

 Duodenal ulcer

 Enuresis

 Gastric ulcer

 Impotence

 Irritable bowel syndrome

 Migraine headache

 Obesity

 Rheumatoid arthritis

 Tension headache

Asthama
 Asthama is a syndrome of airflow limitation characterized by increased responsiveness of the
tracheobronchial tree to various stimuli and manifested by airway smooth muscle contraction.
Psychosocial influence:

 These people have excessive dependancy needs

 Personality characteristics include:
 Fears, emotional lability, increased anxiety and depression

Cancer:
Psychosocial influence:
Nice guy’s disease
Type C personality
 before their own

 Supresses anger and hostility

 Exhibits a calm, placid exterior

 Commonly feels depressed and in despair

 Low self esteem, low self worth

 Puts others needs

Coronary heart diease

Psychosocial influence:
Type A personality
 Easily aroused hostility

 Very aggressive and ambitious, concentrating almost exclusively on his or her career

 Having no time for hobbies

 Seldom feeling satisfied with accomplishments, always feeling must do more

 Measuring achievements in numbers produced and rupees earned

 Never have enough time

 Appearing to be very extroverted and social, dominating conversation,

Type B personalities
 generally apathetic,

 patient, relaxed, easy-going,

 no sense of time schedule, having poor organization skills,

  and at times lacking an overriding sense of urgency.

 These individuals tend to be sensitive of other people's feelings

Peptic Ulcer
Psychosocial influence:
 Presence of hostility, guilt and frustration

 Stress

 Are having excessive worries and have more time of crises than most people

 Always seem to expect the worst from a situation

 Anxiety and depression

Migraine headache
Psychosocial influence: Migraine personality
 Perfectionist

 Overly conscious

 Inflexible

 Neat and tidy, compulsive and very hard workers

 Quite intelligent, setting high expectations on themselves and others

 Experience hostility and anger but cannot express these feelings openly
 REACTION TO STRESS AND ADJUSTMENT DISORDER
1. Acute stress Reaction
 It is characterized by an immediate and clear temporal relationship between an exceptional stressor
and the onset of symptoms.
 This disorder is more likely to develop in presence of physical exhaustion and in extremes of age.
 More commonly seen in females and people with poor coping skills.

Symptoms: anxiety, depression, anger, despair, overactivity or withdrawal and constriction of the field of
consciousness.
The symptoms resolve rapidly if removal from stressful environment is possible.
Treatment:

 Removal of patient from stressful environment and helping the patient to “Pass through” the stressful
experience
 IV Benzpdiazepines

2. Post Traumatic Stress Disorder

 This disorder arises as a delayed / protracted response to an exceptionally stressful life event or
situation which is likely to cause pervasive distress in almost any person
Ex – Disasters, war, rape, serious accidents etc

 The symptoms develop after a period of latency, within 6 months after the stress or may be delayed
beyond this period.
Symptoms

 Recurrent recollections of the stressful event either in flashbacks or in dreams.

 There is an associated sense of re-experiencing of the stressful event.
 There is marked avoidance of the events or situations that arouse recollections of the stressful event,
along with marked symptoms of anxiety
 Other symptoms include partial amnesia for some aspects of the stressful event, feeling of numbness
and anhedonia.

Treatment

 Prevention: Anticipation of disasters in the high risk areas, with the training of personnel in disaster
management.
 Disaster management
  Supportive psychotherapy
 Drug treatment:

Antidepressants
Benzodiazepines

3. Adjustment Disorders
 Commonly seen in adolescents and women.
 Is charecterized by disorders which occur within 1 month of a significant life change (stressor)
 Occurs in those individuals whor are vulnerable due to poor coping skills of personality factors.
 The duration of the disorder is usually less than 6 months

Treatment:
o Supportive psychotherapy
o Crisis intervention
o Coping skill training
o Drugs

Other neurotic disorders (Culture bound disorders)

Amok
Is characterized by a sudden, unproved episode of rage, in which the affected person runs about
and injures or kills any person who is encountered on the way (South east Asia, Ex-Malaysia)

Koro
The affected male person has the belief that his genital organ is shrinking and may disappear in to his
abdominal wall and he may die.
Females are affected infrequently, with a corresponding belief that their breasts are shrinking.

Wihtigo:
This syndrome is seen in native American Indian. The affected person has the belief that he has
been transfromed in to a wihtigo, a cannibal monster, occurring especially during times of starvation.

Latah (Startle Reaction)

South east Asia
Occurring more often in women, is characterized by presence of automatic obedience, echolalia and
echopraxia.

Dhat syndrome
Is culture bound syndrome, which is prevalent in the Indian subcontinent.
Characterized by
 Complaint of passage of Dhat in urine
 Multiple somatic symptoms
 Asthenia (Physical or mental exhaustion)
 Anxiety and depression may be present
 Sexual dysfunction may occur.