SOMATOFORM

DISORDER
Presented by
Greesha
Bsc (N)3rd year
 INTRODUCTIO
N
The somatoform disorders are characterized by
repeated presentation with physical symptoms
which do not have any adequate physical basis(and
are not explained by the presence of other
psychiatric disorder),and a persistent request for
investigations and treatment despite repeated
assurances by the treating doctors.
 DEFINITION

SOMATOFORM DISORDERS
DEFINITIO –is defined
as the useNof physical symptoms to express
emotional problems and psychosocial stress.
 CLASSIFICATION OF
SOMATOFORM DISORDERS
ICD 10:-
oSomatization disorder
oHypochondriacal disorder
oSomatoform autonomic dysfunction
oPersistent somatoform pain disorder
oOther somatoform disorder
oSomatoform disorder ; unspecified
 DSM -5 CLASSIFICATION
Somatic symptom
Illness anxiety disoder
disorder

DSM 5
Conversion disorder
(functional neurological
symptom disorder )
Psychological factors
affecting other medical
conditions

CLASSIFIC
disorder
ATION
Body dysmorphic
Factitious disorder

NOTE:-
“HYPOCHONDRIASIS
Other specified ” was moved from the
/unspecified somatic ICD-10 grouping of
symptom and related somatoform disorder to
disorder. the ICD-11 grouping of
obessive compulsive and
related disorder.
Psychopathology
 IN ICD-10 ,SOMATOFORM DISORDERS ARE DIVIDED INTO THE
FOLLOWING CATEGORIES.

SOMATIZATION DISORDER
1.

somatization disorder is characterized by the

following clinical features:-
Multiple somatic symptoms in the absence of any physical disorder.

The symptoms are recurrent and chronic (of many years duration);at least 2
year duratuon is needed for diagnosis.

The symptoms are vague,presented in a dramatic manner,and involve multiple

organ symptoms .
Abdominal pain Nausea Vomiting Numbness

THE COMMON
Soreness
SYMPTOMS Itching Tingling Menorrhagia
ARE:-
There is Some degree of
impairment of social and
frequent change family functioning
Dysmenorrhea Dyspareunia
of treating attributable to the nature
of symptoms and
physician. resulting behaviour .
Presence of conversion
CONT.
symptoms is common.

This disorder usually

begins in second or third
decade of life and is
much more common in
females .
 DIAGNOSIS
 It is important to ruleout physical disorders before making a diagnosis of
somatization disorder. Particularly those physical disorder,which often present
with apparently vague and multiple somatic symptoms ,must be kept in mind.
 This is especially so if the onset of symptoms is in the later part of life

DIFFERENTIAL
 (>30 years of age ;more so if >40years of age )and in male patients .

 These DIGNOSIS OF
physical disorders include:
SOMATIZATION
 Multiple sclerosis

DISORDER-
 Hypothyroidism

 Hyperparathyroidism

 Carcinoma pancreas

 Somatization is sometime an` idiom of distress’ in the absence of a

diagnosable psychiatric disorder However,certain psychaitric disorder also
must be ruled out.
 CONT.
1.SCHIZOPHRENIA –In the initial
2.MAJOR DEPRESSION – 3 .CONVERSION DISORDER –
stages,multiple somatic symptoms
Particularly in india ,multiple Although conversion symptoms are
may be present but later typical
somatic symptoms are common in common in somatization disorder
features of schizophrenia are
major depression . they are classified separetly .
manifested .

4.HYPOCHONDRIASIS –There
are multiple,vague somatic
symptoms in 5.DELUSIONAL DISORDER-
Eg –monosymptomatic
hypochondriasis ,normal body Somatic delusions may be present
hypochondrical psychosis
functions or minor somatic in delusional disorder
symptoms are interpreted as a the
presence of a serious body disease.

The treatment is often difficult .It
mainly consist of :
link between psychosocial conflict and
TREATMENT
1 .suppportive psychotheraphy -The
first step is to enlist the patient in the
2.Behavior modification –for example
therapeutic alliance by establishing a
ignoring symptoms ,and positively
rapport .It is useful to demonstrate the
reinforcing good behavior.
somatic symptoms,if it is apparent .

4.Drug therapy –Antidepressant &

3.Relaxation therapy,with graded benzodiazepines can be given on a
physical exercises. short term basis for associated
depression and anxiety.
 2.HYPOCHONRIASIS (HYPOCHONDRIACAL DISORDER)
Hypochondriasis is defined as a peristent preoccupation with fear or belief of having one or more serious disease based
on persons own interpretation of normal body function or a minor physical abnormailty .

Other important features are –

Complete physical examination and investigations do not show presence of any significant abnormality.

The fear or belief persists despite assurance to the contrary by showing normal reports to the patient.

Preoccupation with medical terms and syndromes in cimmon .Repeated change of physician is common.
 ETIOLOGY
A.PSYCHODYNAMIC
THEORY : Hypochondriasis is
believed to be based on a
narcissistic personality caused
by a narcissistic libido.

B.AS A SYMPTOM OF
DEPRESSION:
Hypchondriacal symptoms are
commonly present in major
depression.
 It consist of –

TREATME 1. supportive
psychotherapy .
NT
2.Treatment of associated or
underlying depression and
anxiety ,if present.
 SOMATOFORM AUTONOMIC DYSFUNCTION
 According to ICD-10 ,in this disorder symptoms are presented by
the patient as if they were due to a physical disorder of an organ
system that is predominantly under autonomic control.
3.SOMATOFORM
 Eg- A .heart and cardiovascular system
AUTONOMIC
DYSFUNCTION
 Palitation

 B.Upper gastrointestinal tract

 Aerophagy

 Hiccough

 C.Lower respiratory tract

 Flatulence
CONT…
 Irritable bowel

 D.Respiratory system

 Hyperventilation

 E .Genitourinary system

 Dysuria

 Physical examination and investigations do not show

presence of any significant abnormality .
 The preoccupation persists despite repeated assurances
and explanations .
 TREATMENT

1.supportive psychotherapy

2.Drug treatment :The symptoms of anxiety or

depression usually respond to benzodiazepines
(eg alprazolam ) and antidepressant (eg
imipramine )

Some common disorders are described in some

detalil below-
HYPERVENTILATION
 A HYPERVENTILATION
SYNDROME (HVS )
The syndrome is characterized by a habit of hyperventilation which becomes
particularly marked in presence of a psychosocial stress,or any emotional
upheaval.

In its mild form,it is characterized by excessive fatigue ,chest

pain,headache ,palpitations ,sweating and feeling of lightheadedness .

In its severe hyperventilation syndrome ,carpopedal spasm( tetany) ,paresthesias

and loss of consciousness may occur.
 THE DIAGNOSIS IS EASY-

Apart from clinical history and presence of frequent sighing during the
interview ,a simple test would demonstrate the symptomatology .

The patient is asked to breathe rapidly and deeply for 2-3 mint.

This produces the classical physical symptoms

If carried on larger tetany and unconsciousness would result .

1 Relaxation techniques :jacobson’s progressive muscular relaxation ,autohypnosis
or hypnosis ,yoga ,transcendental meditation,or biofeedback
Teching relaxed breathing techinques ,which include
A.Breathing more from the abdomen ,thus avoiding the use of accessory muscle of

TREATMEN
expiration.
B .slow repiration with passive expiration,without muscular effort.

Tto be voluntarily introduced after each respiratory cycle.
C. short rest cycle

2.Treatment of underlying anxiety or depression ,if present ,with benzodiazepines or
tricyclic antidepressants .
3.Breathing –in-bag technique the aim of this technique is to have the patient
rebreathe expired air .
 The patient usually present with one
or more of the following symptoms
–
B. IRRITABLE
BOWEL Abdominal pain ,discomfort or
cramps .
SYNDROME(IB
S)
Alteration of bowel habits (diarrhea
or constipation).
 TREATME
NT

A stable and trustful doctor –patient relationship.

Supportive psychotherapy is best carried out in medical or

GE Clinic by the treating physician.These patient often resent
psychiatric refferals .

Identification of current life stressor.

Antianxiety and antidepressant medication may be helpful at

times.At other times,they just act like placebos.
Premenstrual syndrome or premenstrual tension is a variety of
physical ,psychological and behavioral symptoms occuring in second half of menstrual
cycle .Typically the symptoms start after a few days of ovulation,reach a peak about 4-5days
before menstruation .The period between menstruation and next ovulation is normal.
C.PREMENS
 The syndrome is characterized by feelings of irritability,depression,cryingspells,restlessness
and anxiety . TRUAL
SYNDROME
 This is associated. With changes in appetite sign and symptoms of water retention like-
 Pedal edema.

 Weight gain.

 Swelling of breast .
 Psychotherapy may be helpful in some cases where
TREATMENT conflicts regarding menstruation or femeninity are
present.

Hormonal treatment –oral and parenteral progesterone.

4. PERSISTENT SOMATOFORM PAIN
DISORDER
In this disorder ,persistent ,severe and
distressing pain is the main feature
which is ,either grossly in excess of
what is expected from physical
findings ,or inconsistent with the
anatomical disturbance of nervous
system.

This disorder is more common in

females with an onset in 3rd or4th
decade of life .
 TREATMEN
T
The patient usually refuse psychaitric
instervention.

Drug therapy should be avoided as the risk of

iatrogenic drug abuse in high.

In the absence of other modes of successful

treatment,a supportive relationship with a
physician will prevent doctor –shopping and
provide relief.
 5.) Other somatoform disorder
In ICD-10 ,this category
includes other somatoform
disorder not classified in the
5 OTHER
previous four categories
SOMATOFOR
eg.globus
M DISORDERS
hystericus ,psychogenic
torticollis,psychogenic
pruritus,psychogenic
dysmenorrhea,teeth grinding .
 NURSING DIAGNOSIS
 1.]NURSING DIAGNOSIS : Ineffective coping mechanism
 BEHAVIORS : Verbalization of numerous physical complaints in the absences of
any pathophysiological evidence; focus on the self and physical symptoms.
 INTERVENTIONS: Monitor the physicians on going assessment, laboratory
reports, and other data to maintain assurance that the possibility of organic pathology is
clearly ruled out.
 Recognize and accept that the physical complaint is real to the client even though no
organic etiology can be identified.
 Identify gains that the physical symptoms are providing for the client increase
dependency, attention and distraction from other problems.
 Encourage the client to verbalize fears and anxieties.
 Help the client identify ways to achieve recognition from others without
resorting to physical symptoms.
 Provide pain medication as prescribed by physicians. Client comfort and
safety are nursing priorities.
 Provide instructions and relaxation techniques and assertiveness skills.

2.]NURSING DIAGNOSIS : Deficient knowledge

[psychological causes for physical symptoms]
BEHAVIORS : History of doctor shopping for evidence of organic
pathology to substantiate physical symptoms statement such as I don’t
know why the doctor put me on the psychiatric unit. I have a physical
problems”.
.
INTERVENTIONS:
 Assess clients level of knowledge regarding effects of
psychological problem on the body.
 Assess client level of anxiety and readiness to learn.
 Discuss physical examination and laboratory test that have
been conducted.
 Explore clients feelings and fears. Go slowly this feeling
may have been suppressed or repressed for so long that
their disclosure may be a very painful experience.
3.] Nursing Diagnosis:- Fear (of having a serious disease)
Behavior:- Pre- occupation with and unrealistic of bodily signs and
sensation.
Intervention:-
• Monitor the physician on going assessment and laboratory report. Organic
pathology must be clearly ruled out.
• Refer all new physical complaints to the physician to ignore all physical
complaints could place the clients safety in jeopardy.
• Identify time during which the pre occupation with physical symptom is
worse.
• Convey empathy.
• Encourage the client to discuss feelings associated with fear of serious illness.
4.] Nursing Diagnosis:- Disturbed sensory perception
Intervention:-
• Maintain a non judgmental attitude when providing
assistance with self care activities to the clients.
• Do not allow the client to use the manipulative tool to
avoid participating in therapeutic activities.
• Give positive reinforcement for identification or
demonstration of alternative, more adaptive coping
strategies.
5.]Nursing Diagnosis:- Impaired memory.
Intervention:-
• Obtain as much information as possible about the client
from family and significant others if possible.
• Identify specific conflicts that remain unrobed and help the
client identify possible solutions.
• Provide positive feedback for decision made.
• Encourage the client to discuss situation that have been
specially stressful and to explore the feeling associated
with those times.