Somatoform Disorder

Prof. (Dr.) Rahul Sharma

Professor
HOD of Mental Health Nursing
Ph.D. coordinator
Seedling School of Nursing, Jaipur National
University, Jaipur (Raj.)
 Somatoform Disorder
Somatic disorder is a syndrome of multiple
somatic symptoms that cannot be explained
medically and are associated with
psychosocial distress and long-term seeking
of assistance from health-care professionals
 Somatoform Disorder
These disorders are characterized by
repeated presentation with physical
symptoms which do not have any physical
basis, and a persistent request for
investigations and treatment despite
repeated assurance by the treating doctors.
 Somatoform Disorder
Definition: Somatoform disorders are a
set of psychological conditions where a
person experiences bodily symptoms
that cannot be accounted for by a
medical or neurological diagnosis.
Somatoform Disorder
 Etiology of Somatoform Disorder
o Genetic- Studies have shown an
increased incidence of somatic
disorder.
o Biochemical- Decreased levels of
serotonin and endorphins may play
a role in the etiology of somatic
disorder.
 Etiology of Somatoform Disorder
o Psychodynamic Theory- Some
psychodynamic theorists view illness anxiety
disorder as an ego defense mechanism. They
suggest that physical complaints are the
expression of low self-esteem and feelings of
worthlessness and that the individual
believes it is easier to feel something is
wrong with the body than to feel something
is wrong with the self.
 Etiology of Somatoform Disorder
o Family Dynamics- Some families have
difficulty expressing emotions openly and
resolving conflicts verbally. When this
occurs, the child may become ill, and a shift
in focus is made from the open conflict to
the child’s illness, leaving unresolved the
underlying issues that the family cannot
confront openly.
 Etiology of Somatoform Disorder
o Learning Theory- Somatic complaints are often
reinforced when the sick role relieves the individual
from the need to deal with a stressful situation,
whether it be within society or within the family. The
sick person learns that he or she may avoid stressful
obligations, may postpone unwelcome challenges, and
is excused from troublesome duties (primary gain);
becomes the prominent focus of attention because of
the illness (secondary gain); or relieves conflict within
the family as concern is shifted to the ill person and
away from the real issue (tertiary gain)
 Etiology of Somatoform Disorder
o Past Experience with Physical Illness- Past
experience with serious or life-threatening
physical illness, either personal or that of close
family members, can predispose an individual to
illness anxiety disorder. Once an individual has
experienced a threat to biological integrity, he or
she may develop a fear of recurrence. The fear of
recurring illness generates an exaggerated
response to minor physical changes, leading to
excessive anxiety and health concerns.
 Etiology of Somatoform Disorder
o Neuroanatomical- Brain dysfunction
has been proposed.
 Symptoms of Somatoform Disorder
o Multiple somatic complaints,
unexplained by medical findings.
o Complaints of pain in at least four
different location.
o Two gastrointestinal, one sexual or
reproductive and one neurological
symptoms.
Symptoms of Somatoform Disorder
Symptoms of Somatoform Disorder
Symptoms of Somatoform Disorder
 Symptoms of Somatoform Disorder
o Depressed mood is common.
o Loss or alteration in physical
functioning.
o Blindness or tunnel vision
o Paralysis
o Anosmia (inability to smell)
 Symptoms of Somatoform Disorder
o Aphonia (inability to speak)
o Seizures
o Coordination disturbances
o Pseudocyesis (false pregnancy)
o Akinesia or dyskinesia
o Doctor shopping
 Symptoms of Somatoform Disorder
o Excessive use of analgesics
o Impairment in social or occupational
functioning because of
preoccupation with physical
complaints
o Psychosexual dysfunction
o Excessive dysmenorrhea.
 Symptoms of Somatoform Disorder
o Excessive anxiety and fear of having
a serious illness.
o Exaggerate
 Types of Somatoform Disorder
o Somatization Disorder
o Hypochondriasis
o Somatoform autonomic dysfunction
o Persistent somatoform pain disorder
o Undifferentiated
 Types of Somatoform Disorder
a. Somatization Disorder- Somatization
disorder is characterized by chronic
multiple somatic symptoms in the
absence of physical disorder. The
symptoms are vague, presented in a
dramatic manner and involve multiple
organ systems.
 Types of Somatoform Disorder
b. Hypochondriasis- Hypochondriasis is
defined as a persistent preoccupation
with a fear or belief of having a serious
disease despite repeated medical
reassurance.
Types of Somatoform Disorder
 Types of Somatoform Disorder
c. Somatoform autonomic dysfunction-
In this disorder, the symptoms are
predominantly under autonomic control,
as if they were due to a physical disorder.
Some of them include palpitations,
hiccoughs, hyperventilation, irritable
bowel, dysuria, etc.
 Types of Somatoform Disorder
d. Persistent somatoform pain disorder-
The main feature in this disorder is
severe, persistent pain without any
physical basis. It may be of sufficient
severity so as to cause social or
occupational impairment. Preoccupation
with the pain is common.
 Types of Somatoform Disorder
e. Undifferentiated – The characteristic
that defines this disorder is that although
the person complains, no evidence can
be found that these physical symptoms
actually exist. Even with lab test and
exams by doctors, no physical signs can
be supported to prove that the person
actually has these symptoms.
 D/E of Somatoform Disorder
• Complete patient history with current
psychological stressors.
• Physical workup to rule out medical
and neurological conditions.
• Test according to organic disease.
T/t of Somatoform Disorder
T/t of Somatoform Disorder
 T/t of Somatoform Disorder
• Antidepressants- fluoxetine (Prozac),
paroxetine (Paxil, Pexeva), sertraline
(Zoloft), citalopram (Celexa) and
escitalopram (Lexapro)
• Benzodiazepines- Valium, Xanax,
Halcion, Ativan, and Klonopin.
T/t of Somatoform Disorder
 T/t of Somatoform Disorder
• Supportive psychotherapy
• Relaxation therapy
• Yoga, Meditation and exercise.