SOMATOFORM DISORDERS

These are conditions in which there are physical symptoms in absence of physical disease. These bodily compliants suggest physical pathology, but no actual impairement can be found.

 DSM IV TR describes mainly 5 somatoform disorders.

Pain Disorders-

           Severe prolonged pain, either without organic symptoms or greately in excess of what might be expected to accompany organic symptoms are classified as pain disorder. Complaints maybe to evoke social responses, such as attention, from others. Sometimes seen temporal relationship between occurance of an actual, threatened, or fantasized interpersonal loss to the complaints of pain.

 Reasons can vary from inablity to attend school or work. Can lead to multi dimensional issues like imparement in proffession, frequent use of health care system, the pain becoming major focus of life, substantial use of medication, inter personal problems etc.

Recovery is better with individuals participation in regular scheduled activicties, despite pain, and resisting pain becoming determining factor in life. Pain disorder can be, Acute- less than 6 months, or chronic- more than 6 months. Difficult to diagnose due to faulty evaluation.

Treatment through operant conditioning, Cognitive behavior Therapy, biofeedback

Somatization Disorder-

Somatisation disorders involves presence of somatic symptoms that cannot be adequetly explained by organic findings. These somatic complaints are recurrent and chronic. Physician Briquet described it in 1859, hence also called Briquet’s Syndrome.

Most common symptoms include headache, fatigue, heart palpitations, fainting spells, nausea, vomiting, abdominal pains, bowel troubles, allergies, menstrual and sexual problems.The patients keep going to doctor, change doctors.

Charecteristics- patients believe that they are sick, provide long and detailed histories in support of their beliefs, and take large quantities of medicines. Most often accompanies by dificulty in social relationships.

DSM IV TR Criterias for disorder include atleast 4 pain symptoms in different bodily sites, two gastro intestinal symptoms without pain, and one neurological symptom or deficit.

Seen mainly in women. Family may have more than one somatizer due to suggestiblity of them and not due to heredity. Generally vagueness in complaint. Conitive therapy works but mostly they are poorly motivated as they are not psychologically minded.

Conversion Disorders-

          People with conversion disorder report that they have lost part of or all of some bodily function. The disturbance is not voluntary and not explained in terms of medical terms. Paralysis, blindness, deafnesss, glove anesthesia, difficulty in walking are among symptoms reported. Usually symptoms follows a stressful experience and maybe quite sudden.  Psychodynamic theories believe symptom represent underlying psychological conflict.

          Typical charecteristic is that even if the person is anxious about the other aspects of life, they have a lack of concern towards their physical disturbance, unlike people who have it in real.the symptom allow person to escape from frustrating or challenging aituation through physical incapacity, when pressure of situation is no longer present, the symptoms weakens.

Until recently counted under hysterical disorders- a mental disorder charecterized by emotional immaturity and affective instability. Believed in ancient times as caused due to defect in uterus.

DSM IV TR limits diagnosis to condition in which there are one or more symptoms of motor or sensory dysfunction that cannot be related to medical problem.

Hypochondriasis-

Hypochondriasis is a condition where the person has a persistant belief (lasting 6 months or longer) that she or he has a serious illness despite medical reassurance,  lack of physical findings,  and failure to develop the disease. Such people show poor insight, and does not recognize their concern is excessive.

          They are constantly preoccupied and concerned with the condition of their bodily organs, and continually worry about their health. Since they fear developing desease, they carefully track all potential symptoms by keeping themselves attuned to even most minor changes in bodily functions. They exaggurate a symptom when it occurs and persistantly believes that a serious illness underlies the symptoms presented to the physician. They disregards physicians advice that no serious physical illness or abnormality is underlying the symptoms.

Major Charecteristics-

1.    Physiological Arousal- increased tension, anxiety and sleep disturbance.

2.    Bodily Focus- Close monitoring of bodily features, attention to information that is consistent with worries about illness, preoccupation and rumination about physical complaints.

3.    Behaviours that avoids or check for physical illness- repeated self-inspection, repeated medical consultation, effort to avoid physical contact with people who seems to have a disease.

Reassurance, Support therapy and CBT is seen to have effect. But establishing therapeutic relationship and acknowledging the distress becomes base of approch, followed by eliciting individuals fear and presenting alternate rational explanations.

Bodily Dismorphic Disorder-

People with Bodily Dysmorphic Disorder have a definite preoccupation with an imagined defect, or morbidly excessive concern about a minor unwanted feature of their physical appearance. ]

Unwanted features include Acne, hair thinning, wrinkles, scars etc. As well as shape, size and other aspect of nose, eyes, mouth, teethor head. Marked distress over deformity and describe the preoccupation as intensely painful and devastating. Conciousness about the deformity may lead to avoidance of public situation.

They often report complaints as depression, obsession compulsion, phobias, but fail or hide to mention their bodily preoccupation, due to embarrasement and belief that other people may not take it seriously.

More evident in adolescents. CBT

Fictitious Disorders and Malingering-

Fictious Disorder- This is a condition where physical or psychological symptoms are voluntarily self induced by the patient. Motive for this is same as for other somatoform disorders- getting attention and care.

          Apparent goal of the person is to assume role of patient. Has a history of uncontrollable lying. Begins in early adulthood and often stimulated by hospitalisation for a genuine physical problem. More in women. Since they dramatically present symptoms, generally are hospitalized. Difference between other somatoform disorders is that, here person is just manufacturing syptoms.

Malingering- Malingers seek medical care and hospitalisation in order to get some specific goals such as compensation, disablity pension, evasion of police. Malingering ends when goal achieved.

Both are self induced as a reaction to stress.