Somatoform DisordersSomatoform Disorders1. Somatization disorder Somatization disorder is the generation of recurrent physical symptoms-referred to as ‘somatic symptoms' (a somatic syndrome is also described in depression, and also termed biological symptoms of depression. It is not the same as somatic symptoms discussed here). Somatization here is associated with a demand for medical investigations in case the symptoms are harbingers of an underlying physical illness. The diagnostic features of Somatization disorder include:
Body system Symptoms Gastrointestinal Abdominal pain Nausea Bloatedness Bad taste in mouth Food vomited or regurgitated Frequent/loose motion Cardiovascular Breathlessness without exertion Chest pain Genitourinary Dysuria or frequency of micturation Unpleasant genital sensation Increased or changed vaginal discharge Neurological Joint/limb pain Numbness/tingling Skin Discoloration Rash 2. Hypochondrical disorder For a diagnosis of Hypochondrical disorder there must be present:
Dysmorphophobia (body dysmorphic disorder)is a related condition involving a persistent belief of deformity or disfigurement, again causing distress and producing a demand for medical input. 3. Somatoform autonomic dysfunction Here, although the patient attributes their symptoms to a disorder of the cardiovascular, gastrointestinal, respiratory, or genitourinary system, there is no evidence of true pathological changes affecting the relevant organ system. There must be two symptoms typical of autonomic arousal (palpitation, sweating, flushing, dry mouth, or abdominal churning) and a further non-specific symptoms referred to the relevant organ system (e.g. chest pain) 4. Persistent somatoform pain disorder Here the somatic symptoms are confined to pain, which may occur in various diverse regions of the body and which must be severe and distressing for at least six months. Aetiology of somatoform disorder: The aetiology is poorly misunderstood, although episodes often follow the appearance of astress(remember the 3Ps!). In case of somatoform pain disorder, the stressor typically involves pain (e.g. unexpected physical trauma). Somatization disorder may have somegeneticcomponent in that up to one-fifth of sufferers' female. First-degree relatives also have higher rates. Theories of a biological aetiology include the suggestion that physical symptoms result from a failure to regulate cytokines (e.g. interleukins) There is close association withpersonalitydisorders or dysfunctional personality traits Psychologicalmodels consider the symptoms to be produced as a surrogate form of communication. Patient with Hypochodriasis may simply have a lower threshold for identifying illness or may subconsciously covet the gain to be had from adopting the sick role. Epidemiology A somatization disorder has a lifetime prevalence of about 0.5%. There are no data on the lifetime prevalence of Hypochondriasis or somatoform pain disorder, but both disorders are common and present recurrently to physicians. Somatization disorder usually starts before the age of 30 (in some classification this is essential). The onset of Hypochodriasis, by contrast, may be at any age, although the peak incidence is between 20 and 30. The age of onset for somatoform pain disorder most likely between 30 and 40. Somatization disorder tends to be linked with low socioeconomic, low education individuals. Hypochodriasis is equally common in all groups. Course & prognosis Comorbidity with other psychiatric disorders and personality disorder is extremely common and complicate the clinical picture. Both Somatization disorder and Hypochodriasis tend to have a chronic episodic course, often precipitated by stress. The episode may go for many month s before remission. Hypochondriasis is more likely than Somatization disorder to have a full remission (better prognosis). Good prognostic factors for somatoform disorders are:
Treatment
Reference: 1. Boyle D, Davies S.Psychiatry, Mosby's crash course 2002. 2.Steple D. Oxford 2.Handbook of Psychiatry, Oxford University Press, 2006 |