Somatisation

Question 1

What is somatisation?

Answer 1

A form of a Medically Unexplained Symptom (MUS) = physical complaints without evidence of underlying organic cause.

There is repeated presentation of physical symptoms with persistent requests for medical investigations and no physical basis is found and attempts to discuss possible psychological causes are resisted.

PHYSICAL SYMPTOM DISORDER
EXCESSIVE TIME / WORRY
RESULTS IN FUNCTIONAL IMPAIRMENT

Question 2

What is the ICD-10 criteria for somatisation?

Answer 2

Multiple, recurrent and frequently changing physical symptoms of ≥2 years duration

> 10x more common in women

Question 3

What is Undifferentiated Somatoform Disorder?

Answer 3

Multiple, varying and persistent complaints of <2yrs duration (i.e. not full definition)

Question 4

What is Hypochondrial Disorder?

Answer 4

• Persistent preoccupation with idea of having serious/progressive physical disorders
• Often cancer
• Normal sensations interpreted as abnormal or distressing
• Co-morbid anxiety and/or depression common
• Patient maintains their belief despite being told otherwise (overvalued idea)

Question 5

What is Somatoform Autonomic Dysfunction?

Answer 5

The person experiences physical symptoms due to an overactive autonomic nervous system

• Objective autonomic arousal (palpitations, sweating, flushing, tremor)
• Subjective non-specific (fleeting aches/pains, burning sensation, bloating)

Question 6

What is Persistent Somatoform Pain Disorder?

Answer 6

Persistent, severe and distressing pain (not otherwise explained), & evidence of emotional conflict or psychosocial problems

Question 7

What are the RFs for somatisation?

Answer 7

• Histrionic / dissocial PD
• Anxiety
• Depression
• Alcohol / substance abuse

Question 8

What are the S/S of somatisation?

Answer 8

• ANY SYMPTOMS referred to any part or system of the body
• Multiple, recurrent and frequently changing physical symptoms
• History of interactions with medical professionals without successful outcomes
• The disorder is chronic and fluctuating
• Disruption of social, interpersonal and family behaviour

Question 9

What are the investigations for somatisation?

Answer 9

• Full history and MSE (with physical examination)
• Exclude organic cause (i.e. stroke)
• Exclude co-morbid conditions (i.e. with HADS for potential depression)

Question 10

What is the management for somatisation?

Answer 10

> Mostly based as counselling in the interview

> Continuity of care (seen by the same doctor each time)

> Treat co-morbid conditions (i.e. depression)

1st line: explain and reassure:

1. Broaden clinical agenda from physical cause to a physical and psychological cause
2. Be clear about negative clinical findings and link the symptoms to psychological causes
3. Acknowledge psychosocial distress
4. Elicit childhood experience of illness
5. Explain you’ll not conduct further investigations (and state why you are stopping)
6. Emotional support - encourage coping strategies and letting go of an inappropriate sick role
7. Involve family who may be reinforcing behaviour
8. Encourage normal function (i.e. activities)

2nd line: CBT

Question 11

What is malingering?

Answer 11

The patient reports symptoms with the deliberate intention of gaining something / lying or exaggerating for financial gain

For example someone who fakes whiplash after a road traffic accident for an insurance payment