Somatoform Disorders

Question 1

What are somatoform disorders?

Answer 1

Somatoform disorders refers to pts with predominantly somatic complaints where neither depression, anxiety or a medical condition provides a better explanation.

Question 2

What are the main subcategories of somatoform disorders?

Answer 2

• Conditions in which main feature is concern about having disease (hypochondriasis) or deformity (dysmorphophobia)
• Conditions in which the main feature is concern about somatic symptoms (somatisation disorder, persistent somatoform pain disorder etc)

Question 3

What are the considerations in diagnosing a somatoform disorder?

Answer 3

• 1. Concerns/symptoms must be unexplained by or disproportionate to any organic disease, severe enough to cause distress and last >6m
• 2. Depressive/anxiety symptoms insufficient to justify dx depressive or anxiety d/o
• 3. Sx are not delusional (e.g. distinguish from psychotic disorder with somatic hallucinations)
• 4. Sx not deliberately manufactured (e.g. factitious d/o) nor is there a predominant loss of a specific function (e.g. conversion d/o)
• 5. Aetiologically, childhood deprivation and abuse are RFx. Predisposition to health anxiety and serious illness in a relative also common.

Question 4

principles of Mx somatoform d/o?

Answer 4

• take somatic concerns seriously but do not collude with unfounded beliefs re medical cause
• Ix only as Dr determines, not for pt demands
• ensure clear and consistent b/w drs
• Mx coexisting anxiety / depression
• antidepressants beneficial even when no evidence of anx/dep
• CBT useful but must be adapted for pts primarily psych concern
• encourage return to normal function

Question 5

What is hypochondriasis?

Answer 5

Pt preoccupied with idea of having a serious medical condition when they do not. Repeatedly seek medical medical Ix / Rx, not reassured by either.

Question 6

Mx hypochondriasis?

Answer 6

• Antidepressants effective
• CBT
• Help pts restrict tendency to seek Ix

Question 7

What is somatisation d/o

Answer 7

Extreme case of somatisation. Pts (usually women), present with multiple different medically unexplained symptoms that have occurred over many years.

Question 8

Mx and prognosis somatisation disorder?

Answer 8

• Mx: damage limitation; containment through long term follow up. Rx dep/anx
• prongosis very poor esp due to iatrogenic issues i.e. drug rxns, abdo adhesions

Question 9

What are functional syndromes?

Answer 9

Parallel medical diagnoses to somatoform d/o used in psych

Question 10

How do factitious disorder and malingering differ?

Answer 10

Factitious d/o aims at receiving medical treatment, malingering is conducted with fraudulent intent (e.g. avoid conscription, court dates etc)

Question 11

What are conversion disorders?

Answer 11

Loss of function, either psychological or physical that is not explained by organic disease (aka dissociative d/o)

Question 12

What are important factors in identifying dissociative / conversion d/os?

Answer 12

• MUST exclude all possible organic causes

- distinguish from consciously motivated symptoms i.e. factitious d/os

Question 13

What are the principles for managing conversion disorder?

Answer 13

a) accept reality of pts Sx but explain they are potentially reversible
b) encourage gradual return to normal function
c) treat coexisting depression
d) refer for psychotherapy
e) refer for physical rehabilitation for chronic disorders impairing motor function

Question 14

What are medically unexplained disorders?

Answer 14

Neither organic nor psychological criteria can provide sufficient insight into aetiology but disease reported regardless i.e. chronic fatigue syndrome. Attending to psychosocial concerns central to management

Question 15

What is somatisation?

Answer 15

Tendency to experience, conceptualise and communicate mental states (and distress) as physical symptoms or altered bodily function.

Question 16

Alexithymia?

Answer 16

Literally = no words for emotions. Inability to express emotions in words, underlying the tendency to present instead with physical symptoms.

Question 17

Which personality factors are linked with somatisation?

Answer 17

• Dependency and loss (e.g. inconsistent parenting / loss of key figure -> diff later in life with relationships/loss etc -> distress / Sx -> health care provides alternate gratification)
• Neuroticism
• Masochism e.g. deserved suffering, guilt
• Passive- aggression