Somatoform Disorders

Question 1

What are somatoform disorders?

Answer 1

A collection of mental disorders with features suggestive of physical illness.

• There are no detectable organic or neurophysiological abnormalities to explain these symptoms
• Symptoms occur unintentionally (unlike factitious and malingering disorders)

Question 2

Somatisation disorder

• What are the main features?
• What are some of the common physical symptoms?

Answer 2

-Multiple, recurrent, frequently changing physical symptoms

• GI disturbance; N+V ect
• Skin problems; itching, burning, numbness ect
• Sexual or reproductive problems; loss of libido, erectile dysfunction ect
• Urinary problems; dysuria, frequency, retention, incontinence
• Neurological; paralysis, visual loss, sensory loss ect

-Pts should have numerous symptoms from almost all of these systemic groups, not just a few isolated symptoms

Question 3

According to the ICD-10 what should be present?

-What is a negative result of multiple investigations?

Answer 3

• At least 2 years of symptoms with no adequate physical explanation
• Persistent refusal from the pt to accept reassurance from several doctors that there is no physical cause for the symptoms
• Some degree of functional impairment due to the symptoms and resulting behaviour.

-Iatrogenic disease, with explainable symptoms. Pts are often dependent on many medication, painkillers and sedative

Question 4

Hypochonrial disorder
-What is the difference between somatisation disorder and hypochondrial disorder?

-What is the difference in what these 2 groups may ask for

Answer 4

• Somatisation disorder; pts express concern about numerous physical symptoms
• Hypochondrial disorders pts misinterpret normal bodily sensations and believe that they have a serious and progressive physical disease
• Hypochondrial disorder; ask for investigations to definitely diagnose a specific disease. They refuse accept reassurance from numerous doctors that they are fine
• Somatisation disorder will ask to treat a specific symptom

Question 5

What is body dysmorphia?

Answer 5

-A variant of hypochondrial disorder where pts excessively imagine or accentuate a slight defect in their appearance

Question 6

Factitious disorder and malingering

What is produced in these disorders?

What are pts focused on in factitious disorder?

Malingering pts focus on?

Answer 6

• Physical or psychological symptoms. Can be excessive with pts taking medication to mimic symptoms
• The gain of the sick role. This care seeking behaviour is often a sign of psychological distress. This can also be by proxy e.g a parent poisons their child so they can take care of them.
• They are focused on the secondary external gain of being diagnosed with a disease. This includes medication, benefits, avoiding prison or military service ect

Question 7

What is the lifetime prevalence of somatisation disorder and what age is onset usually before?
-What is the sex ratio?

Answer 7

• 0.2-2% and usually before 25, often in adolescence

- M:F, 1:10

Question 8

What is the lifetime prevalence of hypochondrial disorder?

• Age of onset?
• Sex ratio?

Answer 8

• 1-5%
• Usually in early adulthood
• Occurs equally in men and women

Question 9

Episodes commonly follow what?

What are somatisation disorders due to, in part at least?

Answer 9

• Appearance of stressors

- Genetics, 1/5th of sufferes 1st degree relatives also have the condition

Question 10

What is the course and progression like?

Answer 10

-A chronic episodic course with symptoms often exacerbated by stress

Question 11

Treatment

• What does medication help with?
• What is the most effective strategy to help pts when requested?

Answer 11

-It helps treat symptoms to which the pt has an underlying condition, such as anxiety disorder

• Make appointments at fixed intervals, rather than seeing the pt when requested.
• Limit special investigations and medications unless really necessary.
• Help pts to think in terms of coping with their problems rather than curing them
• Try to involve family members in their care