Somatoform disorders T. Omidvar,MD

The key characteristic of somatoform disorders: preoccupation with physical symptoms without explanation of any medical conditions leading to significant stress not intentionally produced Definition

Somatization disorder Conversion disorder Pain disorder Hypochondriasis Body dysmorphic disorder Somatoform disorder nos Undifferentiated somatoform disorder Somatoform disorders in DSMIV

Epidemiology very common in all countries and cultures physical symptom the most common presentation idiopathic physical symptoms: no organic cause finding 20%-80% co-occuring with psychiatric disorders

Etiology Using a biopsychosocial model biological vulnerability early traumatic experience learning factors Leading to focus on the somatic and difficulty expressing emotions (alexythymia)

Course and prognosis Chronic course associating with personality and cognitive style Inconsistency in symptom presentation With these symptoms psychiatric disorders becoming more severe

Treatment Establishing an alliance Taking the history Reassurance Physical versus psychological focus General therapeutic approach

SOMATIZATION DISORDER

Definition: a polysymptomatic syndrome physical symptoms coming from several organs causing significant stress severe reluctancy to accept psychological etiology Somatization disorder

DSMIV criteria four pain sites or functions (back, chest,..) two non pain GI symptoms(nausea, bloating) one non pain sexual symptom(loss of libido) one pseudoneurological symptom (aphonia,..)

Epidemiology More common among females Individuals from lower socioeconomic states Having comorbidity with depression and anxiety

Some biological factors : –violence in biological fathers of the woman with somatization Etiology

Treatment General considerations Pharmacotherapy Reassurance and supportive therapy psychotherapy

PAIN DISORDER

Pain disorder Pain : one of the most complaints in medical practice Associating with psychological stress Deciding that the pain is psychogenic can be difficult

Definition Complaints of severe, persistent pain in one or more areas Warrant clinical attention Cause significant impairment in function Relatedness of severity, exacerbation and maintenance of symptoms with psychological factors

Treatment Approaching the patient Pharmacological management Psychotherapy