somatoform disorders by : dr seddigh hums dr seddigh

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Somatoform Disorders By : Dr Seddigh HUMS Dr Seddigh

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  • Somatoform Disorders

    By : Dr SeddighHUMS

    Dr Seddigh

  • An Overview of Somatoform DisordersSomatoform Disorders

    Somatization disorderConversion disorderHypochondriasisBody dysmorphic disorderPain disorder

  • Hypochondriasis

  • Hypochondriasis: An Overview Clinical DescriptionAnxiety or fear be or having a seriuos disease bodily symptoms


  • Hypochondriasis: An Overview Statistics4% to 6% of medical patients15% rateFemale : Male = 1:1Onset at any agePeaks: age (20-30)

    Medical students

  • HypochondriasisCausesFamilial history GeneticsModeling/learningOther factorsStressful life eventsBenefits

  • HypochondriasisCausesDisorder of cognition or perceptionPhysical signs and sensations

  • Hypochondriasis in DSM IVA. Preoccupation with fears of having, or the idea that one has, a serious disease based on the persons misinterpretation of bodily symptoms

    B. The preoccupation persists despite apprpriate medical evaluation and reassurance

    C. The belief in Criterion A is not of delusional intensity

  • HypochondriasisD. The preoccupation causes significant distress or impairment in functioning

    E. The duration of the disturbance is at least 6 months

    rumination about illness, suggestibility unrealistic fear of infection, fascination with medical information fear of prescribed medication. rumination about illness plus at least one of five other symptoms form a distinct diagnostic entity performing better than the current DSM-IV hypochondriasis diagnosisAm J Psychiatry 161:1680-1691, September 2004

  • Hypochondriasis Somatoform Disorder or Anxiety Disorder???

  • HypochondriasisDiffer phobia

    Hypochondriasis: already have

    Reassurance temporary

    Better prognosis 1- good socioeconomic 2- anxiety or depression (sensitive) 3-acute onset 4-no personality dx 5- no medical problem

    accidents and criminal victimization develop various diseases. Am J Psychiatry 163:907-912, May 2006

  • Hypochondriasis - TreatmentGroup therapyInsight oriented and HXCognitive-BehavioralIdentify and challenge misinterpretationsSymptom creationStress-reduction Physical exammedications (SSRI)

  • Body Dsmorphic Disorder

  • Body Dysmorphic DisorderClinical DescriptionImagined defect in appearanceImpaired functionSocialOccupationalNot attracted Dysmorphophobia

  • Body Dysmorphic DisorderStatistics1% to 15% (unknown)Female >: Male = ~1:1

    Onset = 15 30 y/oMost remain singleLifelong, chronic courseWith MDD, Anxiety & Psychosis

  • Body Dysmorphic Disorder: CausesLittle scientific knowledge

    Cultural imperativesBody sizeSkin color

    Serotonin ( OCD )

  • Body Dysmorphic Disorder in DSM IVPreoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the persons concern is markedly excessive.

    The preoccupation causes clinically significant distress or impairment in functioning

    The preoccupation is not better accounted for by another mental disorder

  • Body Dysmorphic DisorderComorbidity with depression Some believe it is similar to OCD ObsessionsCompulsions5 most common locations for perceived deficits:Skin 73%Hair 56%Nose 37%Stomach 22%Breasts/chest/nipples 21%partial remission 0.21 Gender and ethnicity did not significantly predict remission Am J Psychiatry 163:907-912, May 2006

  • Body Dysmorphic DisorderClinical Description mirrorsSuicidal ideation and behaviorUnusual behaviorsIdeas of referenceChecking/compensating rituals

    Delusional disorder: somatic type?Suicidal ideation mean of 57.8% per year attempted suicide mean of 2.6% per year. completed suicide (0.3% per year).Am J Psychiatry 163:1280-1282, July 2006

  • Treatment

    The Plastic Surgery Solution?Popular but ExpensiveMost are Disappointed with Results CBT: Exposure and Response Prevention very effectivePimozide,TCA,MAO INHClomipramine, SSRIs moderately effective

    Body Dysmorphic DisorderWith olanzapine treatment, body dysmorphic disorder symptoms minimally improved Pimozide augmentation of fluoxetine treatment for body dysmorphic disorder was not more effective than placebo, Am J Psychiatry 162:377-379, February 2005

  • Pain Disorder

  • Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Have an Important Role in: onset severity exacerbation OR maintenance of the pain

    Pain Disorder

  • Pain Disorder

    Clinical DescriptionPain in one or more areasSignificant impairmentEtiology may be physicalMaintained by psychological factors

  • Pain DisorderStatisticsFairly common5% - 12%

    Sex female 2 timesAge from 30 & 40 y/o

  • Pain Disorder in DSM IVA. Pain in one or more anatomical sites that is of sufficient severity to warrant clinical attentionB. The pain causes clinically significant distress or impairment in functioningC. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance or the painD. The symptom or deficit in not intentionally produced or feigned (as in Factitious Disorder or Malingering)E. The pain is not better accounted for by another mental disorder

  • Treatment Behavioural Management,CBT& Insight oriented

    Medication not effective : analgesic ,antianxiety & sedative effctive :TCA,SSRI & AMPHETAMINE


    Pain Disorder


    **Contrast this with illness phobia and the fear of developing a disease.Technology Tip: The University of Maryland Medical Center website offers more information on hypochondriasis: Tip: The Bio-Behavioral Institute website offers more information on hypochondriasis:

    **Discussion Tip: Have students discuss the current state of the art in terms of diagnosis and ability to detect medical problems. How might ones access to medical providers shape perceptions of illness? Confidence in diagnosis?*Figure 6.1 Integrative model of causes in hypochondriasis (based on Warwick & Salkovskis, 1990).

    *Symptom creation refers to demonstrating how intensity of symptoms changes when theyre attended to, or produced if focused on.*Technology Tip: Visit the Mayo Clinic website for more information on BDD: Tip: Visit the Los Angeles BDD Clinic website for more information on BDD:

    ***Delusional disorder: somatic type will likely drop out of the DSM V, given the lack of difference between those with delusional and non-delusional BDD.*Am J Psychiatry 162:377-379, February 2005 ***See chapter 9 for a more detailed discussion of pain disorders and health psychology*