The presence of physical symptoms that fully suggest a general medical condition but are not FULLY explained by a. a general medical condition,

b. direct effects of a substance, or

c. another mental disorder

Symptoms cause clinically significant distress/impairment in social, occupational areas of functioning

Symptoms are NOT intentional (on contrast w/ Factitious and Malingering)

Issues associated w/ somatoform disorders 

(not cause and effect, simply correlation)

Physical/sexual abuse

Cross cultural expressions (in many culture's, it's not okay to say you are depressed, but you can say that you are sick or have pain)

Depression/Anxiety

Alexithymia - a neurodisorder where you cannot properly express emotions you are feeling

Classifying characteristics of  Somatization Disorder

Is it acute/chronic?

steady/fluctuating?

remitting/unremitting?

Prevalence

• Onset before age 30
• Must have:
  • 4 pain symptoms (back, joint, menstrual) AND 
  • 2 GI symptoms (diarrhea, food intolerance) AND
  • 1 sexual symptom (ED) AND
  • 1 pseudoneurological symptom (aphonia, impaired coord/balance, double vision)  

2. Undifferentiated Somatoform Disorder

def.

6 examples

One or more physical complaints for 6 months or longer not fully explained by med condition/substance,  or complaint/impairment in excess of what would be expected by history/exam/lab findings

(basically somatoform NOS)

Examples:

1. Chronic fatigue

2. Loss of appetite

3. GI symptoms

4. Genitourinary symptoms

5. Fibromyalgia

6. Neurasthenia (weakness/inability to perform due to neuro/emotional issues)

Paralysis/paresis/weakness (motor or sensory) suggesting a neuro or other medical condition

AND

psychological factors are judged to be associated w/ the symptom, or the deficit is preceded by conflict/stressors

(conversion: patient's somatic symptoms represents a symbolic resolution of an UNCONSCIOUS psychological conflict, reducing anxiety and serving to keep the conflict out of awareness)

tends to be psuedoneurological -> related to voluntary motor or sensory functioning

eg's:  besides just general weakness, paralysis, coordination;

aphonia

difficulty swallowing

double vision or blindness

deafness

non-electric seizures

Conversion Disorder: what's unique about its pathophys and concurrent symptoms?

what does it mean that there is often 'history of a model'?

Symptoms do not typically conform to known anatomical pathways/physiological mechs; instead, they follow the patient's conceptualization of the condition

Pseudo-seizures

associated w/? (3 things)

assoc w/ excess stressful events in the year preceding onset; this is much higher than life events correlation w/ epilepsy

percieved childhood neglect/abuse

borderline personality features

La Belle Indifference

much more prevalent in what population?

relative lack of concern about the nature or implications of the symptoms

seen in some patients w/ conversion disorder

Much higher prevalence in medical/surgical inpatients

Pain disorder

Assoc w/?

In what pop is it often acute, and in whom is it chronic?

Prevalence?

Can be associated w/ psychological factors, general medical condition, or both

Acute often seen in surgical patients

Chronic often seen in palliative care patients like cancer, AIDS

Prev:

10-15% of US adults have some form of work disability due to back pain

Hypochondriasis

aka?

def.

Prevalence?

Course/prognosis/treatment?

aka Maladaptive health anxiety

Preoccupation w/ fears of having a serious disease based on the misinterpretation of bodily signs for at least 6 months

Preoccupation persists despite medical reassurance

1-5% in general pop, more like 5% in primary care visits

Usually chronic, fluctuating, complete recovery sometimes occurs (antidepressants have been effective)

Body Dysmorphic Disorder

Onset/course?

Preoccupation w/ a defect in appearance, either imagined or excessive

Onset usually in adolescence, fairly continuous course w/ few symptom free intervals (becomes a lifestyle)

Pseudocysis - the false belief of being pregnant

Presnt w/ symptoms of actual pregnancy; can occur in men too!

Factitious Disorder

def.

Conflict/symptoms profile?

It's NOT classified as a somatoform disorder because it is INTENTIONAL

def:  Intentional production of physical or psychological symptoms in order to assume the sick role

Symptoms are conscious, and for primary gain: (conflict is UN-conscious)

Means you know you're making up the symptoms, but you don't realize that it's because your mom used to ignore you (the conflict)

Malingering

def.

Conflict/Symptoms profile?

INTENTIONAL production of false/exaggerated symptoms motivated by external incentives (Secondary gain)

So you are aware that you are producing symptoms, and you are aware that you are producing them to avoid/deal with the conflict (want to get out of work, want to avoid financial consequences)

To compare, in Conversion Disorder, the patient is not conscious of the conflict, nor the symptoms that he/she is producing

1. Lyrica (anticonvulsant med)

2. 5HT and NE reuptake inhibitor 

may treat by easing psychological symptoms, but that's unclear