Somatoform Disorder - DR - Ziad Arandi Powerpoint

Somatoform Disorders
Dr. Ziad. N. Arandi

Assistant Professor of Psychiatry- An-Najah National
University
B. C. Psych - London
D. P. L Psych - London
J. B. C. Psych - Amman
President of Palestinian Psychiatrists

Association
)Somatoform disorder (Literally Soma means Body.
Definition
Somatoform Disorders are characterized

by:
Complaining of body symptoms
that suggest medical problem.
Meanwhile,
no underlying
organic causes can be found.
Patient preoccupied by these symptoms

feels anxious, which leads to sick illness
behavior.
Over
Over
concern
concern
Produce
Produce
unconscious
unconscious
ly
ly
Anxiety
Anxiety
Stress
Stress
Related
Related
No
No
underlying
underlying
physical
physical
causes!
causes!
Sickness
Sickness
behavior
behavior
Doctors
Doctors
Help
Help
Examination
Examination
s
s&
&
investigatio
investigatio
ns
ns
Symptoms without identifiable cause
Malingering
Gain
Agrees
Psychiatri
Deliberat
to
c
e
Procedu
Disorder
re
External
Factitious Disorder Sick Role
Somatoform Disorder
Etiology
The exact cause of somatic symptom disorder
isn't clear, but any of these factors may play a
role:
1.
2.
3.
4.
5.
Genetic and biological factors.

Family influence.
Personality trait of negativity.
Decreased awareness of or problems
processing emotions.
Learned behavior.
Classification
1. Somatization disorder.
2. Hypochondriasis.
3. Pain disorder.
4. Conversion disorder.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.
Characteristics
Hypochondriasis.
Pain disorder.
Characteristics:
1.
2.
Multiple somatic symptoms in absence of

underlying physical causes.
Recurrent and chronic symptoms for two
years.
Epidemiology
Hypochondriasis.
Pain disorder.
Prevalence: ranging from 0.2% - 2%.

Female male.
Age: before 30 years.
Lower social class.
Diagnostic Criteria
Diagnostic
1.
2.
3.
4.
Hypochondriasis.
Pain disorder.
Criteria:
Four pain symptoms.

Two gastrointestinal symptoms.
One sexual symptom.
One pseudo-neurological symptoms.
Hypochondriasis.
Pain disorder.
Diagnostic Criteria
1.
2.
3.
4.
Four pain symptoms: head, abdomen and back.

Two gastrointestinal: nausea, vomiting and diarrhea.
One sexual symptom: irregular menses and E.D.
One pseudo-neurological symptom: dizziness, vertigo,
lump in throat, paralysis and urinary retention.
Clinical Case
Hypochondriasis
Literally;
Hypo means Below
Chondriasis means
Chondrium.
Characteristics
Hypochondriasis.
Pain disorder.
Patient is preoccupied with fears of having a

serious disease, based on persons
misinterpretation of body symptoms.
Persistence despite reassurance.
Last for six months.
Epidemiology
Hypochondriasis.
Pain disorder.
Prevalence: ranging from 1% 5%.

Female = Male.
Age: from 20 to 30 years.
Upper social class.
Chronic Course.
Etiology
1.
2.
3.
4.
Hypochondriasis.
Pain disorder.
Serious illness from the

surrounding.
Medical Student.
People interesting in Googling!
Early childhood problems.
Diagnostic Criteria
Diagnostic
1.
2.
3.
4.
5.
Hypochondriasis.
Pain disorder.
Criteria:
Preoccupation with fears of having a serious

disease.
The preoccupation persists despite medical
reassurance.
The belief in Criterion A is not of delusional
intensity.
The preoccupation causes clinically significant
distress important areas of functioning.
The duration is at least 6 months.
Clinical Case
Pain Disorder
Characteristics
Hypochondriasis.
Pain disorder.
1.
Pain in one or more anatomical sites.
2.
Psychological factor have an important

role in the onset, severity, exacerbation
and maintenance of the pain.
Epidemiology
Hypochondriasis.
Pain disorder.
Prevalence: 0.5%
Female Male.
Age: ranging from 30 to 50 years.
upper social class.
Diagnostic Criteria
Pain
Hypochondriasis.
Pain disorder.
is not consciously produced.

Pain is vague in description.
Clarifying the patients pain rather than
challenging or insight.
Mainly depression or anxiety are
comorbidities.
Common side is the left side.
Clinical Case
Conversion Disorder

Historically
In
Hypochondriasis.
Pain disorder.
the past it was called Hysteria
Hysteria derived from the hystrum.
Characteristics
1.
2.
3.
4.
Hypochondriasis.
Pain disorder.
Mental disorder characterized by:

Loss of the physical function of the organs.
Sudden onset after a psychological events.
Mainly it involve one or more neurological
systems.
Cant be explained by any neurological
disease.
Epidemiology
Prevalence : 0.5%
Female male.
Age : before 20 years.
Rural urban.
Lower social class.
less educated.
Left side is commoner!
Hypochondriasis.
Pain disorder.
Examination
Left
Hypochondriasis.
Pain disorder.
side is more to be affected.

Signs cant be fully explained by general
medical condition.
Manner of presenting symptoms is dramatic
and histrionic or la belle indifference, i.e.
less concern about the suffering.
Diagnostic Criteria
1.
2.
3.
4.
Hypochondriasis.
Pain disorder.
One or more symptoms affect voluntary

motor or sensory.
The symptom is not due to a general medical
condition.
One or more diagnostic features provide
evidence of incongruity with recognized
neurological or medical disorder.
The symptom causes clinically significant
distress or impairment in areas of functioning
medical evaluation.
Clinical Case
Management
The goal is
management not
Cure
Keep in control of the

case
(Gate keeper)
Schedule regular
appointments
Build good therapeutic

relationship
Listing
Empathy
Sympathy
Warmth
Trust
Explanation
Suggestion
Explain Tension Symptom cycle

Sessions:
20 minutes / month
= 4 hours / year
Psychotherapy
Supportive
psychotherapy
Behavioral Modification
Relaxation therapy with graded physical
exercise.
Cognitive psychotherapy.
In site oriented psychotherapy
Cope stress psychotherapy
Pharmacotherapy
Antidepressants
especially
duloxetine (Cymbalta).
Benzodiazepines
for short period

for coexisting depression and
anxiety comorbidities.
Thank You

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Somatoform Disorders

Dr. Ziad. N. Arandi

President of Palestinian Psychiatrists

)Somatoform disorder (Literally Soma means Body.

Somatoform Disorders are characterized

Patient preoccupied by these symptoms

Symptoms without identifiable cause

Factitious Disorder Sick Role

Genetic and biological factors.

Multiple somatic symptoms in absence of

Prevalence: ranging from 0.2% - 2%.

Four pain symptoms.

Four pain symptoms: head, abdomen and back.

Patient is preoccupied with fears of having a

Persistence despite reassurance.

Last for six months.

Prevalence: ranging from 1% 5%.

Serious illness from the

Preoccupation with fears of having a serious

Pain in one or more anatomical sites.

Psychological factor have an important

is not consciously produced.

the past it was called Hysteria

Hysteria derived from the hystrum.

Mental disorder characterized by:

side is more to be affected.

One or more symptoms affect voluntary

Keep in control of the

Build good therapeutic

Explain Tension Symptom cycle

for short period

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