Somatoform disorders

1
Somatoform disorders

• Somatization and Conversion
• Pain and Hypochondriasis
• Body Dysmorphic Disorder

2
Somatoform symptoms

• Symptoms suggest a physical disorder
• Symptoms cannot adequately be explained
  physiologically
• Symptoms are often (but not always) described in
  dramatic ways
• Other disorders, such as anxiety disorders, mood
  disorders, and personality disorders, often
  co-exist

3
Somatization Disorder (Briquets syndrome)

• Many physical complaints
• Beginning before age 30
• Must include
• Four different pains
• Two gastrointestinal symptoms
• One sexual symptom
• One pseudoneurological symptom
• Symptoms are unfounded or exaggerated

4
Conversion Disorder

• Physical symptoms suggesting neurological
  problems
• Sensory impairment Any modality
• Paresthesias and paralysis (demonstrate)
• Sudden onset, sudden termination, sudden
  reappearance
• Mostly women men in combat
• Often misdiagnosed Overpathologized
• La belle indifference 1/3 of cases

5
Pain Disorder

• Main symptom is pain
• May be exacerbated by psychosocial factors
• May be maintained by gain Eugene
• Primary gain
• Secondary gain

6
Hypochondriasis

• No physical symptoms are necessary
• Preoccupied with the possibility that normal
  sensations are symptoms of serious disease
• Frequent visits to physicians
• Persists despite medical reassurance
• Over-report bodily sensations

7
Body Dysmorphic Disorder

• Excessive concern with real or imagined defects
  in appearance, especially facial marks or
  features.
• Frequent visits to plastic surgeons
• Culturally-influenced, but not culture-bound
• May be a symptom of more pervasive disorders
  Obsessive-compulsive or delusional disorder, for
  example.

8
Do advertisements affect BDD?
Your nose is central to the way you feel about
your appearance and the way other people first
perceive you. If you are in the slightest way
unhappy about it, and feel it detracts from your
looks, you will probably always be unhappy about
it.
9
Can you see the difference?

• Once upon a time there was a young lady who had
  a small problem. She didnt like her nose
• What might be the influence of shows like The
  Swan (Fox), Extreme Makeover (ABC), I Want a
  Famous Face (MTV), or Dr. 90210 (E!)?
• Are pretty and handsome synonymous with
  attractive?

10
More somatoform-like disorders

• Malingering
• Factitious disorder
• Personal Symptoms only when observed
• By proxy (NOS)
• Undifferentiated Somatoform Disorder
• Somatoform Disorder NOS
• Pseudocyesis (no everted umbilicus)
• Hypochondriacal symptoms lt 6 months

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Etiology of somatoform disorders

• Psychoanalytic theory
• Controlling repressed sexual urges
• Displaced anxiety or secondary gain
• Sackeim Deny knowledge but use information
• Behavior theory
• Malingering
• Social learning and reinforcement
• Secondary gain Celia

12
More etiology

• Biological factors
• One sign (objective indicator) of anxiety is an
  increased level of cortisol, a stress hormone.
  Cortisol levels are elevated in patients with
  somatization disorder.
• But there is no concordance in twin studies for
  any somatoform disorder.
• The right hemisphere may be implicated in
  conversion disorder, symptoms of which are more
  likely in the left half of the body. The right
  hemisphere is involved in emotional experience
  and expression.

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Theodor Mandelcorn vision test (1973) Tunnel
vision
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Grosz Zimmerman (1970) Celia I cant see to
read!