Somatoform Disorders

1. Somatoform Disorders 6.30.2006

2. Somatization Disorder A. A history of many physical complaints that occur over a period of several years and result in treatment being sought or significant impairment in functioning beginning before age 30 B. Each of the following must have been met, with individual symptoms occurring at any time during the course of the disturbance: 4 pain symptoms (pain in four different places on the body) 2 gastrointestinal symptoms (e.g. nausea, vomiting, etc.) 1 sexual symptom (e.g. erectile dysfunction, irregular menses, etc.) 1 pseudoneurological symptom (at least one symptom or deficit suggesting a neurological condition: e.g. impaired balance/coordination, blindness, seizures, etc.)

3. Somatization Disorder C. Either 1 or 2: 1. After appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known GMC or substance 2. When there is a related GMC, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings. D. The symptoms are not intentionally produced or feigned (as in Factitious Disorder or Malingering)

4. Facts about Somatization Disorder Prevalence: 0.2-2% in women <0.2% in men Gender: More common in women (gender difference smaller in some cultures) Age of Onset: Initial symptoms � adolescence Criteria met � mid 20s Course: Chronic, rarely remits completely Culture: Symptoms of complaint differ across cultures (e.g. burning hands and feet, worms in the head, ants under the skin � more common in Africa and South Asia)

5. Undifferentiated Somatoform Disorder A. One or more physical complaints (e.g. fatigue, loss of appetite, gastrointestinal complaints, etc.) B. Either 1 or 2: 1. After appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known GMC or substance 2. When there is a related GMC, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings.

6. Undifferentiated Somatoform Disorder C. The symptoms cause clinically significant distress or impairment in functioning D. The duration of the disturbance is at least 6 months E. Not better accounted for by another mental disorder F. The symptom is not intentionally produced or feigned (as in Factitious Disorder or Malingering)

7. Conversion Disorder One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neorological or other GMC Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors The symptom or deficit is not intentionally feigned (as in Factitious Disorder or Malingering)

8. Conversion Disorder D. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience E. The symptom or deficit causes clinically significant distress or impairment in functioning F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of Somatization Disorder, and is not better accounted for by another mental disorder

9. Facts about Conversion Disorder Prevalence: 0.01-0.5% Gender: 2-10 times more common in women Age of Onset: Late childhood � early adulthood Rarely before 10 or after 35 Course: Onset is typically acute or sudden Symptoms remit in about 2 weeks Symptoms will recur in 1/5-1/4 of cases Culture: More common in rural areas, lower SES, developing areas, and lower educational levels

10. Pain Disorder A. Pain in one or more anatomical sites that is of sufficient severity to warrant clinical attention B. The pain causes clinically significant distress or impairment in functioning C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance or the pain D. 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

11. Pain Disorder Prevalence: Unknown 10-15% of U.S. adults experience chronic, disabling pain/year Gender: Appears to be equal Women tend to have more chronic pain Age of onset: At any age Course: Can be acute or chronic Associated w/: Unemployment, disability, family problems, substance abuse/dependence (esp. opiods), depression, suicide, sleep disturbance, money spent on health care

12. Hypochondriasis Preoccupation with fears of having, or the idea that one has, a serious disease based on the person�s misinterpretation of bodily symptoms The preoccupation persists despite apprpriate medical evaluation and reassurance The belief in Criterion A is not of delusional intensity The preoccupation causes significant distress or impairment in functioning The duration of the disturbance is at least 6 months The preoccupation is not better accounted for by another mental disorder

13. Facts about Hypochondriasis Prevalence: 1-5% (community) 2-7% (primary care outpatients) Gender: Equal rates??? Age of Onset: Any age, most common in early adulthood Course: Typically chronic, waxes and wanes Associated w/: Fears of aging and death, �doctor shopping�, poor relationships with physicians, past experience with disease, family and work problems

14. Body Dysmorphic Disorder Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person�s 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

15. Facts about Body Dysmorphic Disorder Prevalence: Unknown (community) 5-40% of patients with Anxiety/Depressive Disorder 6-15% of cosmetic surgery/dermatology clients Gender: Equally common in men and women Age of Onset: Childhood-adolescence Course: Chronic, continual, may wax and wane Associated w/: Excessive checking/grooming, removal of mirrors, social isolation, surgical procedures, suicide

16. Factitious Disorder Intentional production or feigning of physical or psychological signs or symptoms The motivation for the behavior is to assume the sick role External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent

17. Facts about Factitious Disorder Prevalence: Pretty much unknown 1% of hospital cases in which mental health professionals are consulted Gender: More common in females Age of onset: Typically early adulthood Course: Typically episodic

18. Malingering Intentional production of false or grossly exaggerated physical or psychological symptoms Motivated by external incentives (avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs)

19. Malingering Warning signs Medicolegal context � e.g. the person is referred by an attorney to the clinician for examination Marked discrepancy between the person�s claimed stress or disability and the objective findings Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen The presence of Antisocial Personality Disorder

20. Factitious Disorder vs. Malingering Motivation: Factitious Disorder � no external incentives are present, rather, the motivation is a desire to maintain the �sick role� Malingering � external incentives are present