Somatoform Disorders

1. Somatoform Disorders Tae Ho Ryu

2. I. Definition • presence of physical symptoms in the absence of organic pathology or known physiological mechanisms and strong presumption of a psychological component to the symptom. • You feel pain without any symptom. • + Classification is due to difference in clinical utility, not in etiology (reason of disorders) • Somatoform disorders had been conducted with adults, and little information is available on children.

3. Don’t worry, you’re not in Somatoform Disorders • To be definitely diagnosed with somatoform disorder • A. At least 2 years of physical symptoms without enough explanation for those is needed • B. Refusal to accept doctors’ reassuarance and advice that there is not adequate explanation for the physical symptoms. • C. Some degree of social and family impairment due to resulting behaviors of disorders.

4. 1. Somatization disorder • A. Physical complaints begin before age of 30 and must result in impairment in important areas of life. (such as social and family) • B. Each of following must have been met • 4 pain symptoms : a history of pain related to at least four different sites or functions • 2 gastrointestinal symptoms : a history of at least two gastroin • 1 sexual symptom: a history of at least one sexual or reproductive symptom other than pain • 1 pseudo neurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain

5. 2. Undifferentiated Somatoform disorder • One or more physical complaints • Either (1) or (2) • after appropriate investigation, the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)  • when there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or laboratory findings • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. • The duration of the disturbance is at least 6 months. • The disturbance is not better accounted for by another mental disorder. • The symptom is not intentionally produced or feigned

6. 3. Conversion disorder One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition 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 produced or feigned 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. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. 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

7. 4. Pain Disorder Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering) The pain is not better accounted for by a mood, anxiety, or psychotic disorder and does not meet criteria for dyspareunia.

8. 5. 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 appropriate medical evaluation and reassurance. The belief in Criterian A is not of delusional intensity (like delusional disorder) and is not restricted to a circumscribed concern about appearance. (like body dysmorphicdisorder) The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The duration of the disturbance is at least 6 months. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obssessive-Compulsive Disorder, Panic Disorder, A Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

9. 6.Body DysmorphicDisorder (BDD) 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 social, occupational, or other important areas of functioning. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa)

10. Reason and Prevention • The reason for Somatoform disorders are still unclear. The psychologists argue that the reasons are mostly seem to be from somatic amplifications, but this is only one of many factors that have received inconsistent support. • Prevention : Difficult • Because it is shown in different age.

11. III Statistics (1) • Somatization Disorder: • Male: less than 0.2% • Female: 0.2% to 2% • More in Africa and South Asia than in North America • About 0.1% in total • Undifferentiated Somatoform Disorder: • Highest frequency of unexplained physical complaints occurs in young women of low socioeconomic status. • Conversion Disorder • Ranging from 11/100,000 to 500/100,000 (0.011% to 0.5%) • Low socioeconomic status is more frequently reported to have this • More frequent in women than in men, with reported ratios varying from 2:1 to 10:1 • Pain Disorder • 10~15% of adults in the U.S. have some form of work disability due to back pain, but the prevalence of Pain Disorder itself is unclear.

12. Statistics (2) Hypochondriasis Findings with respect to age and gender differences are inconsistent The disorder occurs throughout the lifespan in both men and women. 1%~5% of total population. Body Dysmorphic Disorder 6% to 15% (in cosmetic surgery and dermatology) 5% to 40% (in clinical mental health settings)

13. Example of famous people • Leonardo Di Caprio • Conversion disorder • He thought that the roadblocks will harm him that he couldn’t go out for a while. • This happened when he was making film called, “Aviator” Conversion Disorder Leonardo Dicaprio

14. Example of famous people • Michael Jackson • BDD • a condition that often paralyzes its sufferers with shame, embarrassment, and even disgust. • He decreased the frequency of concert due to BDD. BDD Michael Jackson

15. Reference (Website for celebrity) • DiCaprio suffers from Compulsive Disorder. (2013, November 10). DiCaprio suffers from Compulsive Disorder. Retrieved November 10, 2013, from http://www.femalefirst.co.uk/celebrity/Leonardo+DiCaprio-1662.html • Dr. AnandBalan | Psychiatrist in Chennai. (n.d.). Dr. AnandBalan | Psychiatrist in Chennai. Retrieved November 10, 2013, from http://www.anandbalan.in/somadis.html

16. Reference (Books) • Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association. • Mash, E. J., & Barkley, R. A. (2003). Child psychopathology (2nd ed.). New York: Gilford Press. • VandenBos, G. R. (2007). APA dictionary of psychology. Washington, DC: American Psychological Association.