Somatoform Disorders

present with enduring physical symptoms without an identifiable organic cause,

which causes significant distress or impairment in functioning
***these disorders often represent the final common symptomatic pathway of
many etiologic factors
Primary gain = symptoms are an unconscious defense mechanism against
unacceptable internal conflicts
Secondary gain = symptoms provide unconscious external benefits (attention
from others, less responsibility, avoidance of law, etc)
***if external benefits are produced by conscious feigning of
symptoms = MALINGERING
WOMEN
***must always rule out organic causes of symptoms

Somatization Disorder
***history of multiple unexplained physical symptoms/complaints***
Criteria:
onset before age 30
symptoms (must have all):
4 pain, 2 GI, 1 sexual/repro, 1 neuro(not pain)
not due to general medical condition or substance
**if medical condition is present, symptoms in excess of what is
expected
Tx: scheduled medical visits with a PCP that can limit # of pointless medical
workups
Conversion Disorder
Criteria:
at least one neurological symptom
onset or exacerbation of symptom(s) associated with psychological
factors/stressors
cannot be explained by medical condition or substance use
symptom causes significant impairment
common symptoms: shifting paralysis, blindness, mutism, paresthesias, seizures,
globus hystericus(sensation of lump in throat)
Tx: psychotherapy
most patients spontaneously recover
Hypochondriasis
Criteria:
preoccupation with fear of having or contracting a serious disease,
based on misinterpretation of bodily symptoms
persists despite medical eval and reassurance
MUST exclude physical disease
significant impairment in functioning
persists at least 6 months
only somatoform d/o that does NOT have a higher freq. in women, avg onset 20-

30
Tx: regular scheduled visits with PCP
symptoms wax and wane, exacerbations under stress
Body Dysmorphic Disorder
Criteria:
preoccupation with an imagined defect in appearance or excessive
concern about a slight physical anomaly
must cause significant distress in patients life
onset commonly between 15-20
Tx:
surgery or derm procedures usually unsuccessful in pleasing
patient
SSRIs may help with symptoms
Pain Disorder
Criteria:
pain at one or more anatomic sites, of sufficient severity to warrant
clinical attention
pain causes significant distress or impairment in patients life
psychological factors play important role in pain
Tx: SSRIs, biofeedback, hypnosis, psychotherapy
analgesics not helpful
Factitious Disorder
Criteria:
patients intentionally and consciously produce signs of physical or
mental disorder
goal: primary gain (sick role)
NO secondary gain or external incentives
commonly feigned symptoms: psychiatric (hallucinations, depression), medical
(fever, abdominal pain, seizures, skin lesions, hematuria)
**higher incidence in hospital/healthcare workers (know how to feign symptoms)
Tx: collaborate and collect collateral information to avoid unnecessary
workups/procedures
repeated hospitalizations are common
Malingering
feigning of physical or psychological symptoms for personal gain (secondary
gain)
common motives:
avoiding police, receiving room/board, obtaining
narcotics, monetary compensation
patients usually present with multiple vague complaints that do not
conform to known medical condition
frequent hospital stays, often uncooperative, refusal to accept good
prognosis after a negative extensive medical eval
MEN more common