Running head: Symptoms and Treatment for PTSD and Somatization Disorders 1

Symptoms and Treatment for PTSD and Somatization Disorders: How Do They Differ?

Eleanor Wend HS 513 T301 Assignment 6.3 Bellevue University October 8, 2011

A Comparison of Oppositional Defiance Disorder and Conduct Disorder 2

Abstract This paper will explore how Posttraumatic Stress Disorder and Somatization disorder differ in symptoms and treatment. The areas of similarity will also be discussed as well as the controversies with each diagnosis.

Keywords: Symptoms of Posttraumatic Stress Disorder (PTSD), Somatization Disorder, Treatments

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Introduction The symptoms and clinical picture of both Posttraumatic Stress Disorder and Somatization Disorder have both undergone much change and discussion since being included in the DSM-III in 1980. Posttraumatic Stress Disorder was included in the DSM III through the efforts on behalf of the Vietnam Veterans. In early diagnosis the precursor to Somatization Disorder was hysteria and also psychosomatic. Currently in the DSM IV, Somatization Disorder has been reduced from 35 symptoms to 8 symptoms in 4 symptom clusters. (APA, 1994) Symptomology for Posttraumatic Stress Disorder The common symptoms of PTSD revolve around a central idea: A traumatic event establishes a pathological memory that gives rise to a characteristic profile of signs and symptoms. These signs and symptoms are in three symptomatic clusters: 1. Recurrent re-experiencing of trauma 2. Avoidance of reminders of trauma and emotional numbing 3. Increased arousal (e.g. startle reactions, insomnia, flashbacks) These symptoms need to be present and re-current for over six months after the occurrence of the original traumatizing event. There is a high level of co-morbidity, around 84%, with drug and alcohol abuse, antisocial disorder and major depression. (McNally, 2009)

Symptomology for Somatization Disorder

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The symptoms for somatization disorder revolve around the presence of physical symptoms for which no demonstrable disease or bodily pathology can be identified. These individuals continue to demand more medical attention, lab tests and sometimes even surgery. The disorder is diagnosed when this behavior causes a clinically significant impairment to the individuals life in the areas of personal, social and occupational functioning. The four areas of symptom clusters occur in 1. Back, abdomen and joints, 2. Gastrointestinal, 3. Sexual, 4. Pseudoneurological. The following are the types these symptom clusters fall into:
1. Conversion Disorder: characterized by high anxiety arousal and exhibiting

pseudoneurological symptoms that do not have a neurological source. These may include numbness, tingling and pain without a traceable cause. 2. Pain disorder: acute or chronic pain in one or more body parts that is not explained be a known medical condition or causer. Pain is considered acute if it persists for less than six months and chronic if it persists for more than six months.
3. Hypochondriasis: unjustified fears of convictions that one has a serious & often fatal

illness.
4. 4. Body Dysmorphic Disorder: preoccupation with body disfigurement generally (hardly)

noticed by others. Avoidance, excessive checking of self, seeking reassurance. 5. Factitious Disorder: When physical symptoms produced or feigned to assume the sick role. This is also known as Munchhausen syndrome.

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These disorders are frequently diagnosed through a process of exclusion of other conditions or disorders. There is a high level of risk factors such as child or sexual abuse and childhood trauma leading to these disorders in adulthood. (Blaney & Millon, 2009)

How PTSD and Somatization Disorder differ The most obvious difference in these disorders is that the PTSD diagnosis must identify a central traumatic event that establishes a pathological memory which gives rise to a characteristic profile of signs and symptoms. In the somatization disorders there may not be any identifiable event or source of these conditions but rather an observable behavior cluster that does not have any identifiable origin. In both these disorders there is significant clinical impairment in to the individuals life in the areas of personal, social and occupational functioning. However in PTSD the symptom clusters include the following as found on the Mayo Clinic web site: Post-traumatic stress disorder symptoms are generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal). Symptoms of intrusive memories may include:

Flashbacks, or reliving the traumatic event for minutes or even days at a time Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:

Trying to avoid thinking or talking about the traumatic event Feeling emotionally numb Avoiding activities you once enjoyed

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Hopelessness about the future Memory problems Trouble concentrating Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:

Irritability or anger Overwhelming guilt or shame Self-destructive behavior, such as drinking too much Trouble sleeping Being easily startled or frightened Hearing or seeing things that aren't there

(mayoclinic.com, 2011) Where there is high anxiety or emotional arousal in both disorders the triggering event is external in PTSD and usually internal in Somatization disorder in that the individual is obsession or creating these imagined conditions and seeking medical attention to abate this anxiety.

Treatment for PTSD and Somatization Disorder For both these disorders a combination of behavioral therapy with exposure and extinction of the reactions and mental obsessions and fears will help reduce the interference with the individuals life. Anti-anxiety medication may help reduce insomnia and withdrawal from everyday life which both disorders may produce and thus reduce the clinical impairment in function for the client.

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Research shows the use of psychotherapy, dialectical behavioral therapy (DBT) and trigger exposure for symptom reduction as successful techniques for treating both PTSD and Somatization disorders. However upon leaving therapy there may be a return of the symptoms particularly in somatization disorder. (Andrews, J.D. 1984) (Steil, et al. 2011) It is pointed out that the challenge in treating Somatization disorders is the lack of collaboration between the medical community and mental health providers. The ideal treatment protocol is a team approach addressing both the physical symptoms and the psychological. (Netherton, Holmes and Walker, 1999) Up to 25-30% of the adult population suffers from some form of chronic pain and so the prevalence of pain disorder is the most common complaint for persons presenting to a physician. Pain clinics have emerged throughout the country especially to mediate the dependence on prescription medication. The Mayo Clinic Pain Rehabilitation Center treats approximately 400 patients every year assisting with medication tapers and teaching pain management techniques through cognitive behavioral treatment. (mayoclinic.com, 2011)

Conclusion In conclusion the primary difference in the symptomology between PTSD and Somatization Disorder is that the PTSD diagnosis centers around a central traumatic event with three constellations of symptoms and the Somatization disorders have origins which may not be traceable. There is evidence that these disorders may have co-morbidity with other disorders such as anxiety disorders and major depression as well as alcohol and substance abuse. The treatments have similarities in the use of cognitive-behavioral therapy techniques.

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References Andrews J.D. (1984). Psychotherapy with the Hysterical personality: an interpersonal approach. Psychiatry: August, 1984, Vol. 47, No. 3 pp.211-32. Retrieved October 8 2011, from
http://www.mentalhealth.com/

Francis, Allen et al., Task Force. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association.

McNally, Richard J. (2009). Posttraumatic Stress Disorder. In Blaney, Paul H. & Millon, Theodore (Eds.), Oxford Textbook of Psychopathology (2d ed., pp. 58-66). New York: Oxford University Press. Netherton, Sandra D., Holmes, Deborah & Walker, Eugene C. (Eds.). (1999). Child and Adolescent Psychological Disorders: A Comprehensive Textbook. New York. Oxford University Press. Posttraumatic Stress Disorder- Symptoms. (n.d.) Retrieved October 8, 2011, from Mayo Clinic website http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246 Steil, R. et al. (2011). Dialectical behavioral therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study of an intensive residential program. Journal of Traumatic Stress: February, 2011, Vol. 24, No. 1, pp 102-106. Retrieved October 8, 2011, http://www.mentalhealth.com