Clinical Psychology

SOMATOFORM DISORDERS Hand-Out

Definition: Patients with somatoform disorders present with physical symptoms that have no organic cause. They truly believe that their symptoms are due to medical problems and are not consciously feigning symptoms.

1.) Somatization Disorder Multiple Vague complaints involving many organ systems. Long-standing history of numerous visits to doctors. Symptoms that CANT explain by medical condition. Diagnosis: 2 Gastrointestinal (GI) symptoms 1 sexual or reproductive symptoms At least 1 neurological symptoms 4 Pain symptoms Onset before age 30 Epidemiology: Incidence in Females 5 20 times that of males Life time prevalence: 0.1 05 % Greater prevalence in Low Socioeconomic groups 50 % have co-morbid mental disorder 30 % concordance in identical twins Cause: Have stress that worsen the situation Familial history of illness Treatment: Cognitive-Behavioral Therapy (CBT) - Conduct an assessment and provide education - Develop Stress reduction and mindfulness skills - Apply specific coping skills - Get reactivated in life - Challenge and correct self-defeating thoughts - Develop proem-solving skills - Prevent relapse 2.) Hypochondriasis Involves prolonged, exaggerated concern about health and possible illness.

 Fear having disease or are convinced that one is present Misinterpret normal bodily symptoms as indicative of disease. Diagnosis: Patients fear that they have a serious medical condition based on misinterpretation of normal body symptoms Fears persist despite appropriate medical evaluation Fears present at least for 6 months Epidemiology: Men affected as often as women Average age of onset: 20 30 80 % have coexisting major depression or anxiety disorder Cause: Cognitive Perceptual distortions Familial history of illness Treatment: CBT Stress management Relaxation therapy Antidepressants 3.) Conversion Disorder Least 1 neurological symptom (sensory or motor) Person shows la belle indeffence Diagnosis: At least 1 neurological symptom Symptom not intentionally produced Not limited to pain or sexual symptom Epidemiology: 20 % - 25% incidence in general medical settings 2 5 times more common in women than men Onset at any age, but most often in adolescence or early adulthood Increased incidence in low socioeconomic groups High incidence of co-morbid schizophrenia, major depression, or anxiety disorders. Cause: Psychological factors associated with initiation or exacerbation of symptoms significant distress or impairment in social or occupational functioning or trauma

Treatment: Insight-oriented psychotherapy Relaxation therapy Stress-management therapies CBT 4.) Body Dysmorphic Disorder Preoccupied with body parts that they perceive as flawed or defective Extremely self-conscious about their appearance and spend significant time trying to correct perceived flaws Diagnosis: Preoccupation with an imagined defect in appearance or excessive concern about a slight psychical anomaly Epidemiology: More common in women than men More common in unmarried than married persons Average age of onset between 15 20 90% have co-existing major depression 70% have co-existing anxiety disorder 30% have co-existing psychotic disorder Cause Cause significant distress in the patients life Disorder tends to run in families Detachment from the trauma and negative reinforcement seem critical Treatment: Surgical or dermatological procedures CBT Serotonin reuptake inhibitors (SSRIs) reduce symptoms in 50 % of patients. 5.) Pain Disorder Prolonged, severe discomfort without adequate medical explanation. Pain often co-exists with a medical condition but is not directly caused by it. Patients often have a history of multiple visits to doctors Pain disorder can be acute (< 6 months) or chronic ( > 6 months)

Diagnosis: Feelings of helplessness or hopelessness regarding the pain management Pain causes inactivity, passivity, or disables the affected person Pain increases and requires medical assistance

Other problems arise such as insomnia and fatigue Relationships, school and work are compromised due to pain interference Depression and anxiety occur.

Epidemiology: Women are 2 times as likely as men to have pain disorder Average age of onset 30 50 Increased incidence in first degree relatives Patients have higher incidence of major depression, anxiety disorders, and substance abuse. Cause:

Underlying Medical Condition Psychological problem like excessive stress This can be related to anxiety, depression and other mental problems. History of physical or sexual abuse are more likely to have this disorder

Treatment: SSRIs Cognitive-Behavioral Therapy Acceptance and Commitment Therapy (ACT) - Educate about chronic pain and ACT - Develop Creative Hopelessness - Clarify values - Utilize Cognitive defusion - Focus on Contact with the present moment - Develop Acceptance - Commit to taking action