13. Somatoform Disorders Flashcards
Somatoform Disorder
Age of onset before 30 years old, 4 pain symptoms, 2 GI syptoms, 1 sexual problem and 1 pseudo neurological symptoms
Somatoform Disorder
Patient is worried about SYMPTOMS and asks doctor for symptomatic treatment
- No physical disorders causing the symptoms
Somatisation disorder is associated with which PD?
ASPD
Management of somatisation disorder
Regular appointments
- avoid unnecessary investigations
- offer empathy
- avoid polypharmacy
Pharmacotherapy
- SSRI
Psychotherapy
- Supportive psychotherapy
- CBT
- Self-help techniques
Persistent Somatoform Pain Disorder
Persistent, severe and distressing pain in any part of the body, which cannot be explained by a physiological process or a physical disorder
Hypochondriasis
Excessive preoccupation with having a DISEASE for at least 6 months
- frequently goes to different doctors for check up, scans etc
- usually CANCER or HIV (in sg setting)
Somatoform disorder vs hypochondriasis
Somatoform disorder - concerned with the number and extent of the SYMPTOMS vs hypochondriasis - concerned about having a DISEASE
Body dysmorphic disorder vs hypochondriasis
- BDD - concern about a body defect bs hypochondriasis - concern about having a serious disease
- BDD is a/w an increase in social phobia and compulsive checking
- BDD: interested in surgical correction while hypochondriasis: interested in diagnostic work up
Body dysmorphic disorder
Excessive preoccupation with perceived defects in physical appearance, to the extent that individuals perform repetitive behaviours in response to the perceived defect
- causes much distress and affects functional impairment
Common behavioral problems
- social avoidance
- suicide
- self-injury
- checking rituals of body defect
Common reactions to imagined defects
- Camouflage
- Mirror check
- Compulsion
- Skin picking
Common body sites by frequency
Hair > Nose > Skin > Eyes > Face
BDD vs OCD
OCD patients:
- less likely to have social phobia
- less likely to attempt suicide
- less likely to misuse substances
- have more insight
- have better interpersonal r/s
BDD & OCD
- Obsessions and compulsions are common
- SSRI is the tx
- Both cause significant distress
Management of Body Dysmorphic Disorder / Important symptoms to ask during hx taking
- Risk assessment (suicide, psychotic symptoms eg command hallucinations, patient may self-operate*** (must ask the patient))
- SSRI*
- 2nd gen anti-psychotics (risperidone): BDD + psychosis
- CBT*
