Lecture 15: Somatoform Disorders Flashcards
What is somatization?
Physical symptoms that may not be fully explained by a known medical diagnosis after appropriate work-up.
It has to cause significant distress and functional impairment.
What is somatization generally described as in terms of response?
It is an OVER response to symptoms.
What are the primary risk factors for somatization?
- Female
- Low socioeconomic status
- Education
- Ethnicity
- Other psych comorbidities
How would we code somatoform disorders in ICD-10 and DSM-V-TR?
- ICD 10: Somatoform Disorders
- DSM-V-TR: Somatic symptom and related disorders
What are the 5 somatoform disorders?
- Somatization disorder/Somatic Symptom Disorder
- Conversion disorder/Functional Neurological Symptom Disorder
- Hypochondriasis/Illness Anxiety Disorder
- Body dysmorphic disorder/same
- Pain disorder/Somatic symptom disorder with predominant pain
Written ICD/DSM-V
What is somatic symptom disorder defined as?
A syndrome of multiple, unexplained physical symptoms.
Who is somatic symptom disorder MC in?
Single females who are poorly educated, non-white, and from a rural area.
What is the classic presentation of somatic symptom disorder?
- Multiple, unexplained physical symptoms, often accompanied by a sense of urgency.
- Long, complicated medical histories
- Multiple invasive diagnostic studies/procedures/treatment
- Often describe themselves as “sickly”.
What are the common systems affected by somatoform disorder?
- GI
- Reproductive
- Neuro
What is the criteria for somatic symptom disorder?
- 1+ somatic symptom that causes distress or significant disruption of daily life.
- Excessive thoughts, feelings, or behaviors related to somatic symptom or associated health concerns manifested by 1+ of the following: disproportionate/persistent thoughts about seriousness of symptoms, persistent high level of anxiety about health/symptoms, excessive time and energy devoted to symptoms/health concerns.
- Patient has symptoms > 6 months
What are the specifiers for somatic symptom disorder?
- With predominant pain
- Persistent (> 6 months)
- Severity (mild, moderate, severe)
What qualifies as severe somatic symptom disorder?
2+ symptoms + multiple somatic complaints or 1 severe complaint
How do we treat somatic symptom disorder?
- Use 1 PCP only
- Frequent followups
- Avoid new/excessive diagnostics
- Psychotherapy primarily
What is conversion disorder?
Altered voluntary or sensory motor function.
What is the MC age that conversion disorder appears?
10-35
What are the etiologies for conversion disorder?
- Trauma
- Comorbid psych disorders
- Low IQ
- Impaired ability to articulate distress
How does conversion disorder typically present?
- Neurologic symptoms that DO NOT correlate with the presence of organic neurologic disease.
- Signs of inconsistency and incongruency
- Hoover’s sign: weakness with hip flexion become strong when contralateral leg is flexed.
- Pseudoseizures, paralysis, blindness, mutism, paresthesia, and anesthesia
Describe Hoover’s sign (image)
What is the DSM-V criteria for Conversion Disorder?
- 1+ symptoms/deficits affecting voluntary motor or sensory function
- Clinical findings incompatible with recognized conditions
- Not better explained by another medical or psychiatric condition
- Causes significant distress, etc.
How do we treat Conversion Disorder?
- Educating about disorder
- Psychotherapy referral (insight-oriented or behavioral therapy)
- Can reverse symptoms
- Discuss treatment of comorbid psych diagnoses