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SOMATOFORM DISORDERS DESCRIPTION |
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As a group, the somatoform disorders are
difficult to recognize and treat because patients often have long
histories of medical or surgical treatment with several different
doctors. In addition, the physical symptoms are not under the
patient's conscious control, so that he or she is not intentionally
trying to confuse the doctor or complicate the process of diagnosis.
Somatoform disorders are, however, a significant problem for the
health care system because patients with these disturbances overuse
medical services and resources. Somatization disorder (Briquet's syndrome) Somatization disorder was formerly called Briquet's syndrome, after the French physician who first recognized it. The distinguishing characteristic of this disorder is a group or pattern of symptoms in several different organ systems of the patient's body that cannot be accounted for by medical illness. DSM-IV criteria for this disorder require four symptoms of pain, two symptoms in the digestive tract, one symptom involving the sexual organs, and one symptom related to the nervous system. Somatization disorder usually begins before the age of 30. It is estimated that 0.2% of the United States population will develop this disorder in the course of their lives. Another researcher estimates that 1% of all women in the United States have symptoms of this disorder. The female-to-male ratio is estimated to range between 5:1 and 20:1. Somatization disorder is considered to be a chronic disturbance that tends to persist throughout the patient's life. It is also likely to run in families. Some psychiatrists think that the high female-to-male ratio in this disorder reflects the cultural pressures on women in North American society and the social "permission" given to women to be physically weak or sickly. Conversion disorder Conversion disorder is a condition in which the patient's senses or ability to walk or move are impaired without a recognized medical or neurological disease or cause and in which psychological factors (such as stress or trauma) are judged to be temporarily related to onset or exacerbation. The disorder gets its name from the notion that the patient is converting a psychological conflict or problem into an inability to move specific parts of the body or to use the senses normally. An example of a conversion reaction would be a patient who loses his or her voice in a situation in which he or she is afraid to speak. The symptom simultaneously contains the anxiety and serves to get the patient out of the threatening situation. The resolution of the emotion that underlies the physical symptom is called the patient's primary gain, and the change in the patient's social, occupational, or family situation that results from the symptom is called a secondary gain. Doctors sometimes use these terms when they discuss the aftereffects of conversion disorder or of other somatoform disorders on the patient's emotional adjustment and lifestyle. The specific physical symptoms of conversion disorder may include a loss of balance or paralysis of an arm or leg; the inability to swallow or speak; the loss of touch or pain sensation; going blind or deaf; seeing double; or having hallucinations, seizures, or convulsions. Unlike somatization disorder, conversion disorder may begin at any age, and it does not appear to run in families. It is estimated that as many as 34% of the population experiences conversion symptoms over a lifetime, but that the disorder is more likely to occur among less educated or sophisticated people. Conversion disorder is not usually a chronic disturbance; 90% of patients recover within a month, and most do not have recurrences. The female-to-male ratio is between 2:1 and 5:1. Male patients are likely to develop conversion disorders in occupational settings or military service. Pain disorder Pain disorder is marked by the presence of severe pain as the focus of the patient's concern. This category of somatoform disorder covers a range of patients with a variety of ailments, including chronic headaches, back problems, arthritis, muscle aches and cramps, or pelvic pain. In some cases the patient's pain appears to be largely due to psychological factors, but in other cases the pain is derived from a medical condition as well as the patient's psychology. Pain disorder is relatively common in the general population, partly because of the frequency of work-related injuries in the United States. This disorder appears to be more common in older adults, and the sex ratio is more nearly equal, with a female-to-male ratio of 2:1. Hypochondriasis Hypochondriasis is a somatoform disorder marked by excessive fear of or preoccupation with having a serious illness that persists in spite of medical testing and reassurance. It was formerly called hypochondriacal neurosis. Although hypochondriasis is usually considered a disorder of young adults, it is now increasingly recognized in children and adolescents. It may also develop in elderly people without previous histories of health-related fears. The disorder accounts for about 5% of psychiatric patients, and is equally common in men and women. Hypochondriasis may persist over a number of years but usually occurs as a series of episodes rather than continuous treatment-seeking. The flare-ups of the disorder are often correlated with stressful events in the patient's life. Body dysmorphic disorder Body dysmorphic disorder is a new category in DSM-IV. It is defined as a preoccupation with an imagined or exaggerated defect in appearance. Most cases involve features on the patient's face or head, but other body parts--especially those associated with sexual attractiveness, such as the breasts or genitals--may also be the focus of concern. Body dysmorphic disorder is regarded as a chronic condition that usually begins in the patient's late teens and fluctuates over the course of time. It was initially considered to be a relatively unusual disorder, but may be more common than was formerly thought. It appears to affect men and women with equal frequency. Patients with body dysmorphic disorder frequently have histories of seeking or obtaining plastic surgery or other procedures to repair or treat the supposed defect. Some may even meet the criteria for a delusional disorder of the somatic type. Somatoform disorders in children and adolescents The most common somatoform disorders in children and adolescents are conversion disorders, although body dysmorphic disorders are being reported more frequently. Conversion reactions in this age group usually reflect stress in the family or problems with school rather than long-term psychiatric disturbances. Some psychiatrists speculate that adolescents with conversion disorders frequently have overprotective or overinvolved parents with a subconscious need to see their child as sick; in many cases the son or daughter's symptoms become the center of family attention. The rise in body dysmorphic disorders in adolescents is thought to reflect the increased influence of media preoccupation with physical perfection. |
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| SOMATOFORM DISORDERS RELATED ITEMS | ||
