Case-Based Reviews: Somatoform disorders


somatoform disorder case study

Somatoform Disorder Studies. A case study series treated seven consecutive cases of body dysmorphic disorder with up to three sessions of EMDR 1. These sessions focused on the memory of the first experience of the negative body image. After treatment, five of the seven individuals no longer met diagnostic criteria for body dysmorphic. Sep 11,  · Somatization Disorder. Something's wrong with Meredith, but no one seems to know what. Over the past few years, she's had pain in her uterus, . Sep 07,  · Test and improve your knowledge of Somatoform Disorders in Abnormal Psychology with fun multiple choice exams you can take online with

Somatoform Disorders - American Family Physician

Patient information: See related handout on somatoform disorder, somatoform disorder case study. The somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms. They include somatization disorder involving multisystem physical symptomsundifferentiated somatoform disorder fewer symptoms than somatization disorderconversion disorder voluntary motor or sensory function symptomssomatoform disorder case study, pain disorder pain with strong psychological involvementhypochondriasis fear of having a life-threatening illness or conditionbody dysmorphic disorder preoccupation with a real or imagined physical defectsomatoform disorder case study, and somatoform disorder not otherwise specified used when criteria are not clearly met for one of the other somatoform disorders.

These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing. Treatment success can be enhanced by discussing the possibility of a somatoform disorder with the patient early in the evaluation process, limiting unnecessary diagnostic and medical treatments, focusing on the management of the disorder rather than its cure, using appropriate medications and psychotherapy for comorbidities, maintaining a psychoeducational and collaborative relationship with patients, and referring patients to mental health professionals when appropriate, somatoform disorder case study.

The somatoform disorders are a group of psychiatric disorders in which patients present with a myriad of somatoform disorder case study significant but unexplained physical symptoms. They include somatization disorder, undifferentiated somatoform disorder, hypochondriasis, conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder not otherwise specified. Up to 50 percent of primary care patients present with physical symptoms that cannot be explained by a general medical condition.

Some of these patients meet criteria for somatoform disorders. The unexplained symptoms of somatoform disorders often lead to general health anxiety; frequent or recurrent and excessive preoccupation with unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic symptoms; difficult encounters with the health care system; disproportionate disability; displays of strong, often negative emotions toward the physician or office staff; unrealistic expectations; and, occasionally, resistance to or noncompliance with diagnostic or treatment efforts.

These behaviors may result in more frequent office visits, unnecessary laboratory or somatoform disorder case study tests, or costly and potentially dangerous invasive procedures. Little is known about the causes of the somatoform disorders. Limited epidemiologic data suggest familial aggregation for some of the disorders. Fostering a strong physician-patient relationship somatoform disorder case study integral to managing somatoform disorders. Cognitive behavior therapy is effective in treating patients with somatoform disorders.

The challenge in working with somatoform disorders in the primary care setting is to simultaneously exclude medical causes for physical symptoms while considering a mental health diagnosis. The diagnosis of a somatoform disorder should be considered early in the process of evaluating a patient with unexplained physical symptoms. Appropriate nonpsychiatric medical conditions should be considered, but over-evaluation and unnecessary testing should be avoided. There are no specific physical examination findings or laboratory data that are helpful in confirming these disorders; it often is somatoform disorder case study lack of any physical or laboratory findings to explain the patient's excessive preoccupation with somatic symptoms that initially prompts the physician to consider the diagnosis.

Two related disorders, factitious disorder and malingering, must be excluded before diagnosing a somatoform disorder. In factitious disorder, patients adopt physical symptoms for unconscious internal somatoform disorder case study i. In somatoform disorders, there are no obvious gains or incentives for the patient, and the physical symptoms are not willfully adopted or feigned; rather, anxiety and fear facilitate the initiation, exacerbation, and maintenance of these disorders.

Clinical diagnostic tools have been used to assist in the diagnosis of somatoform disorders. Information from reference 9.

There are three required clinical criteria common to each of the somatoform disorders: The physical symptoms 1 cannot be fully explained by a general medical condition, another mental disorder, or the effects of a substance; 2 are not the result of factitious disorder or malingering; and 3 cause significant impairment in social, occupational, or other functioning.

The additional characteristics of each disorder are discussed briefly in the following and are listed in Table 1. Symptoms include two gastrointestinal, four pain, one pseudoneurologic, and one sexual. Psychological factors play the primary role in the perception, onset, severity, exacerbation, or maintenance of pain.

Information from reference 1. Patients with somatization disorder also known somatoform disorder case study Briquet's syndrome present with unexplained somatoform disorder case study symptoms beginning before 30 years of age, lasting several years, and including at least two gastrointestinal complaints, four pain symptoms, one pseudoneurologic problem, and one sexual symptom Table 2.

Patients with this disorder often have made frequent somatoform disorder case study visits, somatoform disorder case study, had multiple imaging and laboratory tests, and had numerous referrals made to work up their diverse symptoms.

Sexual indifference. Somatization disorder appears to be more common in women than men, with a lifetime prevalence of 0. Subthreshold somatization disorder may have a prevalence up to times greater. Familial patterns exist, somatoform disorder case study a 10 to 20 percent incidence in first-degree female relatives. The diagnosis of undifferentiated somatoform disorder is a less-specific version of somatization disorder that requires only a six-month or longer history of one or more unexplained physical complaints in addition to the other requisite clinical criteria.

Chronic fatigue that cannot be fully explained by a known medical condition is a typical symptom. The highest incidence of complaints occurs in young women of low socioeconomic status, but symptoms are not limited to any group.

Conversion disorder involves a single symptom related to voluntary motor or sensory functioning suggesting a neurologic condition and referred to as pseudoneurologic, somatoform disorder case study.

Conversion symptoms typically do not conform to known anatomic pathways or physiologic mechanisms, but instead they more commonly fit a lay view of physiology e. Patients may present in a dramatic fashion or show a lack of concern for their symptom.

Onset rarely occurs before age 10 or after 35 years of age. Conversion somatoform disorder case study is reported to be more common in rural populations, persons of lower socioeconomic status, and those with minimal medical or psychological knowledge.

Pain disorder is fairly common. Although the pain is associated with psychological factors at its onset e. Pain is the focus of the disorder, but psychological factors are believed to play the primary role in the perception of pain. Patients with pain disorder use the health care system frequently, make substantial use of medication, and have relational problems in marriage, work, or family.

Pain may lead to inactivity and social isolation, and it is often associated with comorbid depression, anxiety, or a substance-related disorder.

Patients with hypochondriasis misinterpret physical symptoms and fixate on the fear of having a life-threatening medical condition. These patients must have a nondelusional preoccupation with their symptom or symptoms for at least six months before the diagnosis can be made. Prevalence is 2 to 7 percent in the primary care outpatient setting, and there do not appear to be consistent differences with respect to age, somatoform disorder case study, sex, or cultural factors.

This fear is pathognomonic for hypochondriasis. Body dysmorphic disorder involves a debilitating preoccupation with a physical defect, real or imagined.

In the case of a real physical imperfection, the defect is usually slight but the patient's concern is excessive. For example, a woman with a small, flat keloid on the shoulder may be so self-conscious of it that she never wears clothing that would reveal it, avoids all social situations in which it may be seen by others, and feels others are judging her because of it.

The disorder occurs equally in men and women. Somatoform disorder not otherwise specified is a psychiatric diagnosis used for conditions that do not meet the full criteria for the other somatoform disorders, somatoform disorder case study, but have physical symptoms that are misinterpreted or exaggerated with resultant impairment. A variety of conditions come under this diagnosis, including pseudocyesis, somatoform disorder case study, the mistaken belief of being pregnant based on actual signs of pregnancy e, somatoform disorder case study.

Patients who experience unexplained physical symptoms often strongly maintain the belief that their symptoms have a physical cause despite evidence to the contrary.

These beliefs are based on false interpretation of symptoms. The initial steps in treating somatoform disorders are to consider and discuss the possibility of the disorder with somatoform disorder case study patient early in the work-up and, after ruling out organic pathology as the primary etiology for the symptoms, to confirm the psychiatric diagnosis. A psychiatric diagnosis should be made only when all criteria are met. Discussing the diagnosis requires forethought and practice.

The physician must first build a therapeutic alliance with the patient. This can be partially achieved by acknowledging the patient's discomfort with his or her unexplained physical somatoform disorder case study and maintaining a high degree of empathy toward the patient during all encounters.

The physician should review with the patient the diagnostic criteria for the suspected somatoform disorder, explaining the disorder as for any medical condition, with information regarding etiology, epidemiology, and treatment. It should also be explained that the goal of treatment for somatoform disorders is management rather than cure.

Once the diagnosis is made and the patient accepts the diagnosis and treatment goals, the physician may treat any psychiatric comorbidities. Psychiatric disorders rarely exist in isolation, and somatoform disorders are no exception. Clinically significant depressive disorder, anxiety disorder, personality disorder, and substance abuse disorder often coexist with somatoform disorders and should be treated concurrently using appropriate modalities.

Studies supporting the effectiveness of pharmacologic interventions targeting specific somatoform disorders are limited. Antidepressants are commonly used to treat depressive or anxiety disorders and may be part of the approach to treating the comorbidities of somatoform disorders.

Antidepressants such as fluvoxamine Luvox, brand not available for treating body dysmorphic disorder, and St. John's wort for treating somatization and undifferentiated somatoform disorders have been proposed.

Cognitive behavior therapy has been found to be an effective treatment of somatoform disorders. Benefits of cognitive behavior therapy include reduced frequency and intensity of symptoms and cost of care, and improved patient functioning.

Collaboration with a mental health professional can be helpful in making the initial diagnosis of a somatoform disorder, confirming a comorbid diagnosis, somatoform disorder case study, and providing treatment.

Results of a recent, small randomized controlled trial conducted in the Netherlands, which combined cognitive behavior therapy provided by general practitioners with psychiatric consultation, suggest improvements in symptom severity, social functioning, and health care use when multiple interventions are employed. A schedule of regular, brief follow-up office visits with the physician is an important aspect of treatment.

Scheduled visits may also prevent frequent and unnecessary between-visit contacts and reduce excessive health care use. The practical management strategies described here and elsewhere are summarized in Table 3. Accept that patients can have distressing, real physical symptoms and medical conditions with coexisting psychiatric disturbance without malingering or feigning symptoms.

Consider and discuss the possibility of somatoform disorders with the patient early in the work-up, if suspected, and make a psychiatric diagnosis only when all criteria are met. Once the diagnosis is confirmed, provide patient education on the individual disorder using empathy and avoiding confrontation.

Avoid unnecessary medical tests and specialty referrals, and be cautious when pursuing new symptoms with new tests and referrals. Focus treatment on function, not symptom, and on management of the disorder, not cure. Address lifestyle modifications and stress reduction, and include the patient's family if appropriate and possible. Collaborate with mental health professionals as necessary to assist with the initial diagnosis or to provide treatment.

Information from references 27 through Already a member or subscriber? Log in. He received his doctoral degree in clinical psychology from Indiana University, Bloomington, and his master's degree in health sciences and a physician assistant certification from Duke University, Durham, N, somatoform disorder case study.

He received his medical degree from St. Louis Mo. Myrtle Ave, somatoform disorder case study. Reprints are not available from the authors. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, D.


Somatoform Disorder Case Study Free Essays


somatoform disorder case study


Mar 17,  · Under DSM-IV, a "diagnosis" of somatization disorder entailed a history of physical symptoms for which, despite thorough medical evaluation, no satisfactory physical etiology could be established. In DSM-5, this "diagnosis" was replaced by somatic symptom Phil Hickey. Somatic Symptom Disorder. Patient Story: Somatic Symptom Disorder. Martin is a year-old married male who has been seen by Dr. Smith, a primary care physician who practices near Martin’s work. Martin began to see Dr. Smith three months ago after abdominal pain he had been experiencing for about a year was becoming progressively worse. Somatoform Disorder Studies. A case study series treated seven consecutive cases of body dysmorphic disorder with up to three sessions of EMDR 1. These sessions focused on the memory of the first experience of the negative body image. After treatment, five of the seven individuals no longer met diagnostic criteria for body dysmorphic.