Somatoform disorder

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Somatoform disorder

ICD-10 | F45
ICD-9 | 300.8
DiseasesDB | 1645
MedlinePlus | 000955
MeSH | D013001

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: Functional disorders or Psychophysiological disorder or Psychosomatic disorders or Somatization disorders or Briquet syndrome or CFS or Chronic fatigue syndromes or Conversion disorder.

## Overview[edit | edit source]

Somatoform disorders are physical ailments (such as pain, nausea, depression, dizziness) or concerns for which no adequate medical explanation has been found. Somatoform disorders are physical symptoms that seem as if they are part of a general medical condition. However, no general medical condition, other mental disorder, or substance is present. The complaints are serious enough to cause significant emotional distress and impairment of social and/or occupational functioning.

A diagnosis of a somatoform disorder implies that psychological factors are a large contributor to the symptoms' onset, severity and duration. It is important to note that somatoform disorders are not the result of conscious malingering or factitious disorders.

In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder (e.g. panic disorder).[1] The symptoms that result from a somatoform disorder are due to mental factors. In people who have a somatoform disorder, medical test results are either normal or do not explain the person's symptoms. Patients with this disorder often become worried about their health because the doctors are unable to find a cause for their health problems. This causes severe stress, due to preoccupations with the disorder that portrays an exaggerated belief about the severity of the disorder.[2] Symptoms are sometimes similar to those of other illnesses and may last for several years. Usually, the symptoms begin appearing during adolescence, and patients are diagnosed before the age of 30 years.[3] Symptoms may occur across cultures and gender.[4] Other common symptoms include anxiety and depression.[3] In order for an individual to be diagnosed with somatoform disorder, they must have recurring somatic complaints for several continuous years.[3]

Somatoform disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) – sufferers perceive their plight as real. Additionally, a somatoform disorder should not be confused with the more specific diagnosis of a somatization disorder. Mental disorders are treated separately from physiological or neurological disorders. Somatoform disorder is difficult to diagnose and treat since doing so requires psychiatrists to work with neurologists on patients with this disorder.[5] Those that do not pass the diagnostic criteria for a somatoform disorder but still present physical symptoms are usually referred to as having "somatic preoccupation".[6]

## Recognized somatoform disorders[edit | edit source]

The somatoform disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association are:

* Conversion disorder
* Somatization disorder
* Hypochondriasis
* Body dysmorphic disorder
* Pain disorder
* Undifferentiated somatoform disorder \- only one unexplained symptom is required for at least 6 months

Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).

* Somatoform disorder Not Otherwise Specified (NOS)[7]

The ICD-10 classifies conversion disorder as a dissociative disorder.

## Proposed somatoform disorders[edit | edit source]

Additional proposed somatoform disorders are:

* Abridged somatization disorder[8] \- at least 4 unexplained somatic complaints in men and 6 in women
* Multisomatoform disorder[3] \- at least 3 unexplained somatic complaints from the PRIME-MD scale for at least 2 years of active symptoms

These disorders have been proposed because the recognized somatoform disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found[9]:

* Somatization disorder \- 1%
* Abridged somatization disorder \- 6%
* Multisomatoform disorder \- 24%
* Undifferentiated somatoform disorder \- 79%

## Diagnosis[edit | edit source]

### DSM-IV-TR Diagnostic Criteria for Somatization Disorder[edit | edit source]

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR,defines somatization disorder as[10]:

A. A history of many physical complaints beginning before age 30 years, occurring over several years, resulting in seeking treatment, or signiﬁcant impairment.

B. Each one of the following criteria must have been met, with individual symptoms occurring at any time:

1\. Four pain symptoms (related to different sites or functions)

2\. Two gastrointestinal symptoms (other than pain)

3\. One sexual symptom (other than pain)

4\. One "pseudoneurological" symptom (not limited to pain)

C. Either (1) or (2):

1\. after appropriate investigation, each of the symptoms cannot be fully explained by a known general medical condition (GMC) or direct effects of a substance.

2\. when there is a related GMC, the physical complaints or resulting impairment are in excess of what would be expected from the history, physical examination, or laboratory ﬁndings.

D. The symptoms are not intentionally produced or feigned(as in factitious disorder or malingering).

### Patient Health Questionnaire-15 (PHQ-15)[edit | edit source]

The Patient Health Questionnaire-15 (PHQ-15) can help diagnose somatoform disorders.[11][12]

## References[edit | edit source]

1. ↑ American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 978-0-89042-025-6. pp 485
2. ↑ Oyama, Oliver. "Somatoform Disorders – November 1, 2007 – American Family Physician." Website – American Academy of Family Physicians. Web. 30 Nov. 2011. <http://www.aafp.org/afp/2007/1101/p1333.html>.
3. ↑ 3.0 3.1 3.2 3.3 La France, Jr. W. Kurt (2009). "Somatoform disorders". Seminars in Neurology. 29 (3): 234–46. doi:10.1055/s-0029-1223875. PMID 19551600.
4. ↑ LaFrance, W. Curt (2009). "Jr., MD., MPH". Somatoform Disorders. 29: 234–246.
5. ↑ LaFrance, C.W. "Somatoform Disorders". SEMINARS IN NEUROLOGY, V. 29 (3), 06/2009, pp. 234–246.
6. ↑ Oyama, O., Paltoo, C., & Greengold, J. (2007). Somatoform disorders. American Family Physician, 76(9), 1333-8. http://search.proquest.com/docview/234242021?accountid=14771
7. ↑ Hales, Robert E; Yudofsky, Stuart C (2004). "Essentials of Clinical Psychiatry". ISBN 9781585620333.
8. ↑ Escobar JI, Rubio-Stipec M, Canino G, Karno M (1989). "Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples". J. Nerv. Ment. Dis. 177 (3): 140–6. PMID 2918297.CS1 maint: Multiple names: authors list (link)
9. ↑ Lynch DJ, McGrady A, Nagel R, Zsembik C (1999). "Somatization in Family Practice: Comparing 5 Methods of Classification". 1 (3): 85–89. PMID 15014690.CS1 maint: Multiple names: authors list (link)
10. ↑ Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
11. ↑ Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345-59. doi:10.1016/j.genhosppsych.2010.03.006. PMID 20633738
12. ↑ Zijlema WL, Stolk RP, Löwe B, Rief W; BioSHaRE, White PD, Rosmalen JG. How to assess common somatic symptoms in large-scale studies: a systematic review of questionnaires. J Psychosom Res. 2013;74(6):459-68. doi:10.1016/j.jpsychores.2013.03.093. PMID 23731742

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