3. INTRODUCTION
• IN THE EARLY 1800S, THE MEDICAL field began
to consider the various social and psychologic
factors that influence illness. The term
psychosomatic began to be used to convey
the connection between the mind (psyche)
and the body (soma) in states of health and
illness.
4. CON…
• Essentially, the mind can cause the body to
create physical symptoms or to worsen
physical illnesses.
5. • Somatoform disorders can be characterized
as the presence of physical symptoms that
suggest a medical condition without a
demonstrable organic basis to account fully for
them.
6. • The three central features of somatoform
disorders are as follows:
• Physical complaints suggest major medical
illness but have no demonstrable organic basis.
• Psychologic factors and conflicts seem
important in initiating, exacerbating, and
maintaining the symptoms.
7. CON…
• Symptoms or magnified health concerns are
not under the client’s conscious control
8. EPIDEMIOLOGY
• Somatization disorder, conversion disorder,
and pain disorder are more common in women
than in men; hypochondriasis and body
dysmorphic disorder are distributed equally by
gender. Somatization disorder occurs in 0.2%
to 2% of the general population.
9. • Genetic.
• Biochemical:
• Decreased levels of serotonin and endorphins
may play a role in the etiology of pain
disorder.
• The deficiency of endorphins seems to
correlate with an increase of incoming sensory
(pain) stimuli
10. Con…
• Psychodynamic
• Some psychodynamicists view
hypochondriasis as an ego defense mechanism.
Physical complaints are the expression of low
self-esteem and feelings of worthlessness,
because it is easier to feel something is wrong
with the body than to feel something is wrong
with the self.
11. Con. ..
• Family Dynamics:
• Some families have difficulty expressing
emotions openly and resolving conflicts
verbally. When this occurs, the child may
become ill, and a shift in focus is made from
the open conflict to the child’s illness, leaving
unresolved the underlying issues that the
family cannot confront openly.
12. 1. Somatization.
2. Conversion disorder.
3. Pain disorder.
4. Hypochondriasis.
5. Body dysmorphic.
6. Factitious disorder
7. Malingering
The specific somatoform disorders
are as follows:
13. • Somatization disorder is characterized by
multiple physical symptoms. It begins by 30
years of age, extends over several years, and
includes a combination of pain and
gastrointestinal, sexual, and pseudoneurologic
symptoms.
14. • Pain symptoms:
• Complaints of headache.
• Pain in the abdomen, head, joints, back, chest,
rectum.
• Pain during urination, menstruation, or sexual
intercourse
15. CON…
• Gastrointestinal symptoms: nausea,
bloating (distention), vomiting (other than
during pregnancy), diarrhea, or intolerance of
several foods.
16. CON…..
• Sexual symptoms:
• sexual indifference, erectile or ejaculatory
dysfunction, irregular menses, excessive
menstrual bleeding, vomiting throughout
pregnancy.
17. CON…
• Pseudoneurologic symptoms:
• conversion symptoms such as impaired
coordination or balance.
• paralysis or localized weakness.
• difficulty swallowing or lump in throat.
• aphonia,
• urinary retention,
18. CON…
• hallucinations,
• loss of touch or pain sensation,
• double vision,
• blindness, deafness,
• seizures;
• dissociative symptoms such as amnesia; or
loss of consciousness other than fainting
19. FACTS
• Anxiety and depression are frequently
manifested, and suicidal threats and attempts
are not uncommon.
• Clients often receive medical care from several
physicians.
• Sometimes concurrently, leading to the
possibility of dangerous combinations of
treatments.
20. CON…
• They have a tendency to seek relief through
overmedicating with prescribed analgesics or
antianxiety agents.
• Drug abuse and dependence are common
complications.
• Some overlapping of personality
characteristics and features associated with
histrionic personality disorder.
21. • Is severe and prolonged pain that causes
clinically significant distress or impairment in
social, occupational, or other important areas
of functioning .
22. CON…
• Characteristic behaviors include:
• Frequent visits to physicians in an effort to
obtain relief.
• Excessive use of analgesics, and requests for
surgery.
23. • (1) appearance of the pain enables the client to
avoid some unpleasant activity [primary
gain].
• (2) the pain promotes emotional support or
attention that the client might not otherwise
receive [secondary gain].
24. CON….
• Symptoms of depression are common.
• Dependence on addictive substances is a
common complication of pain disorder.
25. • Hypochondriasis may be defined as an
unrealistic or inaccurate interpretation of
physical symptoms or sensations, leading to
preoccupation and fear of having a serious
disease.
26. CON…
• The fear becomes disabling and persists
despite appropriate reassurance that no organic
pathology can be detected.
• Occasionally medical disease may be present,
but in the individual with hypochondriasis, the
symptoms are excessive in relation to the
degree of pathology.
27. Facts
• long history of “doctor shopping” and are
convinced that they are not receiving the
proper care.
• Anxiety and depression are common, and
obsessive–compulsive traits frequently
accompany the disorder.
• Social and occupational functioning may be
impaired because of the disorder.
28. • Conversion disorder is a loss of or change in
body function resulting from a psychological
conflict, the physical symptoms of which
cannot be explained in terms of any known
medical disorder or pathophysiological
mechanism.
29. • Clients are unaware of the psychological basis
and are therefore unable to control their
symptoms.
• Conversion symptoms affect voluntary motor
or sensory functioning suggestive of
neurological disease and are therefore
sometimes called “pseudoneurological”
30. CON…
• Presence of primary or secondary gain.
• Primary gain, the conversion symptoms
enable the individual to avoid difficult
situations or unpleasant activities about which
he or she is anxious.
31. CON…
• Conversion symptoms promote secondary
gain for the individual as a way to obtain
attention or support that might not otherwise
be forthcoming.
• The symptom usually occurs after a situation
that produces extreme psychological stress for
the individual.
32. CON…
• The symptom appears suddenly.
• la belle indifference.
• Most symptoms of conversion disorder resolve
spontaneously within a few weeks.
• About 20 to 25 percent of clients will
experience a recurrence of symptoms within 1
year of the first episode.
34. CON…
• Urinary retention.
• Blindness, deafness, double vision,
• Loss of pain sensation, and hallucinations.
• Pseudocyesis (false pregnancy) is a conversion
symptom and may represent a strong desire to
be pregnant.
35. • Formerly called dysmorphophobia, is
characterized by the exaggerated belief that the
body is deformed or defective in some specific
way.
36. • The most common complaints involve :
• Imagined or slight flaws of the face or head,
such as thinning hair, acne, wrinkles, scars,
vascular markings, facial swelling or
asymmetry, or excessive facial hair .
37. CON..
• Other complaints may have to do with some
aspect of the nose, ears, eyes, mouth, lips, or
teeth.
• The significance of the defect is unrealistically
exaggerated, however, and the person’s
concern is grossly excessive.
38. • Symptoms of depression and characteristics
associated with obsessive–compulsive
personality are common.
• Social and occupational impairment may occur
because of the excessive anxiety experienced
by the individual in relation to the imagined
defect.
39. CON….
• Numerous visits to plastic surgeons and
dermatologists in an unrelenting drive to
correct the imagined defect.
• He or she may undergo unnecessary surgical
procedures toward this effort.
• Associated with delusional thinking.
40. • Factitious disorder occurs when a person
intentionally produces or feigns (create)
physical or psychologic symptoms just to gain
attention.
• People with factitious disorder may even
inflict injury on themselves to receive
attention.
41. • is the intentional production of false or
grossly exaggerated physical or psychologic
symptoms; it is motivated by external
incentives such as avoiding work, evading
criminal prosecution, obtaining financial
compensation, or obtaining drugs.
42. • Antidepressants help in some cases.
• Selective serotonin reuptake inhibitors such as
fluoxetine (Prozac), sertraline (Zoloft), and
paroxetine (Paxil) are used most commonly.
• Relaxation.
• CBT.
