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Somatoform disorders.docx

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University of Ottawa
Mark Coates

Somatoform disorders • Physical symptoms that suggest a medical illness, but have no identifiable physical basis • Diagnosis is very difficult, and requires ruling out multiple medical causes (MS, lupus), conscious production of the symptoms (factitious disorder and malingering), and other mental illnesses (pain disorder, borderline personality disorder) • Problems are often described vividly, but with little factual information • As a psychologists its tough bc you have to rule out medial issues but we dont have the skills to go that • Have to work with other professionals like doctors • Have to make sure they arent faking • Have to make sure its not other disorders that have body symptoms • Describe how awful it is but with little detail • Im tired all the time, im stressed all the time, no one listens, everyone says its in my head • Cant pin down specific symptoms • Gate control theory of pain • All parts of the body send signals to the brain, but few enter consciousness • A system in the spinal cord acts as a “gate” to keep most sensations from reaching the brain • Psychological factors can open or close the gate • Somatization disorders, phantom limb pain, sexual pain disorders • Gate control theory: regulates what is sent to the brain, feel all the pain in the brain, have a gate that can keep things from being sent to brain or to open them up in somatoform disorders • Pay more attention to the pain bc the gate is open • Open and closes in response to psychological factors: • Stress • Emotions • Casatrauphic thinking • Focusing on the pain • Phantom limb pain: when they have an ambutation they still feel sensations in the missing limb • Gate wide open • Cognitive factors such as appraisal of body sensations and catastrophizing • Somatic amplification • Learning through experience or vicariously about disease • Psychoanalytic explanation: • Individuals with a tendency to suppress emotions may express psychological pain physically • Less likely to seek treatment than other disorders, although CBT has been shown to be effective • Somatic amplification: • When i start to worry about the pain, the more i think something bad is going to happen it increases the experience of pain • If people in your family has certain illnesses you pay more attention to symptoms that you might have it • Medical students and nurses have the highest rate of somatoform disorders • Knowledge to magnify things • Internet has a huge impact • Psychoanalytic explanation: • Repressing emotions/ memories, come out through pain • Partly professionals fault bc they say that its either medical or its in your head Somatization Disorder • A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning. • B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance: – (1) four pain symptoms: at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination) – (2) two gastrointestinal symptoms: (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods) – (3) one sexual symptom: (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy) – (4) one pseudoneurological symptom: (impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; amnesia; or loss of consciousness other than fainting) • Somatoform is the category, somatization is one of the disorders • A) Going to the doctor and saying they need help • B) Dont need to have all of these at the same time, just some point in their life once they started complaining • If its just the pain its called pain disorder • C. Either (1) or (2): – (1) after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication) – (2) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings • D. The symptoms are not intentionally feigned or produced (as in Factitious Disorder or Malingering). • Prevalence of 0.2-2% in women and <0.2% in men • Can have a medical illness and a somatization disorder • Way more common in women • Rare diagnosis Conversion disorder • A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition. • B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors. • C. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering). • D. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience. • Anxiety and other psychological factors are converted into neurological things like blindness, hearing, paralysis, seizures, etc • Cant be explained by medical condition or goes beyond medical condition • Subtypes: • With motor symptoms • With sensory symptoms • With seizures of convulsions (psychogenic non-epileptic seizures) • With mixed presentation • “La belle indifference” • Relative lack of concern over the symptoms • Prevalence of less than 0.5% • Certain types of conversion are particularly common in medical professionals • Can tell if its physical or psychological by the specific symptoms • Ex: just hand is paralized, impossible to have only hand, psychological • Seizures: even if you can mimic it, very hard to get it exactly right. Test it by lifting up there hand and try dropping it on their face, if they move there arm so they arent hit, its not physical • La belle indifference: dont care aboout the symptoms, doesnt matter if they become blind for a day • When you hear 25% of people that get the flu shot feel nausea after, its already in your head and you might produce this feeling • The more people that hear about these diseases, the more it can spead Pain disorder • A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention. • B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. • C. Psychological factors are judged to have an important role in the onset, severity, exacer
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