Somatoform Disorders

Somatoform Disorders

·        = Presence of physical symptoms that suggest a general medical condition but aren‟t explained by that condition, by substances or medications, or by another mental disorder (eg Panic Disorder)

·        Must cause significant distress or impairment in social or occupational functioning 

·        Difficult to manage: need to check for physical conditions ® constant testing ® reinforces worry. If find something on tests this validates and reinforces the worry 

·        Processes contributing to symptoms and motivation for symptom production is unconscious. They don’t know it’s not real.

·        Cultural, stress, developmental and self-esteem factors may contribute

Somatization

·        = Somatic symptoms with no cause found (+/- anxiety/depression)

·        Aim of treatment is to reattribute the symptoms to relate them to psychological problems

·        Approach to managing in a non-specialise practice setting:

o   Feeling understood:

§  Take full history, including pain during a typical day

§  Watch for emotional clues or links with stressors: “what are you thinking about when it hurts”

§  Ask about social/family factors

§  Explore health beliefs: “What do you think is wrong”

§  Focused exam

o   Change the agenda:

§  Feedback results

§  Acknowledge reality of pain 

§  Reframe complaints: set them in the context of life events. “I‟m struck by the fact that these pains started shortly after … and that you‟ve been crying a lot… Do you think there might be a connection” 

o   Making the link:

§  Make the link to life events clearer to the patient

§  Use negotiating style: “Do you think that‟s possible… perhaps…” 

§  Projection: “Has anyone else suffered from symptoms like these… Did your mother get headaches – what caused those”? May be easier to see the connection in others