Somatoform, Eating and Sexual Dysfunction Disorders

Physical symptoms that are due to psychological rather than medical illness

• 1. Somatization disorder
• 2. Hypochodriasis
• 3. Pain Disorder
• 4. Body Dysmrophic Disorder
• 5. Conversion Disorder

** NOT: malingering or factitious disorders

• Epidemiology:
• -1% of general population
• -women > men
• -usually before 30

• Diagnosis:
• 1. pain (@ least 4 sites)
• 2. at least 2 GI sx
• 3. at least 1 sexual or reproductive sx
• 4. at least one neuro sx
• That cannot be explained by a medical condition or substance

• Treatment:
• -reassurance, education
• -not make detailed inquiries about sx
• -rarely used meds (SSRIs in BMD)

-4% of primary care patients

• -preoccupation with fears of having or the idea that they have a SPECIFIC disease
• -persists despite medical evaluation and reassurance

-usually at least 6 months

-pain in one or more anatomical sites that is the predominant focus of the clinical presentation

-psych factors have an important role in onset, severity and exacerbation of the pain

• Epidemiology:
• -1-3%
• -men = women
• -onset in adolescence, early adulthood

Preoccupation with an imagined defect in appearance

• Epidemiology:
• -women > men
• -onset: late childhood, early adolescence
• -may be acute, chronic or recurrent

• Diagnosis:
• -symptoms or deficits that affect voluntary motor or sensory function
• -often preceded by stressors

• -body weight <85%
• -intense fear of gaining weight
• -disturbance in 1+:
•      -body weight or shape experienced
•      -undue influence of image on self value
•      -deny seriousness of low body weight
• -absence of 3 consecutive periods

"restrictive type"

• Course:
• -onset in adolescence/puberty
• -mainly female (10:1)
• -deny disorder and resist tx
• ->30% develop major depressive sx
• -50% recover
• -30% chronically ill
• -10% die

• Treatment
• 1. Restore nutritional state
• -usually inpatient
• -antidepressants show some efficacy
• 2. Relapse Prevention
• -outpatient
• -difficult to gain weight (dysphoria with meals, lack of hunger mechanism with starvation)
• **high rate of relapse

• Episodes of Binging:
• -larger amount of food than normal consumed withing a discrete period of time
• -lack of control over episode

• Episodes of Purging:
• -self induced vomiting
• -misuse of laxatives
• -diuretics
• -enemas

• -At least 2x/week for 3 months
• -self value unduly influence by body image

• Treatment:
• -outpatient
• -antidepressants (more helpful than in anorexia)

• -sexual deviation
• -at least 6 months of recurrent, arousing fantasies, urges or behaviours involving objects, humiliation or non-consenting individuals

Occur almost exclusively in men

• Causes:
• -unknown
• -brain function/learned behaviour/sx of other disorder

• Treatments:
• -psych/behaviour therapy
• -decrease T (reduce sex drive)
• -leuprolide (GnRH agonist)
• -SSRIs

-exposing genitals to unsuspecting stranger

-observing unsuspecting person disrobe or have sex

-using non-living objects such as underwear or shoes

-cross dressing

-touching or rubbing against non-consenting person

-the act of being beaten, humiliated, bound or other suffering

-sexual excitement from psychological or physical suffering of a victim

-sex with pre-pubertal child

"transexualism"

Strong and persistent cross-gender identification

• -stated desire to be the other sex
• -passing as the other sex
• -desire to live of be treated as the other sex
• -conviction that they have the typical feelings and reactions of the other sex

• Usually begins in childhood:
• 1/30000 males
• 1/100000 females

• -Hypoactive Desire
• -Aversion
• -Female Arousal
• -Male Erectile
• -Male Orgasmic
• -Female Orgasmic
• -Premature Ejaculation
• -Male or Female dyspareunia
• -Vagnismus