Somatoform disorder.txt

• 1. at least 2 years of multiple variable physical SYMPTOMS for which no adequate physical explanation has been found
• 2. persistent REFUSAL to accept advice/reassurance from several Drs that there is no physical explanation for the symptoms
• 3. impairment of social/family functioning attributable to symptoms and the resulting behaviour

• the complete picture of somatisation disorder is not fulfilled eg not very forceful or dramatic or fewer complaints
• but must be no physical basis for symptoms

• need both 1 and 2
• 1. (can be a or b)
• a) persistent belief that theatre is at least one serious PHYSICAL ILLNESS underlying the presenting symptoms even though repeated investigations and examinations have identified no adequate physical explanation,
• or
• b) a persistent preoccupation with a presumed deformity or disfigurement
• 2. persistent refusal to accept the advice and reassurance of several different doctors that there is no physical illness or abnormality underlying the symptoms

• in hypochondriacal disorder - they do not have the same FIXITY as those in depressive and schizophrenic disorders with somatic delusions.
• A disorder in which the patient is CONVINCED that he or she has an unpleasant appearance or is physically misshapen should be classified under delusional disorder

• persistent severe and distressing pain
• not fully explained by a physiological process or physical disorder
• pain often assoc with emotional conflict or psychosocial problems of sufficient severity to suggest that they are the main causal factor

• conscious faking of symptoms to deceive doctors
• may do self inflicted cuts or injection of toxic substances or put blood in urine sample
• patient is aware of deception but little or no insight into motives
• motive is to stay in sick role
• usually assoc with marked abnormalities of personality or relationships

• form of factitious disorder 'hospital addiction'
• totally invented history
• usually present as emergency eg acute abdomen or haemetemesis
• may give false name
• aim to have intervention eg major surgery and often have multiple scars

• form of factitious disorder
• carer or parent fabricates illness symptom in a child or vulnerable adult
• form of child abuse
• can cause death of child!

• faked illness where subject is conscious BOTH of making up symptoms and purpose or nature of potential gain
• eg benefits or medical discharge from work

• usually acute
• after major stress
• often dramatic eg fits, amnesia, blindness
• patients convert an unbearable emotion into a physical phenomenon eg really stressed and then claims she's paralysed but clearly isn't
• patients often not distressed by their symptoms - belle indifference
• the disorder may reduce initial psychological distress or also have secondary gains

• factitious: conscious
• dissociative: unconscious

yes

no

yes

yes

no

no

person experiences a physical symptom for which NO CLEAR ORGANIC PATHOLOGY is found

person experiences and communicates psychological distress in the form of physical symptoms and seeks medical help for them

• 1. stigma or unacceptability of presenting with or acknowledging psychological distress
• 2. history of parental illness or tendency to somatise during childhood
• 3. positive reinforcement of sick role during childhood
• 4. serious physical illness or physical/mental/sexual abuse in childhood

• 1. explore pts belief systems about the symptoms
• 2. pts expectations for investigation or treatment
• 3. impact of symptoms on their life
• 4. why seeking help NOW in particular?
• 5. screen for psychological morbidity
• 6. screen for symptoms of depression (low mood, sleep, appetite, energy) and anxiety (as may indicate somatic presentation of psychological problems)

• 1. review past medical records esp if large look for recurring patterns
• 2. reassess psycho symptoms and treat
• 3. physical examination and investigation if new illness or symptoms
• remember few physical diagnoses result from further investigation more than 6/12 from 1st presentation

• 1. pt coping not curing
• 2. acknowledge reality of symptoms
• 3. empowering explanations (not rejecting)
• 4. aim to broaden the agenda with the pt
• 5. proactive not reactive eg arrange regular fixed interval appt
• 6. consistent approach amongst dr - eg have 1 dr
• 7. reduce drugs
• 8. avoid over ix
• 9. CBT, relaxation
• 10. realistic goals
• 11. support to return to normal life

10:1

1:1