The document summarizes several somatoform disorders including somatization disorder, conversion disorder, hypochondriasis, dysmorphic disorder, and pain disorder. It describes the key symptoms, diagnostic criteria, etiology, and treatment approaches for each disorder. The disorders are characterized by physical symptoms that cannot be fully explained by medical factors and are believed to be linked to underlying psychological issues. Treatment generally involves cognitive behavioral therapy, medication, and helping patients address the psychological stressors contributing to their somatic complaints.

1. Somatoform Disorder
M.S Sara Dawod

2. Introduction
• The term somatoform derives from the Greek
“soma” means body and mind.
• The somatoform disorders are a group of
disorder that include physical signs and
symptoms (for example pain, nausea and
dizziness) for which an adequate medical
explanation cannot be found.
• Patients with somatoform disorder are convinced
that their suffering comes from presumably
untreated bodily derangement.

3. Symptoms of somatoform disorder
• May include frequent headaches, back pain,
abdominal cramping and pelvic pain.
• Other symptoms include pain in the joints, legs
and arms, also may cause gastrointestinal
problems, such as nausea, bloating, vomiting and
food intolerance. It can also cause problem with
sexual function for both men and women.
• Five specific somatoform disorders are
recognized.

4. Somatization disorder
• The essential feature of somatization disorder
is multiple somatic complaints of long
duration, beginning before the age of 30
years. It was known before as hysteria, or
breiquest syndrome, it is common for women
and may coexist with other mental disorders.

5. Diagnosis
• Criteria A:
• Requires that the onset of symptoms before
the age of 30 that occurs over period of
several years, and cause impairment in social,
occupational, or other important areas of
functioning.

6. Diagnosis
• Criteria B: Each of the following criteria must have
been met, with the individual symptoms occurring at
any time during a period of the disturbance:
• Four pain symptoms: 4 different sites: head, back,
abdomen, chest, extremities, joints, rectum, during
menstruation, during sexual intercourse or during
urination.
• two gastrointestinal symptoms: nausea, bloating,
vomiting, diarrhea, intolerance of several food.
• One sexual symptoms: irregular or excessive menses,
erectile or ejaculatory dysfunction, vomiting
throughout pregnancy.

7. Diagnosis
• One pseudo neurological symptom (fake) they
include impaired coordination or balance,
paralysis, blindness, difficult, swallowing, loss
of touch or pain sensation, double vision,
lump in throat, hallucination and none of
which is explained by physical cause.

8. Diagnosis
• Criteria C : either (1) or (2):
• After appropriate investigation, each of the
symptoms in criterion (B) cannot be fully
explained by a known general medical condition
or the direct affect of a substance.
• When there is a related medical condition, the
physical complaints or resulting social or
occupational impairment are in excess of what be
expected from history, physical examinations and
laboratory findings.

9. Diagnosis
• Criteria D:
• The symptoms are not intentionally produced or
feigned as in factitious or malingering.
• Other notes:
• It is chronic disease.
• Somatization disorder is commonly associated with
other mental disorders, including major depressive,
personality disorder, substance-related disorder,
generalized anxiety disorder, phobia and schizophrenia.

10. Conversion disorders
• They were previously known as hysteria.
• Conversion is used by freud who thought that
anxiety and psychological conflict were converted
into physical symptoms.
• Greek used the word hysteria which refers
wandering uterus which symbolized the longing of
women's body for production of child.
• Onset: late childhood and early adulthood, rarely
before 10 years or after 35 years.
• Has short duration, within 2 weeks.
• More F than M and in left side than right side of the
body.

11. Conversion disorder
• Psychiatric examination: no psychosis.
• Symptoms include: loss of voluntary motor (impaired
coordination, balance, paralysis, difficulty swallowing,
urinary retention, seizures) or sensory functioning (loss of
touch or sensation (anesthesia) or pain, sudden blindness,
deafness, hallucination, aphonia (loss of voice), anosmia
(loss of smell) that appears to represent physiology
dysfunction but related to psychological conflict follows an
event or experience perceived as major stressor.
• Characterized by the presense of one or more neurological
symptoms (paralysis, blindness) that cannot be explained a
known neurological or medical disorder.

12. Diagnostic criteria
• A : one or more symptoms or deficits affecting voluntary motor
or sensory function.
• B : psychological factors are judged to be associated with the
symptoms or deficit because the initiation of symptoms is
perceived by stress or conflict.
• C : the symptoms or deficit is not intentionally produced or
feigned as in factitious or malingering disorder.
• D : the symptoms cannot after appropriate investigation or
explained by a general medical condition or effected of a
substance.
• E : the symptoms cause significant distress or impairment in
social, occupational functioning.
• F : the symptoms is not limited to pain or sexual dysfunction.

13. Other associated features
1. Primary gain : by keeping internal conflict out
side their awareness they represent an
unconscious psychological conflict.
2. Secondary gain : seeking attention, receiving
support.
3. La belle indifference : the patient seems to
be unconcerned about what appears to be a
major impairment.

14. Etiology of conversion disorder
• Psychoanalytic perspective: result when the
person experiences an emotionally arousing
event but the emotion is not expressed and the
memory is cut of form of consciousness and
these emotions are expressed as hysterical
symptoms.
• Later he said it occurs as a result of Electra
complex (sexual trauma by father during
childhood which is converted into somatic
symptoms) .

15. Etiology of conversion disorder
• Possible genetics .
• Social and cultural factors: general sexual relax
than before and increase psychological and
medical concepts.

16. Hypochondriasis
• The term is derived from the old medical
term hypochondruim (below the ribs).
• Defined as a persons preoccupation with the
fear of contracting or belief of having a serious
disease, disease phobia despite medical
reassurance.
• It begins at any age and most common in early
adulthood.
• It is chronic disorder.

17. Diagnosis
A. Preoccupation with fears of having, or the idea that
has a serious disease based on the persons
misinterpretation of bodily symptoms.
B. The preoccupation persists despite medical
evaluation.
C. The belief in criterion A is not of delusional intensity
and is not restricted to a concern about appearance.
D. The preoccupation causes significant distress or
impairment in social, occupational of functioning.
E. The duration of the disturbance is at least 6 months.

18. Dysmorphic disorder
• The disorder was recognized and named more than 100
years ago by Emil Krapelin, who consider it a compulsive
neurosis.
• The typical patient with dysmorphobia is convinced that
some part of his body is too large, too small, or misshapen.
• Defects in appearance, especially facial marks or features.
• The common complaints are generally about the nose, ears,
breasts, buttocks, lips, teeth, eyes and penis. Imagined of
face or head such as hair thinning, acne, wrinkles, scars,
excessive facial hair, facial asymmetry, shape, size, but any
part of the body maybe involved.

19. Dysmorphic disorder
• M=F
• Frequent checking of deficit or excessive
grooming behavior or avoid mirror or
excessive exercises, dieting, changing clothes,
or delusional ideas that difficult to change.
• Often are comorbid with OCD.

20. Diagnosis
A. Preoccupation with an imagined defect in
apperance. If a slight physical anomaly is
present, the persons concern is markedly
excessive.
B. The preoccupation causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
C. The preoccupation is not better accounted for
by another mental disorder.

21. Pain disorders
• DSM-IV-TR defines pain disorder as the
presence of pain that is the predominant
focus of clinical attention.
• Patient with chronic pain which is not caused
by any physical or specific psychiatric disorder,
that pain is sufficient to cause distress or
functional impairment, such as pelvic pain and
headache.

22. Diagnosis
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 and severity of pain.
D. The symptoms or deficit is not intentionally produced
or feigned (as in factitious disorder or malingering).
E. The pain is not better accounted for by a mood,
anxiety, or psychotic disorder and doesn’t meet
criteria for dyspareunia (pain in intercourse).

23. Pain disorder
• Acute: duration of less than 6 months.
• Chronic: duration of 6 months or longer.

24. Etiology of pain disorder
1. Biological factors: some neurotransmitters in the
brain like serotonin, endorphins deficiency play a
role in the central nervous system modulation of
pain.
2. Interpersonal factors: the pain has
conceptualized as a mean for gaining advantage
in interpersonal relationship; secondary gain is
most important to patient with pain disorder.
3. Behavioral factors: pain behaviors are reinforced
when ignored or punished or can function.

25. Etiology of somatoform
• Multifactor causing with a complex interaction of
psychological, neurobiological and familial factors
at root of somatoform disorder.
1. Psychological factors: life change that have been
stressful such as marriage, death of love one, ruble
at work, depression is commonly root of SF
disorder. Also Freud believed that hysteria is caused
by the repression of conflict (sexual) which is
converted to physical symptoms to protect persons
from anxiety.

26. Etiology of somatoform
2. Neurobiological factors:
• Physiology play a key role in development of
somatoform disorder.
• According to endocrines', pituitary and
adrenal gland, mechanism in the body's
reaction when defending against stress.

27. Etiology of somatoform
• Abnormal central nervous system regulation
in the coming sensory information, because
decrease awareness in connection between
mind and body.
• Genetics (possible, not strong).
• Sociocultural perspective: social restriction on
women (prevent women from expressing
aggression or sexuality such as hysteria).

28. Etiology of somatoform
• Learning perspective: people assume sick role
because it is reinforcing and it allows them to
escape unpleasant events or avoid
responsibilities.

29. Treatment
• Cognitive behavioral therapy:
• Identify and change the emotion that trigger
their somatic concern.
• Change their cognition regarding their
symptoms.
• Change their behaviors and stop playing sick
role.
• Pay less attention to their body and identify
negative thought.

30. Pain disorder treatment
• Validate the pain (real), relaxation, rewarding the
person for less focus on pain, deal with stress,
engage in more activities, distraction, provide
information.
• Rehabilitation/reduce the pain through discussing
the psychological factors.
• Medications/ antidepressant such as tricyclic and
amphetamine and tofranil.
• Psychotherapy/cognitive therapy/negative and
positive thoughts and attitudes.
• Plasebocupsules (have a sugar) that will reduce his
pain.

31. Dysmorphic disorder treatment
• When it is secondary to a psychiatric disorder
such as schizophrenia or major depression the
primary illness should be treated.
• It should be explained that no real deformity, and
that some people develop mistaken beliefs about
their appearance, some people can be helped by
reassurance and continued support.
• cosmetic surgery is usually successful for patients
who have clear reasons for requesting operation,
and followed by improvement of self esteem and
confidence.

32. Dysmorphic disorder treatment
• Their is some evidence of beneficial effects
from antidepressant medications, especially in
patients with prominent depressive symptoms
such as floxetine (prozac) and clomipramine
(anafranil).
• Exposure therapy and response prevention
(not to look at mirror).

33. Hypochondriasis
• Reduce excessive attention, challenging
negative thought and discouraging seeking
reassurance from doctor, increase
engagement in health activities.

34. Somatization disorder
• Dose not dispute the validity of persons physical
complains minimize the use of diagnostic test and
medication maintaining contact with the person
regardless of weather he or she is complaining of
illness.
• Direct persons attention to sources of anxiety and
depression than focusing on symptoms,
relaxation.
• Focus on social concern associated with
symptoms and teach social skills (communication,
monitor negative thought and change them).

35. Somatization Treatment
• Primary physicians should see the patient, physical
examination should be conducted to each new somatic
complaint.
• Treating the somatic complaints as emotional expressions
rather than as medical complaints.
• Increase the patients awareness of the possibility that
psychological factors are involved in the symptoms.
• Psychotherapy, individual and group helped them cope
with their symptoms to express underlying emotions and
to develop alternative strategies for expressing their
feeling.
• Psychotropic medications use drugs; whenever
somatization disorder coexists with mood or anxiety
disorder.

36. Conversion disorder treatment
• Resolution of the disorder symptoms is usually
spontaneous by insight oriented supportive or
behavior therapy.
• Psychoanalysis: good choice of treatment and
it focuses on stress and coping.
• Hypnosis, and behavioral relaxation, exercises
are effective in some cases.
• Supportive therapy.