Somatoform & Volitional Disorders. Babatunde Idowu Ogundipe M.D. M.P.H. Comprehensive Clinical Services P.C. September 16 2011. Somatoform Disorders. Medically unexplained physical symptoms. Prevalent in primary care-10-15% based on DSM IV criteria.
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BabatundeIdowuOgundipe M.D. M.P.H.
Comprehensive Clinical Services P.C.
September 16 2011
Psychogenic or Neuropathic Pain
No obvious nociceptive stimulus.
Often poorly localized.
Unusual, dissimilar from somatic pain.
Only partially relieved by narcotic analgesics
In DSM-IV, the diagnosis requires complaints of at least 14
symptoms (for women) and 12 symptoms (for men) from the
37 listed below:
Abdominal pain Pain in extremities
Joint pain Painful menstruation
Chest pain Pain in genital area
Pain on urination Back pain
Nausea Other pain (not headaches)
Vomiting spells Severe vomiting throughout
Diarrhoea pregnancy or causing
Bloating (“gassy”) hospitalisation during pregnancy
Difficulty swallowing Intolerance of a variety of foods
Shortness of breath Urinary retention or difficulty
Loss of voice urinating
Trouble walking Paralysis
Double vision Dizziness
Blurred vision Muscle weakness
Memory loss Loss of consciousness or fainting
Palpitations Seizures or convulsions
Sexual indifference Belief that he/she has been sickly
Menstrual irregularity for a good part of life
Pain during intercourse Excessive menstrual bleeding
Lack of pleasure during intercourse
Expert rating of diagnostic usefulness of
Most useful (common; patient insists cause is physical):
Back pain, chest pain, muscular pain, dyspepsia, palpitations
Useful (common; patients tend to accept a psychological
explanation): Tension headaches, inability to relax, epigastric
discomfort, feelings of heaviness or lightness in the head,
breathlessness without exertion
Useful (but specific to some cultures): Loss of voice, pain
during intercourse, dizzy spells or seizure-like attacks
without unconsciousness, burning in the sexual organs or
rectum, unpleasant sensations in or around genitals
Not useful (common but not specific): Sleep disturbance,
irritability, abdominal pain, diarrhoea, dry mouth
Not useful (rare and not specific): Deafness, complaints of
vaginal discharge, urinary retention or difficulty urinating,
amnesia, seizure or convulsion
Singh, Bruce. Managing Somatoform Disorders. MJA Practice Essentials, 15, 90-95.