Somatoform disorder Hypochondriasis Body dysmorphic disorder (BDD) Undifferentiated somatoform disorder
Somatoform disorder Somatoform disorder, is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder (i.e. panic disorder).
The symptoms that result from a somatoform disorder are due to mental factors. In people who have a somatoform disorder, medical test results are either normal or don't explain the person's symptoms. Patients with this disorder often become worried about their health because the doctors are unable to find a cause for their health problems. Symptoms are sometimes similar to those of other illnesses and may last for several years.
Somatoform disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) - sufferers perceive their plight is real. Additionally, a somatoform disorder should not be confused with the more specific diagnosis of a somatization disorder.
Recognized somatoform disorders :- The somatoform disorders are actually a group of disorders, all of which fit the definition of physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. They are recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association as the following:
1) Conversion disorder 2) Somatization disorder 3) Hypochondriasis 4) Body dysmorphic disorder 5) Pain disorder 6) Undifferentiated somatoform disorder - only one unexplained symptom is required for at least 6 months. Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria). • Somatoform disorder Not Otherwise Specified (NOS)
Hypochondriasis Hypochondria refers to excessive preoccupation or worry about having a serious illness. Hypochondriacs become unduly alarmed about any physical symptoms they detect, no matter how minor the symptom may be, they are convinced that they have or are about to have a serious illness.
Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, the concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. The duration of these symptoms and preoccupation is 6 months or longer.
Diagnostic criteria: The DSM-IV defines hypochondriasis according to the following criteria: A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms. B. The preoccupation persists despite appropriate medical evaluation and reassurance.
C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder). It may be further specified as "with poor insight if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable.
Treatment :- Recent scientific studies have shown that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine and paroxetine) are effective treatment options for hypochondriasis Psycho-educational “talk” therapy, helps the worrier to address and cope with bothersome physical symptoms and illness worries and is found helpful in reducing the intensity and frequency of troubling bodily symptoms.
Body dysmorphic disorder (BDD) Body dysmorphic disorder (BDD) is a (psychological) somatoform disorder in which the affected person is excessively concerned about and preoccupied by a perceived defect in his or her physical features (body image). It is previously known as dysmorphophobia and sometimes referred to as body dysmorphia or dysmorphic syndrome.
The sufferer may complain of several specific features or a single feature, or a vague feature or general appearance, causing psychological distress that impairs occupational and/or social functioning, sometimes to the point of severe depression and anxiety, development of other anxiety disorders, social withdrawal or complete social isolation, and more. It is estimated that 1–2% of the world's population meet all the diagnostic criteria for BDD.
The exact cause(s) of BDD differ(s) from person to person. However, most clinicians believe it could be a combination of biological, psychological and environmental factors from their past or present. Abuse and neglect can also be contributing factors. Onset of symptoms generally occurs in adolescence or early adulthood, where most personal criticism of one's own appearance usually begins, although cases of BDD onset in children and older adults is not unknown. BDD is often misunderstood to affect mostly women, but research shows that it affects men and women equally.
Symptoms :- * Obsessive thoughts about (a) perceived appearance defect(s). * Obsessive and compulsive behaviors related to (a) perceived appearance defect(s) (see section below). * Major depressive disorder symptoms. * Delusional thoughts and beliefs related to (a) perceived appearance defect(s). * Social and family withdrawal, social phobia, loneliness and self-imposed social isolation. * Suicidal ideation. * Anxiety; possible panic attacks. * Chronic low self-esteem.
* Feeling self-conscious in social environments; thinking that others notice and mock their perceived defect(s). * Strong feelings of shame. * Avoidant personality: avoiding leaving the home, or only leaving the home at certain times, for example, at night. * Dependent personality: dependence on others, such as a partner, friend or family. * Inability to work or an inability to focus at work due to preoccupation with appearance. * Decreased academic performance (problems maintaining grades, problems with school/college attendance). * Problems initiating and maintaining relationships (both intimate relationships and friendships).
* Alcohol and/or drug abuse (often an attempt to self-medicate). * Repetitive behavior (such as constantly (and heavily) applying make-up; regularly checking appearance in mirrors; see section below for more associated behavior). * Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface. * Perfectionism (undergoing cosmetic surgery and behaviours such as excessive moisturising and exercising with an aim to create an unattainable but ideal body and reduce anxiety).
Compulsive behaviors :- * Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces. * Alternatively, an inability to look at one's own reflection or photographs of oneself; also, the removal of mirrors from the home. * Attempting to camouflage the imagined defect: for example, using cosmetic camouflage, wearing baggy clothing, maintaining specific body posture or wearing hats. * Use of distraction techniques: an attempt to divert attention away from the person's perceived defect, e.g. wearing extravagant clothing or excessive jewelry.
* Excessive grooming behaviors: skin-picking, combing hair, plucking eyebrows, shaving, etc. * Compulsive skin-touching, especially to measure or feel the perceived defect. * Becoming hostile toward people for no known reason, especially those of the opposite sex, or same sex if same-sex attracted. * Seeking reassurance from loved ones. * Excessive dieting or exercising, working on outside appearance. * Self-harm
* Comparing appearance/body parts with that/those of others, or obsessive viewing of favorite celebrities or models whom the person suffering from BDD wishes to resemble. * Compulsive information-seeking: reading books, newspaper articles and websites that relate to the person's perceived defect, e.g. hair loss or being overweight. * Obsession with plastic surgery or dermatological procedures, often with little satisfactory results (in the perception of the patient). * In extreme cases, patients have attempted to perform plastic surgery on themselves, including liposuction and various implants with disastrous results. * Excessive enema use (if obesity is the concern).
Common locations of perceived defects :- Skin (73%) Hair (56%) Weight (55%) Nose (37%)
Causes :- 1) Psychological A) Teasing or criticism: It has been suggested that teasing or criticism regarding appearance could play a contributory role in the onset of BDD. of people with BDD report frequent or chronic childhood teasing. B) Parenting style: Similarly to teasing, parenting style may contribute to BDD onset. C) Other life experiences: Many other life experiences may also act as triggers to BDD onset; for example, neglect, physical and/or sexual trauma, insecurity and rejection.
2) Environmental Media: It has been theorised that media pressure may contribute to BDD onset; for example, glamour models and the implied necessity of aesthetic beauty. However, BDD occurs in all parts of the world, including isolated areas where access to media is limited or (practically) non-existent. Media pressure is therefore an unlikely cause of BDD, although it may act as a trigger in those already genetically predisposed or could worsen existing BDD symptoms.
3) Personality Personality traits which have been proposed as contributing factors include: * Perfectionism * Introversion / shyness * Neuroticism * Sensitivity to rejection or criticism * Unassertiveness * Avoidant personality * Schizoid personality * Shyness * Social phobia * Social anxiety disorder
Diagnoses :- According to the DSM IV, to be diagnosed with BDD, a person must fulfill the following criteria: 1) Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive. 2) The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 3) The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)
Treatment :- 1) Cognitive Behavior Therapy (CBT) has proven to be effective.BDD symptoms decreased significantly in patients undergoing CBT. BDD was eliminated in 82% of cases at post treatment and 77% at follow-up. 2) SSRI drugs (Selective Serotonin Reuptake Inhibitor) is another commonly used treatment , due to believed low levels of serotonin in the brain. At the end of treatment, 53% of patients responded to the fluoxetine. In extreme cases patients are referred for surgery as this is seen as the only solution after years of other treatments and therapy.
A combined approach of Cognitive Behaviour Therapy (CBT) and anti-depressants is more effective than either alone. The dose of a given anti-depressant is usually more effective when it exceeds the maximum recommended doses that are given for Obsessive Compulsive Disorder (OCD) or an major Depressive episode.
Undifferentiated somatoform disorder Undifferentiated somatoform disorder occurs when a person has physical complaints for more than six months that cannot be attributed to a medical condition. If there is a medical condition present, the complaints must be far more severe than can be accounted for by the presence of the medical problem.
Description :- The physical complaints that are expressed are many and varied. The similarity between all physical complaints is an absence of medical evidence for the symptoms or for their severity. The physical complaints usually begin or worsen when the patient is under stress .People with USD experience problems functioning in their daily lives due to the physical symptoms that they experience. Seeing multiple doctors in an effort to find a physical cause for the reported symptoms is typical of people with this disorder. USD is also sometimes referred to as somatization syndrome.
Causes and symptoms :- The symptoms vary widely from person to person. Some of the most common physical complaints are :- * Pain * Fatigue * Appetite loss * Various gastrointestinal problems. The physical complaints generally last for long periods. Patients with undifferentiated somatoform disorder tend to complain of many different physical problems over time.
There is no physical reason can be found for the patients. Laboratory tests and examinations by doctors reveal no medical reason for the pains or problems. The physical problems persist after the person has been told no explanation can be found. The causes of USD are not clear. * There is believe that problems in the family when the affected person was a child may be related to the development of this disorder. * Depression and stress are thought to be other possible causes. * People who overreact to even minor medical conditions, include paying obsessive attention to any minor changes or sensations that their bodies experience. They give the feelings undue weight and worry unnecessarily about them.
Demographics :- USD is relatively common. It is estimated that between 4% and 11% of the population experience the disorder at some time in their lives. Women are more likely to have it. Also the elderly and people of lower socioeconomic backgrounds.50% of the people with this disorder have other psychological or psychiatric disorders as well, such as anxiety or depression. • Diagnosis :- A person with USD usually begins by visiting physicians looking for treatments for physical complaints. Later, he or she may be referred to a mental health professional. Referring physicians may continue to see the patient so that a trusting relationship can be established, and the patient does not continue to bounce from doctor to doctor.
Diagnostic criteria :- 1) There must be no underlying medical cause evident that could explain the patient's physical complaints. 2) The unexplained physical symptoms must persist for at least six months. 3) The symptoms must cause problems in the patient's daily life or relationships or interfere with the patient achieving his or her goals. 4) There cannot be another mental disorder that accounts for the complaints. 5) The patient cannot knowingly make false complaints of physical distress.
Treatment :- Treat any underlying psychological problems or stresses that may be causing the disorder. If the disorder occurs in conjunction with another mental health problem such as depression, treating that problem often helps to resolve or lessen the symptoms of USD. Some studies indicate that antidepressants are effective There are benefits from programs intended to teach patients how to manage stress and to understand the correlation between psychological stressors and physiological symptoms. These programs also teach people how to cope with criticism and how to stop negative behavior patterns.
Prognosis :- USD is a life-long disorder. Physical complaints increase or decrease in relation to stressors in the affected person's life. Many people with this disorder are eventually diagnosed with another mental disorder or with a legitimate medical problem. For some people, treatment can be successful at lessening or completely resolving symptoms.
Working group :- Esra’aAtya AyaSha’aban Basma Mohammed Do’aaAlaaElden Reham El Sayed HalaHelal
References http://en.wikipedia.org/wiki/Somatoform_disorder http://en.wikipedia.org/wiki/Hypochondriasis http://en.wikipedia.org/wiki/Body_dysmorphic_disorder http://www.minddisorders.com/Py-Z/Undifferentiated-somatoform-disorder.html