SOMATOFORM DISORDERS
In somatoform disorders, psychological problems arise in the form of physical
disorders. The physical symptoms of somatoform disorders, which cannot be
physiologically explained and are not in consciousness, are thought to be related to
psychological factors, presumably anxiety, so they are assumed to have a psychological
cause. In short, somatoform disorders are a group of disorders characterized by
complaints about physical problems or symptoms that cannot be explained by the cause
of the physical damage.
Somatoform disorders consist of pain disorders, body dysmorphic disorders,
hypochondriasis, conversion disorders, and somatization disorders.
A. . PAIN DISORDERS
• Pain disorder is one of the somatoform disorders that is significantly
influenced by psychological factors in the appearance, persistence and
severity of pain. Pain can have a temporal association with some kind of
conflict or stress, or allow the individual to avoid unpleasant activities and
gain sympathy that would not be gained if the individual was in good
health.
• The difference in the picture of pain described by somatoform patients
compared to the picture given by patients whose pain is clearly related to
physical problems. Patients whose pain is underpinned by a physical
disorder can show the painful part more specifically, provide a more
detailed sensory description of their pain, and more clearly associate the
pain with various conditions that can increase or reduce the pain.
B. BODY DYSMORPHIC DISORDER
• Body dysmorphic disorder is a disorder in which a person is filled with
worries with damage to appearance that is only in his shadow or
exaggerated.
• Examples: wrinkles on the face, disproportionate shape or size of the
nose, dense facial hair. Some patients who suffer from this disorder may
spend hours compulsively looking at themselves in the mirror to check
for these deficiencies. This disorder mainly occurs in women, generally
originates in late adolescence, and is often comorbid with depression,
social phobia, and personality disorders.
Cases of Body Dysmorphic Disorder
Lolita Richi (16) from Ukraine is the latest (and youngest) "Barbie Man" to
appear. Lolita has a 20-inch waist, and wears tinted contact lenses to mimic
the big eyes of her fictional idol. He rejected the notion of having had plastic
surgery and digitally manipulated his photographs, but his body proportions
suggest otherwise. In fact, if Lolita's claim that she did not undergo plastic
surgery is believed, her body image is still concerning. She admitted that she
started dressing up because she wanted to look perfect and that all women
would want the same thing
C. HIPOKONDRIASIS
• Hypochondriasis is a somatoform disorder in which the preoccupied
individual is afraid of experiencing a serious illness that persists despite
medical certainty to the contrary. This disorder generally appears in early
adulthood, and tends to have a chronic journey.
• Hypochondriasis often presents along with anxietas and mood disorders,
leading some researchers to think that hypochondriasis is not a disorder
in itself, but a symptom of various other disorders. For example, it occurs
in those who when they are young too guarded from activities that may
cause illness, such as rain or heat.
Hypochondriatic Cases:
Robert, a 38-year-old radiologist, had just returned from a 10-day visit to a
renowned diagnostic center where he underwent extensive testing of his
entire digestive system. The evaluation proved a negative sign for any
physical ailment, but instead of feeling relieved, the radiologist seemed angry
and disappointed with the discovery. The radiologist had been bothered for
several months with various physical symptoms, which he described as mild
abdominal pain, a feeling of "fullness", "rumbling stomach content", and a
feeling of "hard stomach upset". He became convinced that these symptoms
were caused by colon cancer and he became accustomed to testing his blood
samples every week and carefully examining his stomach for what it found
in it while lying on his back in bed every few days. During the evaluation,
his heart vibration proved to be harmless, and he instead began to worry that
something had forgotten to check. He developed that fear can be completely
put aside, it never really goes away.
D. CONVERSION DISRUPTION
• Conversion disorders are symptoms that affect sensory or motor function
that indicate a disease associated with neurological damage or the like,
even if the organs and nervous system are in good condition. The
psychological nature of conversion symptoms is also reflected in the fact
that they appear suddenly in stressful situations, which often allow the
individual to avoid some activities or responsibilities.
• Conversion symptoms usually develop in adolescence or early adulthood,
generally after a stressful life has occurred. An episode can end abruptly,
but sooner or later the disorder is likely to return, either in its initial form
or in a symptom that has a different nature and place.
DSM IV-TR Criteria for Conversion Disorders
▪ A symptom or more that affects motor and sensory function and
indicates a neurological or medical condition
▪ Symptom has a link to conflict or stress
▪ Symptomatic symptoms do not occur intentionally and are not
medically explainable
Conversion Disruption Cases
Anna O. is the pseudonym for Bertha Pappenheim, a Jewish patient who was
the subject of Sigmund Freud's research with Josef Breuer for two years,
between 1880 and 1882. As explained above, Anna O has conversion
disorder, a psychic disorder that converts into a form of physical illness, with
the main symptoms of epilepsy and partial paralysis of one of her arms. Anna
O was taken to Breur and Freud after the anatomist failed to diagnose Anna's
disease, because physically Anna did not have any biological disorders. For
2 years Freud and Breuer conducted psychological research and tried to
'enter' Anna's mind through what they called 'the talking cure' (the forerunner
of psychoanalysis). All of these processes were recorded in a record which
was then published into a book titled 'Studies on Hysteria'. Anna is the third
of four children. His brother was named Henriette (died aged 18) and Flora
(died aged 2), his sister was named Wilheilm. After the death of her brothers,
Anna became very close to her father until finally a few years later her father
also passed away, leaving the three of them with their mother and sister. Anna
was never close to her mother because (according to Anna's subconscious)
her mother was too busy taking care of Wilhem. And during the process of
talking cure, Freud and Breuer finally found a bright spot when in a state of
abscence, Anna told how before she died, Anna had met her father, and how
Anna's father actually died in his arms. Anna experienced a very heavy guilt
process until her arm became paralyzed. In 1882 Anna's hand paralysis was
cured after the talking cure succeeded in reconciling her guilt.
E. SOMATIZATION INTERFERENCE
• Somatization disorder is a disorder characterized by repeated and diverse
somatic complaints, so that the sufferer feels that he needs medical
attention and often seeks medical help, even though he does not have a
clear physical cause.
• These disorders have several symptoms, where the specific symptoms can
vary between cultures. This disorder was first described by French
physician Pierre Briquet in 1859, so long before DSM-IV-TR changed the
term to somatization disorder, this disorder was called Briquet syndrome.
• This syndrome begins in late adolescence or in early adulthood. This
disorder can be chronic and last throughout the patient's life (Kirmayer,
Robbins, & Paris, 1994; Smith; 1994), and this disorder can cause people
to be difficult in carrying out daily activities. Usually this disorder is
suffered by patients who are less than 30 years old.
Diagnostics of Somatization Disorders in DSM-IV-TR :
A. A history of many physical complaints that begin before the age of 30 that
occur over a period of several years and cause sought therapy or
meaningful impairment in social, occupational or other important
functions.
B. Each of the following criteria should be found with individual symptoms
that occur at any time during the course of the disorder:
1. Four symptoms of pain: a history of pain associated with at least 4
different places or functions (e.g. head, abdomen, back, joints, limbs,
chest, rectum (end of the colon), during menstruation, during sexual
intercourse or during the mic (urination).
2. Two gastrointestinal symptoms: a history of at least 2 gastrointestinal
symptoms other than pain (e.g. nausea, bloating, vomiting other than
during pregnancy, diarrhea or intolerance to certain foods).
3. One sexual symptom: history of at least 1 sexual or reproductive
symptom other than pain (e.g. sexual indifference, erectile dysfunction
or ejaculation, irregular menstruation, excessive menstrual bleeding,
vomiting throughout pregnancy).
4. One pseudoneurological symptom: a history of at least 1 symptom or
deficit leading to a neurological condition that is not limited to pain
(e.g. conversion symptoms such as impaired coordination or balance,
local paralysis, difficulty swallowing or a lump in the throat, aphonia
(loss of voice due to vocal cord disorders), urinary retention (retention
of urine), hallucinations, loss of touch sensation or pain, double vision,
blindness, deafness, seizures, dissociative symptoms such as amnesia
or loss of consciousness other than fainting).
C. One of points 1 or 2:
1. After the necessary research, each symptom in criterion B cannot be
fully explained by a known common medical condition or the
immediate effects of a substance (e.g. injury, medication, drug or
alcohol effects).
2. If there is a general medical condition, physical complaint or social or
occupational disorder that is in excess of what is expected from the
medical history, physical examination or laboratory findings
D. Symptoms are not intentional or contrived (such as in artificial or pretend
disorders).
Case Examples:
Silila, a 31-year-old woman, was seeking treatment because doctors said
there was nothing she could do for Sila. When asked about her health
problems, Sila recounted a series of complaints, such as often not being able
to remember about the events that happened to her and at other times her
vision was blurred, so she could not read the letters on the printed page. Sila
likes to read and do other activities around her house, but she easily feels
tired and has difficulty breathing for unclear reasons. He often can't enjoy the
food he has made because he will feel nauseous and want to vomit when he
eats anything, even when he only tastes the spices. According to her husband,
Sila has lost interest in having intercourse, only doing it once in a period of
several months, and is usually done at the insistence of her husband. Sila
complained of very painful cramps during her menstrual period and at other
times she felt that "inside her she felt burning". Because of the pain felt in his
back, legs, and chest. Please want to stay in bed all day. The precepts lived in
a house with a large courtyard but rarely did he go around "because I had to
lie down when my legs hurt".
