Somatoform Disorders Health Article

Definition

Somatoform disorders is the umbrella term developed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1980 to describe a group of conditions characterized by the presence of physical symptoms without evidence of a physiologic cause. DSM-IV divides these conditions into six separate psychiatric disorders.

• somatization disorder
• undifferentiated somatoform disorder
• conversion disorder
• pain disorder
• hypochondriasis
• body dysmorphic disorder

Description

It is helpful to understand that the present classification of these disorders reflects recent historical changes in the practice of medicine and psychiatry. When psychiatry first became a separate branch of medicine at the end of the nineteenth century, the term hysteria was commonly used to describe mental disorders characterized by altered states of consciousness (for example, sleepwalking or trance states) or physical symptoms (for example, a "paralyzed" arm or leg with no neurologic cause) that could not be fully explained by a medical disease. The term dissociation was used for the psychological mechanism that allows the mind to split off uncomfortable feelings, memories, or ideas so that they are lost to conscious recall. Sigmund Freud and other pioneering psychoanalysts thought that the hysterical patient's symptoms resulted from dissociated thoughts or memories reemerging through bodily functions or trance states. Prior to the fourth edition of DSM in 1980, all mental disorders that were considered to be forms of hysteria were grouped together on the basis of this theory about their cause. Since 1980, however, the somatoform disorders and the so-called dissociative disorders have been placed in separate categories on the basis of their chief symptoms. In general, the somatoform disorders are characterized by disturbances in the patient's physical sensations or ability to move the limbs or walk, while the dissociative disorders are marked by disturbances in the patient's sense of identity or memory.

Somatization disorder

Somatization disorder was formerly called Briquet's syndrome, after the French physician who first recognized it. Z. J. Lipowski defined somatization in the American Journal of Psychiatry as "the tendency to experience and communicate somatic distress and symptoms not accounted for by pathologic findings, to attribute them to physical illness and to seek medical help for them."

Somatization disorder typically begins before the age of 30. It is estimated that worldwide, between 0.2% and 2% of the population will develop this disorder in their lifetime. In the United States, it is nearly twice as common in women, but in other cultures, it is believed to be more widespread in men. Some psychiatrists think that the high female-to-male ratio in this disorder in North America reflects the cultural pressures on women and the social expectation that women are generally physically weak or sickly. It is also likely to run in families. As many as 20% of the mothers, sisters, or daughters of somatization disorder patients have the same illness. Their male first-degree relatives are more apt to have anti-social personality disorder or addiction problems. When asked to self-assess health, somatization disorder patients usually rate their well-being as worse than people suffering from actual long-term illness do. Physical complaints normally develop or increase during times of stress, and though these people look for help frequently, it is highly unusual for them to find relief.

Undifferentiated somatoform disorder

Undifferentiated somatoform disorder is generally less specific than somatization disorder, and requires only the presence of one symptom to be consistently present. But patients suffering from undifferentiated somatoform disorder often complain of fatigue, loss of appetite, or difficulty swallowing. Symptoms commonly develop when the person is under stress or is depressed, and to meet DSM-IV criteria, must have no physical basis and remain for more than six months.