The common feature of the Somatoform Disorders is the presence of physical symptoms that suggest a general medical and are not fully explained by a general medical condition. The physical symptoms are not intentional (i.e., under voluntary control). Somatoform Disorders differ from Psychological Factors Affecting Medical Condition in that there is no diagnosable general medical condition to fully account for the physical symptoms. These disorders are often encountered in general medical settings.
- Somatization Disorder
(historically referred to as hysteria)
A poly-symptomatic disorder that begins before age 30, extends over a period of years, and is characterized by a combination of pain, gastrointestinal, sexual, and pseudo-neurological symptoms.
There also must be a history of at least two gastrointestinal symptoms other than pain. Most individuals with the disorder describe the presence of nausea and abdominal bloating. Vomiting, diarrhea, and food intolerance are less common. Gastrointestinal complaints often lead to frequent X-ray examinations and can result in abdominal surgery that in retrospect was unnecessary. There must be a history of at least one sexual or reproductive symptom other than pain. In women, this may consist of irregular menses, menorrhagia, or vomiting throughout pregnancy. In men, there may be symptoms such as erectile or ejaculatory dysfunction. Both women and men may be subject to sexual indifference. Finally, there must also be a history of at least one symptom, other than pain, that suggests a neurological condition (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, or seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting. The symptoms in each of the groups have been listed in the approximate order of their reported frequency. Finally, the unexplained symptoms in Somatization Disorder are not intentionally feigned or produced.
- Somatoform Disorder
- Characterized by unexplained physical complaints, lasting at least 6 months, that are of less severity than are seen with Somatization Disorder. this is a very common outlet for stress. For instance, one might become nausiated prior to speaking in public, or while studying for a final exam, one might have diarehea for a time. It is rather common for people to turn their unexpressed feelings of stress, fear and anxiety into physical symptoms. Research is beggining to put together the link between physical illnes and unexpressed emotions.
- Conversion Disorder
Involves unexplained symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition, (i.e. stress related blindness, or paralysis of a limb). Psychological factors are judged to be associated with the symptoms or deficits.
Years ago when people suffered from paralysis of a limb with no medical explanation, or were blind although their eyes were normal, they were labeled as being hysterical. It is now understood that extreme stress, anxiety or fear can contribute to a conversion disorder. The stress or fear is "converted" to a part of the body, often a part of the body that when disabled will render the client unable to perform the activities that had brought on the original stress. Such cases prove that the mind/body connection is very strong, and that our minds can create ingenious, subconcious ways of surviving psychological pain.
- Pain Disorder
- Characterized by pain as the predominant focus of clinical attention. In addition, psychological factors are judged to have an important role in its onset, severity, exacerbation, or maintenance.
The preoccupation with the fear of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms or bodily functions.
The term Hypochondria is often missused to label people who are always ill or seem to have one complaint after another. Hypochondia is actually the constant fear that one has a serious disease or illness such as cancer. Often these people will hear about the symptoms of a disease and begin to believe they have the illness. A mild headache will be feared to be a brain tumor. A pain in a joint will be interpreted as a rare, crippling arthritis. Someone who is always ill or in pain may actually have a somatiform disorder (see above for interpretation) rather than hypochondriasis. Or a person who is never truly ill but feigns illness may be diagnosed with melingering or a facticious disorder rather than with hypochondriasis.
- Body Dysmorphic Disorder
The preoccupation with an imagined or exaggerated defect in physical appearance.
The essential feature of Body Dysmorphic Disorder is a preoccupation with a defect in one's body. The defect is either imagined, or if a slight physical anomaly is present, the individual's concern is markedly excessive. The preoccupation must cause significant distress or impairment in social, occupational, or other important areas of functioning. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).
Complaints commonly involve imagined or slight flaws of the face or head such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion, swelling, facial asymmetry or disproportion, or excessive facial hair. Other common preoccupations include the shape, size, or some other aspect of the nose, eyes, eyelids, eyebrows, ears, mouth, lips, teeth, jaw, chin, cheeks, or head. However, any other body part may be the focus of concern (e.g., the genitals, breasts, buttocks, abdomen, arms, hands, feet, legs, hips, shoulders, spine, larger body regions, or overall body size). The preoccupation may simultaneously focus on several body parts. Although the complaint is often specific (e.g., a "crooked" lip or a "bumpy" nose), it is sometimes vague (e.g. a "falling" face or "inadequately firm" eyes). Because of embarrassment over their concerns, some individuals with Body Dysmorphic Disorder avoid describing their "defects" in detail and may instead refer only to their general ugliness.
Most individuals with this disorder experience marked distress over their supposed deformity, often describing their preoccupations as "intensely painful," "tormenting," or "devastating." Most find their preoccupations difficult to control, and they may make little or no attempt to resist them. As a result, they often spend hours a day thinking about their "defect," to the point where these thoughts may dominate their lives. Significant impairment in many areas of functioning generally occurs. Feelings of self-consciousness about their &qout;defect&qout; may lead to avoidance of work or public situations
- Somatoform Disorder Not Otherwise Specified
- Included for coding disorders with somatoform symptoms that do not meet the criteria for any of the specific Somatoform Disorders.