Somatoform Disorders

Key Features

Essentials of Diagnosis

• A symptom suggesting physical dysfunction

• No physical disorder accounting for the symptom

• Symptoms causing distress, dysfunction, or both

• Symptoms not voluntarily created or maintained, as in malingering

General Considerations

• Includes body dysmorphic disorder, conversion disorder, hypochondriasis, somatization disorder, and somatoform pain disorder

• Body dysmorphic disorder: Manifests as preoccupation with an imagined defect in personal appearance

• Conversion disorder: Defined as symptom onset follows psychologically stressful event; symptoms express unconscious feelings and result in secondary gain

• Hypochondriasis: Characterized by preoccupation with worry that physical symptoms manifest unrecognized and threatening condition; medical assurance does not provide relief from worry

• Somatization disorder: Defined as long-standing preoccupation with multiple somatic symptoms

• Somatoform pain disorder: Manifests as preoccupation with pain that results in distress or impairment beyond what would be expected from physical findings

Clinical Findings

• Most common symptoms include neurologic and gastrointestinal complaints

• In conversion disorder

  • Symptoms include unusual sensory phenomena, paralysis, vomiting, abdominal pain, intractable headaches, and movement or seizure-like disorders

  • Symptoms and examination findings are not consistent with the clinical manifestations of any organic disease process

  • Physical symptoms often begin within the context of a family experiencing stress, such as serious illness, a death, or family discord

  • On closer examination, the child's symptoms are often found to resemble symptoms present in other family members

Diagnosis

• Clinical

Treatment

• In most cases, conversion symptoms resolve quickly when the child and family are reassured that the symptom is a way of reacting to stress

• The child is encouraged to continue with normal daily activities, knowing that the symptom will abate when the stress is resolved

• If the symptom does not resolve with reassurance, further investigation by a mental health professional is indicated.

• Comorbid diagnoses such as depression and anxiety disorders should be addressed, and treatment with pharmacologic agents may be helpful

Outcome

Prognosis

• Patients with somatoform disorders are often resistant to mental health treatment, in part fearing that any distraction from their vigilance will put them at greater risk of succumbing to a medical illness

• Psychiatric consultation is often helpful

References