|Childhood Mental Health: Somatoform Disorders|
The somatoform disorders are a group of mental disturbances placed in
a common category in DSM-IV on
the basis of their external symptoms. The terms hypochondriasis and hysteria
were traditionally designated to these disorders and are still widely
used. Somatoform disorders in the DSM-IV are described as follows:
The somatoform disorders are distinguished by physical symptoms
suggesting a medical condition, yet the symptoms are not fully explained
by the medical condition, by substance use, or by another mental disorder.
The symptoms are severe enough to cause patients significant distress
or impaired social, occupational, or other functioning.
The physical symptoms of somatoform disorders are not intentionally produced
as are those of factitious disorders and malingering, but no medical condition
can fully explain the somatic symptoms.
The DSM-IV describes 5 subtypes: conversion disorder ,
somatization disorder , psychogenic
pain disorder , hypochondriasis and
Body dysmorphic disorder .
Symptoms, Signs and Treatment of each Subtype
- Somatization disorder. This disorder was
previously designated Briquet's syndrome .
The essential features consist of multiple, recurrent physical complaints
made over many years and starting in young adult life or adolescence.
The sufferer demands medical attention, but no organic cause is found.
Symptoms invariably occur in many different bodily systems, for
instance back pains, painful menstruation, dizziness, indigestion, difficulty
with vision, and partial paralysis; and the symptoms may follow fashions
in health concerns among the public.
The condition is relatively common and occurs in about 1% of adult women.
It is very unusual to see this disorder in males. There are no clear
Treatment involves not colluding with the patient's inclination
to attribute organic causes to the symptoms and insuring that physicians
and surgeons do not co-operate with the patient in seeking excessive
diagnostic procedures or surgical remedies for the complaints.
- Conversion disorder or hysterical
neurosis , conversion type . This disorder
was traditionally labelled hysteria . Since
the time of the ancient Greeks the term hysteria has referred to unexplained
physical symptoms. Only in 1859 was the the first attempt to scientifically
describe the syndrome of hysteria made (by Paul Briquet). Charcot, the
famous turn of the century French hypnotist, treated hysterical symptoms
with hypnosis. Freud, Charcot's pupil, published Studies on Hysteria ,
(1895), along with his friend and colleague Breuer, in what is now recognised
as one of the main events in the birth of psychoanalysis.
Symptoms of conversion disorder are a loss of or alteration in
physical functioning, typically the paralysis suggesting neurological
disease. The physical symptoms occur in the absence of organic pathology
and are instead apparently the expression of an underlying emotional
conflict. The characteristic motor symptoms of hysteria include the
paralysis of the voluntary muscles of an arm or leg, tremor, tics, and
other disorders of movement or gait. The neurological symptoms may be
widely distributed and may not conform with medical knowledge of physical
nerve distribution. Blindness, deafness, loss of sensation in arms or
legs, the feeling of "pins and needles," an increased sensitivity to
pain in a limb, and many other symptoms have been described. Hysterical
symptoms usually occur in a setting of extreme psychological stress
and appear suddenly. The course is variable, with recovery often occurring
in a few days but with symptoms persisting for years or decades in chronic
cases that remain untreated. The causation of hysteria has been linked
with fixations; i.e., arrested stages in the individual's early psychosexual
development. Freud's theory that threatening or emotionally charged
thoughts are repressed out of consciousness and converted into physical
symptoms is still widely accepted.
The treatment of hysteria thus requires psychological rather
than pharmacological methods, notably the exploration of the sufferer's
underlying emotional conflicts. Hysteria (and hypochondriasis) can also
be considered as different forms of "illness behaviour"; i.e., the patient
uses the hysterical symptoms to gain a psychological advantage in social
relationships, either by gathering sympathy or by being relieved of
burdensome or stressful obligations and withdrawing from emotionally
disturbing or threatening situations. Thus it may be advantageous to
the patient, in a psychological sense, to have the consequences of the
- Hypochondriasis or hypochondriacal
neurosis . Hypochondriasis is a preoccupation with physical signs
or symptoms that the patient unrealistically interprets as abnormal,
leading to the fear or belief that he is seriously ill. A thorough physical
examination may find no organic cause for the physical signs the patient
is concerned about, but the examination fails to relieve unrealistic
fears about having a serious disease.
The symptoms of hypochondriasis may occur with mental illnesses
other than neuroses, for instance,
or . Hypochondriacal
neurosis occurs in both sexes. The onset may be associated with precipitating
factors such as an actual organic disease with physical and psychological
after-effects (coronary thrombosis in a previously fit person). It often
begins during the fourth and fifth decades of life but is also common
at other times, such as during pregnancy.
Treatment aims to provide understanding and support and to reinforce
healthy behaviour; antidepressant drugs may be used when there are depressive
- In psychogenic pain disorder the main
feature is the persistent complaint of pain in the absence of organic
disease and with evidence of a psychological cause. The pattern of pain
may not conform to the known anatomic distribution of the nervous system.
Psychogenic pain may occur as part of hypochondriasis or as a symptom
of a depressive disorder.
Appropriate treatment depends on the context of the symptom.
- Body dysmorphic disorder .
These somatoform disorders may occur together in one patient. Alternatively,
they may occur in atypical form or in association with another physical
or mental illness.
During diagnosis for a somatoform disorder, the doctor will try to exclude
any true physical illness such as temporal lobe epilepsy, hemiplegic migraine,
multiple sclerosis, lupus erythematosus or Guillian-Barre syndrome. However,
extensive tests are generally avoided as they may further convince the
child that a physical problem exists.
The information in this page is presented in summarised form and has been taken
from the following source(s):
The Encycloædia Britannica© Online: http://www.britannica.com/
2. Young Choi, M.D., Department of Psychiatry, Chonnam National University,
College of Medicine
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