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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

  1. 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 causes.
    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.
  2. 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 symptoms.
  3. 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, depression or schizophrenia . 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 symptoms.
  4. 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.
  5. 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):
1. The Encycloædia Britannica© Online:
2. Young Choi, M.D., Department of Psychiatry, Chonnam National University, College of Medicine

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Somatoform Disorders
Somatization disorder
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Somatoform Disorders
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