Somatoform Disorder

1. Background
   1. Somatizers generate 9 times the average medical cost
   2. Despite medical attention, somatizers highly disabled
   3. Physicians report frustration in treating somatizers
      1. Lack sense of effectiveness
      2. Patient does not fit into standard diagnoses
      3. Patient does not fit into standard office schedule
2. Pathophysiology
   1. Sensory amplification
      1. Preoccupation with disease focuses on body sensations
      2. Normal variations in senses interpreted as abnormal
      3. Exacerbates anxiety and panic, as well as discomfort
   2. Identified patient within a dysfunctional family
      1. Family dysfunction transferred to the patient
      2. Patient's "illness" stabilizes family
      3. Other family member's anxiety relieved
   3. Need to be sick
      1. Patient pursues sick role to relieve stressors
      2. Not the same as Malingering or faking symptoms
         1. Somatizing Patient unaware of symptom generation
   4. Dissociation
      1. Activation of Pain Sensation without physical pain
3. Types: Somatoform Disorders
   1. Somatization Disorder
   2. Undifferentiated Somatoform Disorder
   3. Hypochondriasis
   4. Conversion Disorder
   5. Body Dysmorphic Disorder
   6. Pain Disorder
4. Differential Diagnosis
   1. Organic disease (exclude completely before making Somatization diagnosis)
   2. Reported symptoms adopted by patient for Secondary Gain
      1. Factitious Disorder (Adoption of physical symptoms for unconscious internal gain)
      2. Malingering (Purposeful feigning of physical symptoms for external gain)
5. Risk Factors
   1. See Somatization Risk Factors
   2. Underlying mental health condition
   3. History of physical abuse or sexual abuse
6. Definition
   1. Emotional distress experienced as physical symptoms
7. Symptoms
   1. See Somatization Symptoms
8. Associated Conditions: Syndromes
   1. Vague Food Allergy
   2. Vague Vitamin Deficiency
   3. Multiple chemical sensitivity
   4. Atypical Chest Pain
   5. Temporomandibular Joint Syndrome (TMJ)
   6. Hypoglycemia
   7. Chronic Fatigue Syndrome
   8. Fibromyalgia
   9. Premenstrual Syndrome
9. Associated Conditions: Psychiatric
   1. Major Depression (60%)
   2. Anxiety Disorder (50%)
      1. Panic Disorder
      2. Obsessive Compulsive Disorder
   3. Personality Disorder (60%)
   4. Substance Abuse
10. Precautions
    1. Reassess for underlying medical condition
11. Management
    1. See Somatization Management
12. References
    1. McCahill (1995) Am Fam Physician, 52(1):193-203
    2. Oyama (2007) Am Fam Physician 76(9):1333-8
    3. Ringel (April 1998) Patient Care, p.131-56
    4. Schwer (March 1999) Hosp Med, p.38-43
    5. Servan-Schreiber (2000) Am Fam Physician 61(4):1073-8
    6. Servan-Schreiber (2000) Am Fam Physician 61(5):1423-8