Somatoform Disorders

• Presence of physical symptoms that suggest a general medical condition but aren‟t explained by that condition, by substances or medications, or by another mental disorder (eg Panic Disorder)
• Must cause significant distress or impairment in social or occupational functioning 
• Difficult to manage: need to check for physical conditions ® constant testing ® reinforces worry. If find something on tests this validates and reinforces the worry 
• Processes contributing to symptoms and motivation for symptom production is unconscious. They don’t know it’s not real.
• Cultural, stress, developmental and self-esteem factors may contribute

Somatization

• Somatic symptoms with no cause found (+/- anxiety/depression)
• Aim of treatment is to reattribute the symptoms to relate them to psychological problems
• Approach to managing in a non-specialise practice setting:
  • Feeling understood:
    • Take full history, including pain during a typical day
    • Watch for emotional clues or links with stressors: “what are you thinking about when it hurts”
    • Ask about social/family factors
    • Explore health beliefs: “What do you think is wrong”
    • Focused exam
  • Change the agenda:
    • Feedback results
    • Acknowledge reality of pain 
    • Reframe complaints: set them in the context of life events. “I‟m struck by the fact that these pains started shortly after … and that you‟ve been crying a lot… Do you think there might be a connection” 
  • Making the link:
    • Make the link to life events clearer to the patient
    • Use negotiating style: “Do you think that‟s possible… perhaps…” 
    • Projection: “Has anyone else suffered from symptoms like these… Did your mother get headaches – what caused those”? May be easier to see the connection in others