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Chapter 19. Somatoform Disorders

Marc E. Agronin, M.D.
DOI: 10.1176/appi.books.9781585623754.393720

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Excerpt

Somatoform disorders comprise a heterogeneous group of psychiatric illnesses in which physical symptoms or complaints without objective organic causes are present and in which there are strongly associated psychological factors. The seven somatoform disorders listed in DSM-IV-TR (American Psychiatric Association 2000) are 1) somatization disorder, 2) undifferentiated somatoform disorder, 3) hypochondriasis, 4) conversion disorder, 5) pain disorder, 6) body dysmorphic disorder (BDD), and 7) somatoform disorder not otherwise specified. Prevalence rates vary by diagnosis, but in general, across ages, somatoform disorders and their less severe variants have been seen in 16% of primary care outpatients (DeWaal et al. 2004) and in 23% of outpatients with medically unexplained symptoms (Smith et al. 2005).

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Table Reference Number
Table 19–1. Factors associated with somatoform disorders

References

Aigner M, Bach M: Clinical utility of DSM-IV pain disorder. Compr Psychiatry 40:353–357, 1999
[PubMed]
 
Bailey PE, Henry JD: Alexithymia, somatization and negative affect in a community sample. Psychiatry Res 150:13–20, 2007
[PubMed]
 
Barsky AJ: Patients who amplify bodily sensations. Ann Intern Med 91:63–70, 1979
[PubMed]
 
Barsky AJ: The patient with hypochondriasis. N Engl J Med 345:1395–1399, 2001
[PubMed]
 
Barsky AJ, Klerman GL: Overview: hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry 149:273–283, 1983
 
Barsky AJ, Frank C, Cleary P, et al: The relation between hypochondriasis and age. Am J Psychiatry 148:923–928, 1991
[PubMed]
 
Behrouz R, Heriaud L, Benbadis SR: Late-onset psychogenic nonepileptic seizures. Epilepsy 8:649–650, 2006
[PubMed]
 
Bellino S, Zizza M, Paradiso E: Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery. Psychiatry Res 144:73–78, 2006
[PubMed]
 
Boland RJ: How could the validity of the DSM-IV pain disorder be improved in reference to the concept that it is supposed to identify? Curr Pain Headache Rep 6:23–29, 2002
[PubMed]
 
Breuer J, Freud S: Studies on hysteria (1893–1895), in Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 2. Translated and edited by Strachey J. London, Hogarth Press, 1955, pp 1–319
 
Brink T, Janakes C, Martinez N: Geriatric hypochondriasis: situational factors. J Am Geriatr Soc 29:37–39, 1981
[PubMed]
 
Brown RJ, Schrag A, Trimble MR: Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. Am J Psychiatry 162:899–905, 2005
[PubMed]
 
Brown RJ, Cardena E, Nijenhuis E: Should conversion disorder be reclassified as a dissociative disorder in DSM-V? Psychosomatics 48:369–378, 2007
[PubMed]
 
Chabolla DR, Krahn LE, So EL, et al: Psychogenic nonepileptic seizures. Mayo Clin Proc 71:493–500, 1996
[PubMed]
 
Cloninger CR: Somatoform and dissociative disorders, in The Medical Basis of Psychiatry. Edited by Winokur G, Clayton PJ. Philadelphia, PA, WB Saunders, 1986, pp 123–151
 
D'Allesio L, Giagante B, Oddo S: Psychiatric disorders in patients with psychogenic non-epileptic seizures, with and without comorbid epilepsy. Seizure 15:333–339, 2006
 
De Gucht V: Stability of neuroticism and alexithymia in somatization. Compr Psychiatry 44:466–471, 2003
 
DeWaal MWM, Arnold IA, Eekhof JAH: Somatoform disorders in general practice: prevalence, functional impairment and comorbid anxiety and depressive disorders. Br J Psychiatry 184:470–476, 2004
 
Dula DJ, DeNaples L: Emergency department presentation of patients with conversion disorder. Acad Emerg Med 2:120–123, 1995
[PubMed]
 
Escobar JI, Gara M, Waitzkin H, et al: DSM-IV hypochondriasis in primary care. Gen Hosp Psychiatry 20:155–159, 1998
[PubMed]
 
Fallon BA, Schneier FR, Marshall R, et al: The pharmacotherapy of hypochondriasis. Psychopharmacol Bull 32:607–611, 1996
[PubMed]
 
Faravelli C, Salvatori S, Galassi F, et al: Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 32:24–29, 1997
[PubMed]
 
Fink P, Hansen MS, Oxhoj ML: The prevalence of somatoform disorders among medical inpatients. J Psychopharm Res 56:413–418, 2004
[PubMed]
 
Fishbain DA, Cutler RB, Rosomoff HL, et al: Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis. Psychosom Med 60:503–509, 1998
[PubMed]
 
Garcia-Campayo J, Sanz-Carrillo C: Gabapentin for the treatment of patients with somatization disorder (letter). J Clin Psychiatry 62:474, 2001
[PubMed]
 
Grant JE: Successful treatment of nondelusional body dysmorphic disorder with olanzapine: a case report. J Clin Psychiatry 62:297–298, 2001
[PubMed]
 
Grant JE, Phillips KA: Recognizing and treating body dysmorphic disorder. Ann Clin Psychiatry 17:205–210, 2005
[PubMed]
 
Hasin D, Katz H: Somatoform and substance use disorders. Psychosom Med 69:870–875, 2007
[PubMed]
 
Hollander E, Allen A, Kwon J, et al: Clomipramine vs. desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry 56:1033–1039, 1999
[PubMed]
 
Hollifield M, Tuttle L, Paine S, et al: Hypochondriasis and somatization related to personality and attitudes towards self. Psychosomatics 40:387–395, 1999
[PubMed]
 
Kellner R: Somatization and Hypochondriasis. New York, Praeger, 1986
 
Kellner R: Hypochondriasis and somatization. JAMA 258:2718–2722, 1987
[PubMed]
 
Krem MM: Motor conversion disorders reviewed from a neuropsychiatric perspective. J Clin Psychiatry 65:783–790, 2004
[PubMed]
 
Leveille SG, Ling S, Hochberg MC, et al: Widespread musculoskeletal pain and the progression of disability in older disabled women. Ann Intern Med 135:1038–1046, 2001
[PubMed]
 
Liskow B, Othmer E, Penick EC, et al: Is Briquet's syndrome a heterogeneous disorder? Am J Psychiatry 143:626–629, 1986
[PubMed]
 
Lundh LG, Simonsson-Sarnecki M: Alexithymia, emotion, and somatic complaints. J Pers 69:483–510, 2001
[PubMed]
 
Mace CJ, Trimble MR: Ten-year prognosis of conversion disorder. Br J Psychiatry 169:282–288, 1996
[PubMed]
 
Mari F, Bonaventure C, Vanacore N: Video-EEG study of psychogenic nonepileptic seizures: differential characteristics in patients with and without epilepsy. Epilepsia 47 (suppl 5):64–67, 2006
 
Maurer I, Volz HP, Sauer H: Gabapentin leads to remission of somatoform pain disorder with major depression. Pharmacopsychiatry 32:255–257, 1999
[PubMed]
 
McDermid AJ, Rollman GB, McCain GA: Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 66:133–144, 1996
[PubMed]
 
Menza M, Lauritano M, Allen L, et al: Treatment of somatization disorder with nefazodone: a prospective, open-label study. Ann Clin Psychiatry 13:153–158, 2001
[PubMed]
 
Miller AR, North CS, Clouse RE, et al: The association of irritable bowel syndrome and somatization disorder. Ann Clin Psychiatry 13:25–30, 2001
[PubMed]
 
Moene FC, Landberg EH, Hoogduin KA, et al: Organic syndromes diagnosed as conversion disorder: identification and frequency in a study of 85 patients. J Psychosom Res 49:7–12, 2000
[PubMed]
 
Ness D: Physical therapy management for conversion disorder: case series. J Neurol Phys Ther 31:30–39, 2007
[PubMed]
 
Noyes R Jr, Langbehn DR, Happel RL, et al: Personality dysfunction among somatizing patients. Psychosomatics 42:320–329, 2001
[PubMed]
 
Okasha A, Ismail MK, Khalil AH, et al: A psychiatric study of nonorganic chronic headache patients. Psychosomatics 40:233–238, 1999
[PubMed]
 
Oosterbaan DB, van Balkom AJ, van Boeijen CA, et al: An open study of paroxetine in hypochondriasis. Prog Neuropsychopharmacol Biol Psychiatry 25:1023–1033, 2001
[PubMed]
 
O'Sullivan SS, Spillane JE, McMahon EM: Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review. Epilepsy Behav 11:77–84, 2007
[PubMed]
 
Otis JAD, McGeeney B: Managing pain in the elderly. Clin Geriatr 8:48–62, 2000
 
Otto MW, Cohen WS, Harlow BL: Prevalence of body dysmorphic disorder in a community sample of women. Am J Psychiatry 158:2061–2063, 2001
[PubMed]
 
Phillips KA: Body dysmorphic disorder: diagnosis and treatment of imagined ugliness. J Clin Psychiatry 57 (suppl 8):61–64, 1996
 
Phillips KA: Body dysmorphic disorder: clinical aspects and treatment strategies. Bull Menninger Clin 62:A33–A48, 1998
 
Phillips KA: Olanzapine augmentation of fluoxetine in body dysmorphic disorder. Am J Psychiatry 162:1022–1023, 2005
[PubMed]
 
Phillips KA, Dufresne RG: Body dysmorphic disorder: a guide for dermatologists and cosmetic surgeons. Am J Clin Dermatol 1:235–243, 2000
[PubMed]
 
Phillips KA, McElroy SL: Personality disorders and traits in patients with body dysmorphic disorder. Compr Psychiatry 41:229–236, 2000
[PubMed]
 
Phillips KA, Dwight MM, McElroy SL: Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry 59:165–171, 1998
[PubMed]
 
Phillips KA, Albertini RS, Siniscalchi JM, et al: Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. J Clin Psychiatry 62:721–727, 2001
[PubMed]
 
Phillips KA, Albertini RS, Rasmussen SA: A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Arch Gen Psychiatry 59:381–388, 2002
[PubMed]
 
Polatin PB, Kinney RK, Gatchel RJ, et al: Psychiatric illness and chronic low-back pain: the mind and the spine—which goes first? Spine 18:66–71, 1993
[PubMed]
 
Pribor EF, Smith DS, Yutzy SH: Somatization disorder in elderly patients. J Geriatr Psychiatry 2:109–117, 1994
 
Rabinowitz T, Hirdes JP, Desjardins I: Somatoform disorders in late life, in Principles and Practice of Geriatric Psychiatry. Edited by Agronin ME, Maletta G. Philadelphia, PA, Lippincott Williams & Wilkins, 2006, pp 489–503
 
Reid S, Whooley D, Crayford T, et al: Medically unexplained symptoms—GPs' attitudes towards their cause and management. Fam Pract 18:519–523, 2001
[PubMed]
 
Rief W, Hessel A, Braehler E: Somatization symptoms and hypochondriacal features in the general population. Psychosom Med 63:595–602, 2001
[PubMed]
 
Ritsner M, Ponizovsky A, Kurs R, et al: Somatization in an immigrant population in Israel: a community survey of prevalence, risk factors, and help-seeking behavior. Am J Psychiatry 157:385–392, 2000
[PubMed]
 
Roelofs K, Keijsers GP, Hoogduin KA, et al: Childhood abuse in patients with conversion disorder. Am J Psychiatry 159:1908–1913, 2002
[PubMed]
 
Sack M, Lahmann C, Jaeger B, et al: Trauma prevalence and somatoform symptoms: are there specific somatoform symptoms related to traumatic experiences? J Nerv Ment Dis 195:928–933, 2007
[PubMed]
 
Samelius L, Wijma B, Wingren G, et al: Somatization in abused women. J Womens Health 6:909–918, 2007
 
Sar V, Akyüz G, Kundakçi T: Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 161:2271–2276, 2004
[PubMed]
 
Scherder E, Bouma A, Slaets J, et al: Repeated pain assessment in Alzheimer's disease. Dement Geriatr Cogn Disord 12:400–407, 2001
[PubMed]
 
Scudds RJ, Ostbye T: Pain and pain-related interference with function in older Canadians: the Canadian Study of Health and Aging. Disabil Rehabil 23:654–664, 2001
[PubMed]
 
Sheehan B, Banerjee S: Review: somatization in the elderly. Int J Geriatr Psychiatry 14:1044–1049, 1999
[PubMed]
 
Simon GE, Gureje O, Fullerton C: Course of hypochondriasis in an international primary care study. Gen Hosp Psychiatry 23:51–55, 2001
[PubMed]
 
Smith RC, Gardiner JC, Lykes JS, et al: Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosom Med 67:123–129, 2005
[PubMed]
 
Speed J: Behavioral management of conversion disorder: retrospective study. Arch Phys Med Rehabil 77:147–154, 1996
[PubMed]
 
Stone J, Zeman A, Simonotto E, et al: FMRI in patients with motor conversion symptoms and controls with simulated weakness. Psychosom Med 69:961–969, 2007
[PubMed]
 
Stuart S, Noyes R Jr: Attachment and interpersonal communication in somatization. Psychosomatics 40:34–43, 1999
[PubMed]
 
Thomson AB, Page LA: Psychotherapies for hypochondriasis. Cochrane Database Syst Rev CD006520, Oct 17, 2007
 
Vuilleumier P: Hysterical conversion and brain function. Prog Brain Res 150:309–329, 2005
[PubMed]
 
Vuilleumier P, Chicherio C, Assal F, et al: Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain 124:1077–1090, 2001
[PubMed]
 
Waldinger RJ, Schulz MS, Barsky AJ, et al: Mapping the road from childhood trauma to adult somatization: the role of attachment. Psychosom Med 68:129–135, 2006
[PubMed]
 
Waller E, Scheidt CE: Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia. J Psychosom Res 57:239–247, 2004
[PubMed]
 
Weddington WW: Conversion reaction in an 82 year old man. J Nerv Ment Dis 167:368–369, 1979
[PubMed]
 
Woolfolk RL, Allen LA, Tiu JE: New directions in the treatment of somatization. Psychiatr Clin North Am 30:621–644, 2007
[PubMed]
 
Yazící KM, Kostakoglu L: Cerebral blood flow changes in patients with conversion disorder. Psychiatry Res 83:163–168, 1998
[PubMed]
 
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The diagnostic feature of somatization disorder that is most difficult to establish in elderly patients is
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Undifferentiated somatoform disorder is defined by all of the following except
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