Skip to content →

Somatoform Disorders

(11-12-14)

  • Somatization Disorder
    • Bouman, Eifert, & Lejuez (1999) note sexual abuse and traumatization are often cited as precursors of Somatization Disorder
  • Conversion Disorder
    • Morrison (1995) suggests that conversion symptoms are not uncommon and may not be a very useful “marker for identifying disease” (p. 290), he recommends that a conversion symptom should prompt a review for possible Somatization Disorder
  • Pain Disorder
    • Morrison (1995) notes that Pain Disorder Associated with a General Medical Condition is used when psychological factors play only a minor role in a patient’s pain, is not considered a Mental Disorder, and is coded only on Axis III
  • Hypochondriasis
    • Alternative criteria for hypochondriasis
    • Suggestions for interacting with “hypochondriacal patients” in Harvard Mental Health Letter article (2004, p. 5):
    • focus on need to cope with symptoms rather than trying to eliminate the symptoms
    • schedule regular appointments rather than responding to complaints
    • limit reassurance, focus on establishing trusting relationship
    • “Explain that the patient’s suffering results from the intensification of normal physical symptoms.” (HMHL, 2004, p. 5)
      • “explain that the symptoms are not life-threatening, while sympathizing with the patient’s frustration and admitting the limits of medicine. The patient might be told, ‘You have a syndrome that causes you to experience distressing intensity of physical sensations.’ Another increasingly popular term is ‘health anxiety.'” (HMHL, 2004, p. 5)
  • Body Dysmorphic Disorder
  • Somatoform Disorder NOS
    • Pseudocyesis: “false pregnancy”
    • “transient hypochondrical states” (Morrison, 1995): meet symptom but not 6 month duration criteria for Hypochondriasis

Alternative criteria for hypochondriasis

Fink, Ornbol, Toft, Sparle, Fronstholm, & Olesen (2004) suggest alternative criteria for Hypochondriasis based on a latent class analysis of data from 701 patients:

Criterion Description

  • A Obsessive rumination with intrusive thoughts, ideas, or fears of
    • harboring an illness that cannot be stopped or can be stopped
    • only with great difficulty
  • B One (or more) of the following five symptoms
    • 1. Presence of a. b. or both
      • a. Worrying about or preoccupation with fears of harboring a severe physical disease or the idea that disease will be contracted in the future or preoccupation with other health concerns
      • b. Attention to and intense awareness of bodily functions, physical sensation, physiological reactions, or minor bodily problems that are misinterpreted as serious disease
    • 2. Suggestibility or autosuggestibility; if the patient hears or reads about an illness, he or she is inclined to fear that he or she has the same disease
    • 3. Excessive fascination with medical information
    • 4. Unrealistic fear of being infected or contaminated by something touched or eaten or by a person met
    • 5. Fear of taking prescribed medication
  • C. If a medical condition is present, the patient’s reaction clearly exceeds
    • what would be expected from the medical condition alone
  • D. The symptoms are not better explained by another psychiatric disorder
  • E. The symptoms are present for most of the time for at least 2 weeks
  • F. Specify whether the disorder is severe or mild—severe: at lease one of
    • the symptoms in criteria A and B is severely disturbing or significantly interferes with everyday activities; mild: all others

(Fink, Ornbol, Toft, Sparle, Frostholm, & Olesen 2004, p. 1683)

from Fink, P., Ornbol, E., Toft, T., Sparle, K.C., Frostholm, L., & Olesen, F. (2004). A new, empirically established hypochondriasis diagnosis. American Journal of Psychiatry, 161, 1680-1691.

Body Image & Adjustment

(11-4-03)

A study of cause-specific mortality in a group of 2,166 Finnish women who underwent cosmetic breast augmentation surgery between 1970 and 2000 found an excess of death from suicide–10 of the 31 deaths in the group were from suicide. This was a statistically significant excess from expectations. Dr. Pukkala said this finding was consistent with a previous report with a Swedish cohort of breast implant patients. The authors point out the the relationship is not necessarily causal, but may reflect characteristics of women who choose cosmetic breast implantation.

Dr. James Well, president of the American Society of Plastic Surgeons was reported in a telephone interview with Reuters Health as saying studies of U.S. breast implant patients had not shown evidence of increased risk. [www.medscape.com/viewarticle/462516]


Causes of Death Among Finnish Women with Cosmetic Breast Implants, 1971-2001
Annals of Plastic Surgery 51(4): 339-342; Oct 2003
Eero Pukkala, PhD; Ilona Kulmala, MSc; Sirpa-Liisa Hovi, LicNSci; Elina Hemminki, DrPH; Ilmo Keskimäki, MD; Loren Lipworth, ScD; John D. Boice Jr, ScD; Joseph K. McLaughlin, PhD

Skip to toolbar