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Argosy University/ ... Somatic symptoms •• The somatizationsomatizationof anxiety of anxiety is very common among North American and British patients in primary care settings ••

Apr 19, 2020

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  • Somatoform DisordersSomatoform Disorders

    Cornelia Pinnell, Ph.D.Cornelia Pinnell, Ph.D. Argosy University/PhoenixArgosy University/Phoenix

  • Lecture Outline Lecture Outline

    •• Hysteria & hysteriaHysteria & hysteria--like symptomslike symptoms •• Somatic symptoms & Somatic symptoms & somatizationsomatization •• Somatoform disordersSomatoform disorders•• Somatoform disordersSomatoform disorders

  • HysteriaHysteria--like syndromeslike syndromes

    •• In In premodernpremodern societiessocieties, , hysteriahysteria--like syndromes like syndromes are most likely to manifest in trance or spirit are most likely to manifest in trance or spirit possession syndromes that include possession syndromes that include somatic somatic symptomssymptoms & symptoms of& symptoms ofsymptomssymptoms & symptoms of& symptoms of

    ••AnxietyAnxiety ••DepressionDepression ••DissociationDissociation

    Somatization Disorder (in the DSM-IV-TR) v      In premodern societies with different cultural schemas, hysteria-like syndromes are most likely to manifest in trance or spirit possession syndromes that include a cluster of anxiety, somatic, dissociative, and possibly depressive symptoms, with dissociative symptoms being the most prominent (e.g., ataques the nervios) v     

  • HysteriaHysteria

    •• South AsiaSouth Asia:: –– Urban IndiaUrban India –– emotional distress (e.g., emotional distress (e.g., following a social stressor such as a family following a social stressor such as a family argument) is likely to be experienced as an argument) is likely to be experienced as an argument) is likely to be experienced as an argument) is likely to be experienced as an illness illness –– convulsions, tremors, crying, shouts convulsions, tremors, crying, shouts of abuse, amnesia; ‘of abuse, amnesia; ‘fitsfits’ of 30’ of 30--60 minutes 60 minutes duration likely to occur 2x/monthduration likely to occur 2x/month

    –– Rural IndiaRural India -- emotional distress is likely to be emotional distress is likely to be epxeriencedepxerienced as as spirit possessionspirit possession; exorcism ; exorcism rituals would be performed with good rituals would be performed with good outcomeoutcome

    Hysteria in (urban) India. A dissociative response to emotional distress is extremely common in South Asia. Urban Indian patients, as indigenous elite, are more likely to adopt illness concepts from the colonizing culture that, after decolonization, became part of the indigenous culture. In the DSM-IV Casebook: “Fits” – sudden onset, 30 to 60 minutes in duration, characterized by rigidity throughout the body, convulsions and unresponsiveness, frothing at the mouth, crying, shouts of abuse, amnesia for the episodes; fits recur once or twice/month, typically following a social stressor such as a family argument). In rural India, similar dissociative symptoms would be experienced as spirit possesison and appropriate exorcism rituals would be performed with good outcome (signifying the need of family members to treat the patient with more respect).

  • Somatic symptomsSomatic symptoms

    •• The The somatizationsomatization of anxietyof anxiety is very is very common among North American and common among North American and British patients in primary care settingsBritish patients in primary care settings

    •• CrossCross--cultural studies indicate that somatic cultural studies indicate that somatic symptoms are the most common clinical symptoms are the most common clinical manifestations of anxiety disorders manifestations of anxiety disorders worldwide worldwide

    SOMATOFORM DISORDERS   Cross-cultural studies indicate that somatic symptoms are the most common clinical manifestations of anxiety disorders worldwide. The somatization of anxiety is very common among North American and British patients in primary care settings. Castillo’s contention is that, from a client-centered perspective, separating mental disorders expressing emotional distress into distinct anxiety, somatoform, and mood groupings is questionable. (p.189)  

  • SomatizationSomatization

    •• A tendency to seek medical attention out A tendency to seek medical attention out of proportion to evident physiological of proportion to evident physiological signs and symptoms (Fink et al., 1999)signs and symptoms (Fink et al., 1999)

    •••• Transduction of unrecognized negative Transduction of unrecognized negative affect into somatic symptoms (e.g., affect into somatic symptoms (e.g., unexplained pain) (unexplained pain) (WickramasekeraWickramasekera, , 1988)1988)

  • Somatoform DisordersSomatoform Disorders

    •• Common featureCommon feature:: –– Presence of physical symptoms that suggest a Presence of physical symptoms that suggest a general medical condition but are not fully general medical condition but are not fully explained by a general medical condition, the explained by a general medical condition, the explained by a general medical condition, the explained by a general medical condition, the direct effects of a substance, or by another direct effects of a substance, or by another mental disorder mental disorder –– grouping based on clinical grouping based on clinical utilityutility

    –– Symptoms cause clinically significant distress Symptoms cause clinically significant distress or impairment in social, occupational, or other or impairment in social, occupational, or other areas of functioningareas of functioning

    SOMATOFORM DISORDERS   Somatization Disorder (in the DSM-IV-TR) v      Hysteria or Briquet’s syndrome ( v      DSM-IV-TR does not include the emotional or psychoform symptoms of the Briquet’s syndrome; thus, patients are given diagnoses of somatization disorder and comorbid diagnoses of panic disorder, generalized anxiety disorder, or major depressive disorder; this lead to administration of several medications designed to alleviate specific symptoms. v      Hysteria in (urban) India   Undifferentiated somatoform disorder: Residual category for persistent somatoform type illnesses that do not meet full criteria for somatization disorder.   Neurasthenia in China is one of the most commonly diagnosed disorders in China.   Conversion disorder (listed in the ICD-10 as a dissociative disorder) is characterized by pseudoneurological (dissociative somatic) symptoms such as amnesia, paralysis, impaired coordination, or balance, localized anesthesia, blindness, deafness, double vision, hallucination, tremors, seizures without medical explanations. These symptoms typically result from exposure to traumatic events and from emotional stress.   Pain disorder. Is characterized by a subjective experience of pain that does not have sufficient medical justification. v      With psychological factors v      With both psychological factors and a general medical condition   Hypochondriasis is characterized by persistent and unfounded fears of having serious disease based on misinterpretation of normal bodily functions or minor symptoms.   Body dysmorphic disorder is characterized by a person’s belief that the appearance is somehow defective; complaints involve perceived defects in the face or head, but can involve any body part. In the US it frequently results in cosmetic surgery.      

  • Somatoform DisordersSomatoform Disorders

    •• 300.81 Somatization Disorder300.81 Somatization Disorder •• 300.82 Undifferentiated Somatoform Disorder300.82 Undifferentiated Somatoform Disorder •• 300.11 Conversion Disorder300.11 Conversion Disorder •• 307.80 Pain Disorder Associated With Psychological 307.80 Pain Disorder Associated With Psychological •• 307.80 Pain Disorder Associated With Psychological 307.80 Pain Disorder Associated With Psychological

    FactorsFactors •• 307.89 Pain Disorder Associated With Both Psychological 307.89 Pain Disorder Associated With Both Psychological

    Factors & a General Medical ConditionFactors & a General Medical Condition •• 300.7 Hypochondriasis300.7 Hypochondriasis •• 300.7 Body Dysmorphic Disorder300.7 Body Dysmorphic Disorder •• 300.82 Somatoform Disorder NOS300.82 Somatoform Disorder NOS

    SOMATOFORM DISORDERS   Somatization Disorder (in the DSM-IV-TR) v      Hysteria or Briquet’s syndrome ( v      DSM-IV-TR does not include the emotional or psychoform symptoms of the Briquet’s syndrome; thus, patients are given diagnoses of somatization disorder and comorbid diagnoses of panic disorder, generalized anxiety disorder, or major depressive disorder; this lead to administration of several medications designed to alleviate specific symptoms. v      Hysteria in (urban) India   Undifferentiated somatoform disorder: Residual category for persistent somatoform type illnesses that do not meet full criteria for somatization disorder.   Neurasthenia in China is one of the most commonly diagnosed disorders in China.   Conversion disorder (listed in the ICD-10 as a dissociative disorder) is characterized by pseudoneurological (dissociative somatic) symptoms such as amnesia, paralysis, impaired coordination, or balance, localized anesthesia, blindness, deafness, double vision, hallucination, tremors, seizures without medical explanations. These symptoms typically result from exposure to traumatic events and from emotional stress.   Pain disorder. Is characterized by a subjective experience of pain that does not have sufficient medical justification. v      With psychological factors v      With both psycho

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