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PubMedDate not supplied

Searching for a gastrointestinal subgroup within the somatoform disorders.

The authors examined whether patients suffering from functional gastrointestinal symptoms constitute a separate group within the broader concept of the somatoform disorders. The authors compared 103 patients with a severe gastrointestinal syndrome, 220 patients with a somatization syndrome according to DSM-IV, and 250 clinical control subjects with nonsomatoform mental disorders. The gastrointestinal group showed more catastrophizing thinking, complained more about autonomic sensations, felt bodily weaker, was less tolerant towards bodily discomfort, had developed more hypochondriacal fears and behaviors, was more depressed, and was more severely disabled in different areas of psychosocial functioning than the other groups. These differences, however, disappeared when general somatization was controlled for by analysis of covariance. Only a small effect related to dysfunctional cognitions remained specific to the gastrointestinal syndrome. Because these results do not confirm the idea of an independent gastrointestinal syndrome, general mechanisms of somatization seem to play the dominant role.

Adolescent↗

PubMed1999

[Personality of patients with somatoform disorders].

36 patients of a medical outpatient clinic with cardiopulmonary and gastrointestinal somatoform complaints were interviewed two times at an interval of one year about physical symptoms, personal characteristics and need for professional assistance. The investigated patients felt more depressed than a normal cohort of comparable age. In 25% of the tests a disorder of personality according to ICD-10 was diagnosed. Anxious/depressive and obsessive/compulsive personality traits were predominant. Patients with suspected personality disorder felt more disturbed by a somatoform disorder, had more diffuse complaints and suffered more from symptoms of exhaustion. They were less satisfied with the obtained treatment but did on an average not demand more medical help than patients without personality disorders. The results are discussed with regard to the importance to treat patients with somatoform disorders and to the prognosis of the further course of disease.

Adolescent↗

PubMed1992

Respiratory stridor and repressive defense style in adolescent somatoform disorders.

Three cases of adolescents with respiratory stridor of psychiatric etiology are described. All three fulfilled DSM-III-R criteria for diagnoses of somatoform disorders and showed characteristics of repressive defense style. Such patients are likely to undergo extensive medical investigation and treatment if the psychiatric nature of their disorder is not recognized, but few data describing their psychological characteristics or treatment exist. Repressors are typically unaware of emotional arousal and do not recognize the negative affects which lead to their somatic symptoms. They therefore respond poorly to confrontational psychotherapy and are at risk of discontinuing treatment and repeating their maladaptive symptom cycle. Identification of repressive defense style in patients with stridor which has no obvious organic cause may be useful both as a possible "marker" of psychiatric disorder and as a guide to treatment.

Adolescent↗

PubMed1993

[Somatoform disorders. Analysis of 43 patients in an unit of internal medicine. Diagnostic attitude and proposal of management].

The frequency of hospitalization for somatoform disorders in France has been difficult to evaluate owing to the lack of papers published on this subject. Retrospective analysis of the medical records of 43 patients hospitalized on an internal medicine ward for whom this diagnosis was retained enabled us to characterize this population according to the following criteria: socioeconomic-professional group, family environment, probable triggering factors, and patient's evolution before and after hospitalization. Based on this study, we propose a diagnostic approach to and some guidelines for management of these patients, and discuss their place in internal medicine.

Adult↗

PubMed1984

An adoption study of somatoform disorders. III. Cross-fostering analysis and genetic relationship to alcoholism and criminality.

The genetic and environmental antecedents of two clinically distinct somatoform disorders were compared in 859 Swedish women adopted at an early age by nonrelatives. The characteristics of both the biological and adoptive parents of high-frequency "somatizers" were different from those of diversiform somatizers. The risk of diversiform somatization was increased in the adopted-away daughters of men treated for male-limited (type 2) alcoholism, but not in daughters of milieu-limited (type 1) alcoholics. In contrast, the biological fathers of high-frequency somatizers often had a history of recurrent convictions for violent crimes since adolescence, but no treatment for alcoholism. Similarly, alcohol abuse by the adoptive father was associated with increased risk of diversiform but not high-frequency somatization. Thus, high-frequency and diversiform somatization are not only clinically distinct, but also have different genetic and environmental backgrounds. The association of diversiform somatization with male-limited alcoholism, and not with milieu-limited alcoholism, also provides independent support for our earlier distinction between these two types of alcoholism.

Adolescent↗

PubMed1987

Cyproheptadine dependence associated with an atypical somatoform disorder.

A case is described of cyproheptadine dependence in a woman with a persistent belief that she was too thin, and diagnosed with an atypical somatoform disorder. The cyproheptadine was initially prescribed to promote weight gain but its continued use seemed related to other psychological and/or pharmacological effects. Cognitive impairment was present, possibly as a result of the longstanding cyproheptadine abuse. There have been no previous reports of cyproheptadine dependence or of CNS toxicity from its long-term use.

Adult↗

PubMed1991

Suspicion of somatoform disorder in undiagnosed tabes dorsalis.

We present a case of tabes dorsalis, which consisted of intermittent, sharp pains and diffuse neurological abnormalities, and was initially considered to be a somatoform disorder. The unusual behavioural presentations of neurosyphilis may lead to premature psychiatric diagnoses. It is thus important that psychiatric consultants be aware of the myriad manifestations of the disease.

Diagnosis, Differential↗

PubMed1997

[In the gray area between body, psyche and social difficulties. II: Psychiatric assessment of somatoform disorders (exemplified by chronic pain patients].

Medico-legal assessment for long-term disability benefits in patients with mainly somatoform pain disorders is in increasing demand. Since impairment does not explain the loss of function in somatoform disorders, the expert must determine to what extent the patient is able to cope more actively with pain in order to attain a higher level of functioning. Consistency of behavioral signs, flexibility and initiative in the way of coping are helpful criteria in this respect. Special attention is given to problems in the assessment of migrants with these disorders. We strongly support the concept of an interdisciplinary approach in medico-legal assessment. Postgraduate medical training in this field should receive greater attention accordingly.

Disability Evaluation↗

PubMed2000

Hypochondriasis and somatization: two distinct aspects of somatoform disorders?

We investigated boundaries and overlap between somatization and hypochondriasis on different levels of psychopathology: (1) comorbidity between hypochondriasis and somatization on the level of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994): (2) comorbidity with other mental disorders; (3) differences in clinical characteristics: and (4) overlap on the level of psychometric measures. The sample consisted of 120 psycho somatic inpatients. Somatoform, hypochondriacal, and depressive symptomatology, cognitions about body and health, and further aspects of general symptomatology were investigated. Diagnoses of Axis I and II were based on DSM-IV Our results suggest a large overlap on the level of DSM-IV-diagnoses: only 3 of 31 hypochondriacal patients had no multiple somatoform symptoms, while 58 of 86 patients with multiple somatoform symptoms had no hypochondriasis. However, the overlap between hypochondriacal and somatization symptomatology on the level of psychometric measurement is only moderate, indicating that hypochondriasis is a markedly distinct aspect of somatoform disorders.

Adult↗

PubMed2003

[Subjective body experience and therapy of somatoform disorders].

The article addresses the problem of subjective body experience in patients with somatoform mental disorders. Perspectives of multi-axial model of subjective body experience and methodical approaches to its descriptions are discussed. Different variants of body experience organization are described. Clinical peculiarities of somatoform mental disorders were closely connected with the complicated structure of body experience. Main processes involving body experience are those of self-identification structuring: determination of the borders of subjectivity, relations with objects, representation of self-ego. An analysis of structure of subjective body experience enabled to work out differentiated psychotherapeutic approaches to complex rehabilitation of patients with somatoform mental disorders.

Adult↗

PubMed2000

[Discrepancies between physicians and patients with long-term functional somatoform disorders as a central treatment problem. How the quality of assistance can be improved].

In a qualitative sociological investigation analyses of the process of disease, care and treatment of patients with long-term somatoform disorders were carried out. In connection with this discrepancies between physicians and patients are seen as the central treatment problem. Different views of patients and physicians concerning the way the disorders should be understood and successfully treated lead to crisis in the treatment process and may have serious consequences for the patients. It is shown how the questioned practising family doctors deal with discrepancies in a professional way and how the quality of help increases. Practice-theoretical reflection for the described action and aspects of quality assurance are presented.

Family Practice↗

PubMed2005

Teaching somatoform disorders in a "nervous system and behaviour" course: the opportunities and limitations of problem-based learning.

PURPOSE: To determine the opportunities and limitations of problem-based learning (PBL) in psychosomatic medicine, especially in the field of somatoform disorders. METHOD: A written case of conversion neurosis of a 22-year-old subway worker, who had been suffering from dizziness for the past 18 months, was presented to students as one of seven cases during a "Nervous System and Behaviour" course. RESULTS: Tutors and students are normally accustomed to focusing on organic lesions such as aetiologies for neuro-psychiatric disorders. Understanding behavioural and pseudo-neurological symptomatology without brain damage, accepting emotional and biographical factors and referring to the role of the unconscious seems to be a great challenge for tutors and students alike. DISCUSSION: Studying the case of a somatoform syndrome in a PBL tutorial may teach the students skills in taking the psychosocial history into account and deepen their knowledge of neuro-psychiatric differential diagnosis.

Clinical Competence↗

PubMed2004

Psychobiological aspects of somatoform disorders: contributions of monoaminergic transmitter systems.

OBJECTIVE: To evaluate the possible biological aspects of 'unexplained physical symptoms', this study examined serotonergic and noradrenergic monoamino acids in somatoform disorders and/or depression. METHODS: Blood samples of 150 subjects from 4 groups (somatization syndrome; depression; depression and somatization; controls) were analyzed for amino acids contributing to the serotonergic and noradrenergic system and peripheral muscle energy balance (tryptophan, valine, leucine, isoleucine, phenylalanine and tyrosine). RESULTS: Tryptophan, branched chain amino acids and other serotonergic amino acids were decreased in patients with somatoform symptoms, even when no depression was present. CONCLUSIONS: We conclude that serotonergic amino acids are biological correlates of multiple unexplained symptoms. Ways of action do not only involve brain mechanisms, but also energy metabolism in peripheral muscles.

Adult↗

PubMed2001

[Somatoform disorders. Historical development and modern diagnostic conceptualization].

Patients with "medically unexplained" bodily symptoms form a major group in the medical care system. Diagnostic and therapeutic problems very often arise, and the concept of "somatization" promotes a better understanding of this patient group. Important historical stages in the development toward a modern diagnostic classification of somatoform disorders are outlined. A critical comment on the diagnostic approaches according to DSM-IV and ICD-10 follows.

Conversion Disorder↗

PubMed1985

Treatment outlines for the management of the somatoform disorders. The Quality Assurance Project.

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: the treatment outcome literature, the opinions of a sample of practising psychiatrists and the views of a panel of nominated experts. The recommendations for the treatment of somatoform disorders were as follows: brief dynamic psychotherapy, family therapy and excellent medical consultation are the basis for the treatment of hypochondriasis. Limited long-term supportive psychotherapy and good medical consultation are important in somatization disorder. Symptom relief, psychotherapeutic support and meticulous collaboration with physicians are the keys to managing psychogenic pain disorder. Physiotherapy to improve physical functioning and patient education to facilitate the distinction between normal symptoms and abnormal illness behaviours are important in all three conditions. Neither the benzodiazepines nor behaviour therapy appear to be of use in these conditions.

Adult↗

PubMedDate not supplied

Evidence for overlap between idiopathic environmental intolerance and somatoform disorders.

OBJECTIVE: Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a chronic, polysymptomatic condition that cannot be explained by an organic disease. Physical and psychological complaints are believed to be sustained by low levels of chemically unrelated substances in the environment. At present, it is unclear whether IEI is an environmental illness or a variant of somatoform disorders (SFD). This study examined whether IEI can be distinguished from SFD with respect to self-reported symptoms, trait anxiety, body-related cognitions, and symptom attributions. METHODS: We compared 54 subjects with IEI, 54 subjects with SFD but without IEI, and 44 subjects with neither IEI nor SFD on symptom scales, psychological questionnaires, and structured interviews for IEI, depression, anxiety, and SFD. RESULTS: More than half of the IEI subjects met Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria of SFD. This group shared both symptoms and psychological features of somatization with the SFD group. IEI subjects who did not fulfill criteria for a specific SFD were less impaired by their chemical sensitivity but differed nevertheless from nonsomatoform controls by significantly higher symptom scores, higher trait anxiety, a focus on autonomic sensations, and more pronounced somatic symptom attributions. These psychological features were significantly associated with the burden of somatic symptoms in both SFD and IEI. Furthermore, self-reported allergy but not total immunoglobulin E correlated with symptom burden in the total sample. CONCLUSIONS: The similarity of IEI and SFD regarding symptoms and psychological features of somatization support the hypothesis that IEI is a variant of SFD.

Adult↗

PubMed2006

Depression, pain, and somatoform disorders.

PURPOSE OF REVIEW: The frequent co-occurrence of depression and somatic symptoms poses a continuing challenge to clinicians, researchers and experts involved in drawing up classifications. In this review we present recently published literature on aspects of epidemiology, classification and treatment in this important overlap area. RECENT FINDINGS: From the multitude of papers published annually on the co-occurrence of different pain conditions and depression, temporomandibular dysfunction stands out this year by sheer quantity; it can be seen as a model case of the necessity for differentiated high-quality assessments on the biological as well as the psychosocial level. There is a general move to separate utility of diagnostic classifications from their validity, and this strengthens classificatory approaches that help to view the regular overlap of depression, pain and other somatic symptoms as the rule rather than the exception. The incorporation of cognitive variables like causal attributions should help to distinguish clinically relevant subtypes among overlap cases. The classificatory future of the category of 'somatoform disorders' is somewhat in doubt, but reforms seem to be more productive than abolishment. Psychopharmacology provides rather intense recent coverage of the overlap field, with newer dual serotonergic-noradrenergic reuptake inhibitors offering some promise. SUMMARY: Treating the overlap of depression, pain and other somatic symptoms as the rule rather than the exception is necessary for adequate aetiological research as well as for diagnosis and treatment, with one-dimensional classificatory and treatment approaches almost certainly being insufficient.

Depression↗

PubMed1994

Somatoform disorders: personality and the social matrix of somatic distress.

Personality traits that may contribute to somatization are reviewed. Negative affectivity is associated with high levels of both somatic and emotional distress. Agreeableness and conscientiousness may influence interactions with health care providers that lead to the failure of medical reassurance to reduce distress. Absorption may make individuals more liable to focus attention on symptoms and more vulnerable to suggestions that induce illness anxiety. More proximate influences on the selective amplification of somatic symptoms include repressive style, somatic attributional style, and alexithymia; however, data in support of these factors are scant. Most research on somatoform disorders confounds mechanisms of symptom production with factors that influence help seeking. Longitudinal community studies are needed to explore the interactions of personality with illness experience and the stigmatization of medically unexplained symptoms.

Adaptation, Psychological↗