Chapter 19

Somatoform
Disorders
Somatization is the transference of mental
experiences and states into bodily
symptoms.

Somatoform disorders are

the presence of physical
symptoms that suggest a
medical condition without
a demonstrable organic
basis to account fully for
them.
The three central features of somatoform
disorders:
• Physical complaints suggest major medical
illness but have no demonstrable organic
basis
• Psychological factors and conflicts seem
important in initiating, exacerbating, and
maintaining the symptoms
• Symptoms or magnified health concerns are
not under the client’s conscious control
Five specific somatoform disorders:
• Somatization disorder: multiple physical
symptoms; combination of pain, GI, sexual,
and pseudoneurologic symptoms
• Conversion disorder: unexplained deficits
in sensory or motor function associated with
psychological factors; attitude of la belle
indifference (lack of concern or distress)
• Pain disorder: pain unrelieved by
analgesics; psychological factors influence
onset, severity, exacerbation, and
maintenance
• Hypochondriasis: preoccupation with the
fear that one has a serious disease
(disease conviction) or will get a serious
disease (disease phobia)
• Body dysmorphic disorder:
preoccupation with imagined or
exaggerated defect in physical appearance
 Onset and Clinical Course

• Symptoms usually onset in adolescence or

early adulthood
• All the somatoform disorders are either
chronic or recurrent
• Clients will go from one physician or clinic to
another, or they may see multiple providers
at once in an effort to obtain relief of
symptoms
 Related Disorders

•Malingering is the intentional

production of false or grossly
exaggerated physical or
psychological symptoms; it is
motivated by external incentives
such as avoiding work, evading
criminal prosecution, obtaining
financial compensation, or
obtaining drugs
 Related Disorders

• Factitious disorder occurs when a

person intentionally produces or feigns
physical or psychological symptoms
solely to gain attention
(In malingering and factitious
disorders, people willfully control the
symptoms. In somatoform disorders,
clients do not voluntarily control their
physical symptoms.)
 Related Disorders

Munchausen by proxy occurs when a

person inflicts illness or injury on someone
else to gain the attention of emergency
medical personnel or to be a“hero” for
saving the victim
Munchausen’s syndrome:
a factitious disorder where the person
intentionally causes injury or physical
symptoms to self to gain attention and
sympathy
 Treatment
• Treatment is focused on managing
symptoms, improving quality of life, and
improving coping skills
• Antidepressants are sometimes used for
accompanying depression
• Referral to a pain clinic is helpful in pain
disorder
• Involvement in therapy groups to
improve coping and express emotions
verbally has shown some benefit
 Self-Awareness Issues

• Deal with feelings of frustration

• Be realistic about small successes
• Validate client’s feelings
• Deal with feeling that client “could do
better if he tried”