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Somatoform Disorders – Psychological Disorders (PSY)

by Tarry Ahuja, MD
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    00:02 Now we’re going to get into somatoform disorders.

    00:04 This is a psychological disorder characterized primarily by physical symptoms.

    00:08 And the reason why we’re making this differentiation is this is quite common as individuals come in and saying you know, “I have this general pain in my legs and my back,” and the doctor might say, “Well, okay, you have this pain and that’s what you’re describing to me. I’m going to try to treat that pain.” So they might give you a treatment therapy that typically works for low back pain, but it’s not resolving the situation for you.

    00:35 The reason is because the main driver behind why you’re expressing that lower back pain is not actually physical.

    00:42 It’s not that you’ve pulled a muscle or you have a certain virus that’s causing an inflammation in your back, it’s psychologically driven.

    00:50 And so a medicine is not going to treat your psychological disorders.

    00:54 You need a medicine that’s specifically psychologically oriented, right? So this is why it’s difficult for a lot of doctors trying to figure out and establish is this truly a physical disorder or are these really physical symptoms, or is this a psychological disorder that’s being expressed as physical symptoms.

    01:15 Conversion disorder is another one where you experience change in your sensory or motor function.

    01:21 So we’re highlighting two specific types of function now, sensory or motor, with no apparent physiological cause and it is affected by psychological factors.

    01:28 Again, the name implies to you converting psychological -- psychological drivers into a physical response but more specifically to sensory and motor function.

    01:42 So you just treating that sensory or motor function is not going to solve your problem because you need to get down to the underlying psychological factors.

    01:49 Pain disorder is which is previously known as chronic pain disorder is where you suffer from clinically important pain affected by psychological factors.

    01:58 So this would be, I’m feeling a lot of neuropathic pain or just a general fibromyalgia or pain in my legs and my arms.

    02:06 And the pain is there, it’s clinically important, but what’s causing that pain? It’s not because you were beaten by a stick and that’s why your legs hurt.

    02:16 It’s because you have a psychological driver behind that pain.

    02:21 So you’re seeing some commonalities here where you’re seeing something physical, but it’s actually psychologically driven, and that would under the umbrella of somatoform disorders.

    02:32 Now, somatization disorder is again in the same family and you’re going to experience physical symptoms that are linked to psychological drivers, but here we’re a little bit more specific in some of the criteria.

    02:47 So you need to have pain in at least four areas of the body, you need to have at least two GI or gastrointestinal symptoms, you need to have at least one sexual symptom, you need to at least have one pseudoneurological symptom, which is things like your balance or double vision.

    03:02 And so collectively, if you’ve achieved all of those, we can say that you’re a somaticizer or you’re suffering from somatization disorder.

    03:11 Body dysmorphic disorder, so this is when you feel like a specific attribute of your body is bothering you.

    03:19 And I know we all have our likes and dislikes of our physical appearance so we might say, “Well, you know I’m not bad but I hate the length of my arms,” or “I hate my nose” or what have you, and I think that’s fairly normal.

    03:33 But with individuals with body dysmorphic disorder, what’s happening is they are so preoccupied with that slight, we say slight physical anomaly or an imagined defect where really it’s essentially normal and you’re saying, “What are you talking about? Your nose is perfect.” These individuals will hone in on that and focus on that to the point where they can't actually function.

    03:54 And a lot of times this is focused on things like hair, face, breasts, things like that.

    04:00 And that’s all they see.

    04:01 And they focus on it and you’ll be talking to them and you’re saying, “Are you listening to me?” and “Oh, sorry. I was just looking at my hair. It’s driving me nuts. I hate my hair.” And they go on that rant.

    04:10 And we know while at work, all they’re thinking about is, “Oh my God. I maybe I should get it cut or fixed. I can’t deal with this anymore.” It really impacts their ability to function.

    04:21 Hypochondrias is another quite commonly used catchall where we say this individual is concerned, overly concerned or preoccupied with fears of having a serious illness for at least six months.

    04:33 So they don’t actually have an illness.

    04:36 They have a fear that “I think I’m sick.” So say for example you wake up in the morning with a sore throat and you have maybe a small cough and you say to yourself, “Oh no, I think I’m getting a cold.” That’s normal.

    04:52 But an individual who’s hypochondriac might be like, “-- oh God. Yeah. I’m pretty sure that I have SARS. I’m going to die and I have SARS.” And you know, you say, “Well, it’s probably not SARS. Just take it easy.

    05:03 Maybe take some cough syrup,” and then a day later they’re fine and you’re like, “How’s that SARS coming along?” "Oh, it wasn’t SARS actually. I think I’m fine. But I’m still worried about it.” And a couple of days later they might get a small itch on their arm, maybe they changed the detergent that their using and they look at them and say, “Yeah. I’m pretty sure I got skin cancer,” and they make that huge leap and they get into it and they’re so concerned about that and it has to last for kind of an extended period of time.


    About the Lecture

    The lecture Somatoform Disorders – Psychological Disorders (PSY) by Tarry Ahuja, MD is from the course Individual Influences on Behavior.


    Included Quiz Questions

    1. Somatization disorder
    2. Factitious disorder
    3. Malingering
    4. Conversion disorder
    5. Hypochondria
    1. Body dysmorphic disorder
    2. Normal teenage behavior
    3. Somatoform disorder
    4. Anorexia nervosa
    5. Obsessive compulsive disorder
    1. Conversion disorder
    2. Hypochondria
    3. Somatization disorder
    4. Acute stress disorder
    5. Retinal detachment

    Author of lecture Somatoform Disorders – Psychological Disorders (PSY)

     Tarry Ahuja, MD

    Tarry Ahuja, MD


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