Name :- DASAYA PRADYUMNA 5018
Topic :- somatoform disorder
Disorder according ICD-10 :- Somatoform disorders are a group of psychiatric conditions where physical
symptoms suggest a medical condition, but no clear organic cause is found. They include:
Somatization disorder (F45.0)
Undifferentiated somatoform disorder (F45.1)
Hypochondriacal disorder (F45.2)
Somatoform autonomic dysfunction (F45.3)
Persistent somatoform pain disorder (F45.4)
Other and unspecified somatoform disorders (F45.8, F45.9)
Etiology 1. Genetic predisposition – Family history of somatoform or related disorders
2. Psychosocial factors – Childhood trauma, abuse, or stressful life events
3. Neurobiological factors – Altered pain perception, serotonin/dopamine
imbalances
Risk Factors 1. Personality traits (neuroticism, alexithymia)
2. Previous medical conditions (chronic illness, history of medical procedures)
3. Psychiatric comorbidities (anxiety, depression, personality disorders)
4. Socioeconomic and cultural influences (low education, social stress, cultural
beliefs)
Diagnoctics Each type of examination may reveal specific findings:
(Explain what
changes will be 1. Clinical examination – No clear organic cause for symptoms despite detailed
with each type of history
examination) 2. Laboratory tests – Rule out metabolic, endocrine, or infectious causes
3. Neuroimaging (MRI, CT scans) – No structural abnormalities to explain
symptoms
4. Psychiatric evaluation – Identifies psychological distress, somatic fixation
5. Autonomic function tests – May reveal functional dysregulation in
somatoform autonomic dysfunction
Simptoms 1. Chronic, multiple, and unexplained physical complaints
2. Pain symptoms (headache, back pain, muscle pain)
3. Gastrointestinal distress (nausea, bloating, diarrhea)
4. Cardiovascular symptoms (palpitations, chest pain)
5. Neurological complaints (dizziness, weakness, pseudoseizures)
6. Sensory disturbances (numbness, tingling, vision changes)
7. High healthcare utilization with dissatisfaction from negative test results
Leading syndrome Somatic symptom syndrome – Distressing physical complaints without
medical explanation
Hypochondriacal syndrome – Persistent fear of serious illness despite medical
reassurance
Pain syndrome – Chronic pain without clear organic cause
Indications for 1. Severe functional impairment affecting daily life
hospital treatment 2. Suicidal ideation or severe depression associated with the disorder
3. Need for extensive diagnostic testing to rule out medical conditions
4. Failure of outpatient treatment or severe psychological distress
Treatment (Each symptom/syndrome with corresponding drug treatment)
(Explain which 1. Somatic symptom distress – SSRIs (Fluoxetine, Sertraline)
symptom / 2. Hypochondriacal concerns – CBT + SSRIs or TCAs
syndrome with 3. Pain syndrome – SNRI (Duloxetine), Pregabalin (for neuropathic pain)
which drug should 4. Anxiety-related symptoms – Benzodiazepines (short-term), Buspirone
be treated) 5. Depressive symptoms – SSRIs (Paroxetine, Escitalopram), Mirtazapine
6. Sleep disturbances – Low-dose Trazodone or Melatonin
7. Severe cases with delusional intensity – Atypical antipsychotics
(Risperidone, Olanzapine)
Non-drug 1. Cognitive Behavioral Therapy (CBT) – To challenge maladaptive health
treatment beliefs
2. Physiotherapy & relaxation techniques – Biofeedback, mindfulness, yoga
3. Supportive psychotherapy – Address emotional distress and trauma
Length of hospital Typically 2-4 weeks depending on severity and response to treatment
treatment
Recommendations 1. Regular outpatient psychiatric follow-up
after hospital 2. Continuation of psychotherapy (CBT, supportive therapy)
treatment 3. Gradual reduction of unnecessary medical testing to avoid reinforcement
4. Lifestyle modifications – Exercise, stress management, social support
Disease prognosis Mild cases – Good prognosis with therapy and lifestyle changes
Chronic cases – May persist for years but can improve with structured
treatment
Poor prognosis – Associated with comorbid psychiatric disorders and persistent
avoidance of psychological intervention
Special Notes Avoid excessive medical investigations unless indicated
Address comorbid depression/anxiety early
Build a strong therapeutic alliance to reduce doctor-shopping behavior
