Somatic Symptoms and Related
Disorder
Muh. Irsan Hidayat
B A G I A N / S M F I L M U K E D O K T E R A N J I WA
FA K U LTA S K E D O K T E R A N U N I V E R S I TA S S A M R AT U L A N G I
R S U P P R O F. R . D . K A N D O U M A N A D O
DEFINISI
• Istilah somatoform berasal dari bahasa Yunani sama artinya tubuh; dan gangguan
somatoform adalah kelompok penyakit yang luas dan memiliki tanda serta gejala
yang berkaitan dengan tubuh sebagai komponen utama
• Gangguan ini mencakup interaksi pikiran-tubuh, di dalam interaksi ini, dengan
cara yang masih belum diketahui, otak mengirimkan berbagai sinyal yang
memengaruhi kesadaran pasien dan menunjukkan adanya masalah serius di
dalam tubuh.
SOMATIC SYMPTOM DISORDER
A. One or more somatic symptoms that are distressing or result in significant
disruption of daily life.
B. Excessive thoughts, feeli ngs, or behaviors related to the somatic symptoms or
associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one's
symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
• Although any one somatic symptom may not be continuously present, the state of
being symptomatic is persistent (typically more than 6 months).
ILLNESS ANXIETY DISORDER
A. Preoccupation with having or acquiring a serious i l lness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If
another medical condition is present or there is a h igh risk for developing a
medical condition (e.g., strong family history is present), the preoccupation is
clearly excessive or disproportionate.
C. There is a h igh level of anxiety about health, and the individual is easily
alarmed about personal health status.
ILLNESS ANXIETY DISORDER (CONT)
D. The individual performs excessive health-related behaviors (e.g., repeatedly
checks his or her body for signs of ill ness) or exhibits maladaptive avoidance (e.g.,
avoids doctor appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific ill
ness that is feared may change over that period of time.
F. The i l lness-related preoccupation is not better explained by another mental
disorder, such as somatic symptom disorder, panic disorder, generalized disorder,
body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder,
somatic type.
CONVERSION DISORDER (CURRENT
NEUROLOGICAL SYMPTOM DISORDER)
A. One or more symptoms of altered voluntary motor or sensory function
B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical conditions
C. The symptom or deficit is not better explained by another medical or mental
disorder
D. The symptom or deficit caused clinically significant areas of functioning or
warrants medical evaluation.
CONVERSION DISORDER (CURRENT
NEUROLOGICAL SYMPTOM DISORDER) - CONT
• Conversion Disorder, with weakness or paralysis
• Conversion Disorder, with abnormal movement
• Conversion Disorder, with swallowing symptom
• Conversion Disorder, with speech symptom
• Conversion Disorder, with attacks or seizures
• Conversion Disorder, with anesthesia or sensory loss
• Conversion Disorder, with special sensory symptom
• Conversion Disorder, with mixed symptoms
PSYCHOLOGICAL FACTORS AFFECTING
OTHER MEDICAL CONDITIONS
A. A medical symptom or condition (other than a mental disorder) is present
B. Psychological or behavioural factors adversely affect the medical condition in
one of the following ways.
1. The factors have influenced the course of the medical condition as shown by
close temporal association between the psychological factors and the development
of exacerbation of, or delayed from medical condition
2. The factors interfere with the treatment of the medical condition (e.g. poor
adherence)
PSYCHOLOGICAL FACTORS AFFECTING
OTHER MEDICAL CONDITIONS
3. The factors constitute additional well-established health risks for the individual
4. The factors influence the underlying pathophysiology, precipitating or
exacerbating symptoms or necessitating medical attention
C. The psychological and behavioural factors in Criterion B are not better
explained by another mental disorder (e.g., panic disorder, major depressive
disorder, post traumatic stress disorder)
ETIOLOGI
• Kausa utama: penyakit SSP, penyakit sistemik, baik intoksikasi maupun keadaan
putus obat dari zat farmakologis atau toksik
- Saat mengevaluasi pasien delirium, klinisi harus menganggap bahwa obat
apapun yang dikonsumsi pasien dapat terkait secara kausatif dgn deliriumnya
FACTITIOUS DISORDER IMPOSED ON SELF
A. Falsification of physical or psychological signs or symptoms, or induction of
injury or disease, associated with identified deception
B. The individual presents himself or herself to other as ill, impaired, or injured
C. The deceptive behaviour is evident even in the absence of obvious external
rewards
D. The behaviour is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorder
• Specify: Single episode; Recurrent episodes
FACTITIOUS DISORDER IMPOSED ON ANOTHER (PREVIOUSLY
FACTITIOUS DISORDER BY PROXY)
A. Falsification of physical or psychological signs or symptoms, or induction of
injury or disease, associated with identified deception
B. The individual presents another individual (victim) to other as ill, impaired, or
injured
C. The deceptive behaviour is evident even in the absence of obvious external
rewards
D. The behaviour is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorderSpecify: Single episode;
Recurrent episodes
TREATMENT
Patients with somatic symptom disorder usually resist psychiatric treatment,
although some accept this treatment if it takes place in a medical setting and
focuses on stress reduction and education in coping with chronic illness. Group
psychotherapy often benefits such patients, in part because it provides the social
support and social interaction that seem to reduce their anxiety. Other forms of
psychotherapy, such as individual insight-oriented psychotherapy, behavior
therapy, cognitive therapy, and hypnosis, may be useful..
TREATMENT
Frequent, regularly scheduled physical examinations help to reassure patients
that their physicians are not abandoning them and that their complaints are being
taken seriously. Invasive diagnostic and therapeutic procedures should only be
undertaken, however, when objective evidence calls for them. When possible, the
clinician should refrain from treating equivocal or incidental physical examination
findings.
TREATMENT
Pharmacotherapy alleviates somatic symptom disorder only when a patient has
an underlying drug-responsive condition, such as an anxiety disorder or depressive
disorder. When somatic symptom disorder is secondary to another primary mental
disorder, that disorder must be treated in its own right. When the disorder is a
transient situational reaction, clinicians must help patients cope with the stress
without reinforcing their illness behavior and their use of the sick role as a solution
to their problems.
TERIMA KASIH
