Somatisation Disorders (incomplete)

Definition

Multiple

Characterised by repeated presentation of medically unexplained symptoms affecting multiple organ systems (at least 2) - presenting before the age of 40

Usually chronic in adults

Children: involves 1 or a few organ systems for shorter period

Full blown disorder = Briket's disorder

Clinical Features

Non-specific, atypical symptoms

Discrepancy between subjective and objective findings

Symptoms are usually concentrated on one system at a time but may move to another

Multiple, atypical and inconsistent medically unexplained symptoms in patient under 40

Aetiology

  • Observable clinical association with childhood illnesses in the patient
  • History of parental anxiety towards illness
  • Increased frequency of somatisation disorder in 1st degree relatives
  • Association with sexual abuse in childhood

Epidemiology

Lifetime prevalence of 0.2%

F > M

Diagnosis

ICD-10 F.45

A) History of at least 2 years complaints of multiple and variable physical symptoms that cant be explained by any detectable physical disorder

B) Preoccupation with the symptoms causes epristent distress and leads to seeking >6 consultations/investigations from doctors

C) Peristent refusal to accept medical advice that there is no apparent physical cause for the physical symptoms

D) Total of >6 symptoms from multiple body systems with symptoms occuring in at least 2 seperate groups

Management

Initial Management

  • Communicate the diagnosis
  • Acknowledge severity and experience of distress
  • Emphasise negative investigations
  • Assess and treat psychiatric comorbidity as necessary
  • reduce and stop unnecessary drugs

Ongoing Management

Psychotherapy

Use of eclectic psychotherapy gives insight into psychological disorders