Chapter 8 - Management of somatoform disorders

Summary

Some familial preponderance with somatization disorder has been found in 10% to 20% of first-degree female relatives. An increased incidence of alcohol abuse, antisocial personality disorder, and depression has been reported in first-degree male relatives. The differential diagnosis includes anxiety disorders, factitious disorder, malingering, mood disorders, multi-system medical disorders, schizophrenia with somatic delusions, and other somatoform disorders. Cognitive-behavioral therapy (CBT) reduces disability, physical symptoms, and psychological distress for both somatoform disorders and medically unexplained physical symptoms. Caution is prudent in making this diagnosis as many organic disorders may present in a similar fashion to conversion disorders. Hypochondriasis (HC) is the misinterpretation of benign symptoms resulting in preoccupation with having a serious disease. Patients with body dysmorphic disorder (BDD) are thought to be fearful of negative appraisals from others, because of a bias for misinterpreting facial expressions as negative.