Somatoform disorders

Encyclopedia of Nursing and Allied Health,  ,  by Joan M. Schonbeck

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Body dysmorphic disorder

Body dysmorphic disorder is a new category in DSM-IV. It is defined as a preoccupation with an imagined or exaggerated defect in appearance. Most cases involve features on the patient's face or head, but other body parts-especially those associated with sexual attractiveness, such as the breasts or genitals-may also be the focus of concern. Patients with this disorder are often found in plastic surgery clinics. They frequently have histories of seeking or obtaining plastic surgery or other procedures to repair or treat supposed defects, but it seldom if ever provides them with long-term relief.

Though the average age of body dysmorphic disorder patients is thirty, it is regarded as a chronic condition that usually begins in the patient's late teens and fluctuates over the course of time. It was initially considered to be a relatively unusual disorder, but it is now estimated that two percent of those seeking plastic surgery may be dysmorphic disorder patients. It appears to affect men and women with equal frequency. Some may even meet the criteria for a delusional disorder of the somatic type.

Somatoform disorders in children and adolescents

In children and adolescents, the most common somatoform disorder is conversion disorder, though body dysmorphic disorders are being reported more frequently. Conversion reactions in this age group usually reflect stress in the family or problems with school, rather than long-term psychiatric disturbances. Some psychiatrists speculate that adolescents with conversion disorders frequently have overprotective or over-involved parents with a subconscious need to see their child as sick. In many cases the son or daughter's symptoms become the center of family attention. The rise in incidence of body dysmorphic disorder in adolescents is thought to reflect the increased influence of media preoccupation with physical perfection.

Causes and symptoms

In somatoform disorders, the patient's reported symptoms are considered to be the unconscious manifestation of very real emotional suffering. In classic psychoanalytic theories, unconscious conflicts are the result of painful early-life events that are re-awakened in adult life by similar stressors. Because the person is unable to express the re-awakened emotion because of fear or guilt, their emotions are repressed and changed into physical symptoms.

Because DSM-IV groups the somatoform disorders into their present category on the basis of symptom patterns, their causes as presently understood include several different factors.

Family stress

Family stress is believed to be one of the most common causes of somatoform disorders in children and adolescents. Conversion disorders in this age group may also be connected with physical or sexual abuse within the family of origin.

Parental modeling

Somatization disorder and hypochondriasis may result in part from the patient's unconscious reflection or imitation of parental behaviors. This "copycat" behavior is particularly likely if the patient's parent derived considerable secondary gain from his or her symptoms.