n CME : Your SA Journal of CPD - Managing the somatoform disorders : main topic

Volume 21, Issue 3
  • ISSN : 0256-2170



Somatomform disorders are characterised by physical symptoms in the absence of a diagnosable medical condition. Somatoform disorders are classified in the DSM-IV into five specific types: somatisation disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder. Somatisation disorder exhibits a combination of multiple organ symptoms, involving pain, gastrointestinal, sexual and pseudoneurological symptoms. Conversion disorder is defined by the presence of one or more neurological symptoms, e.g. blindness, paralysis, seizures or numbness. Hypochondriasis is defined by the presence of a preoccupation with fears of having a serious disease. Physical symptoms are misinterpreted. Body dysmorphic disorder is characterised by a preoccupation with an imagined anatomical defect such as a large nose, or an exaggeration of a minor appearance defect. Pain disorder is similar to conversion disorder, with pain being the presenting complaint. Management should be prompt, with a thorough assessment, initially directed at excluding an underlying physical illness. A complete psychiatric assessment may be required, and identification of co-morbid psychiatric conditions may have significant implications regarding treatment and prognosis. The doctor-patient relationship may suffer or be severely strained. Psychopharmacological treatments and/or cognitive behaviour therapy may be indicated.

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