Individual Planning: A Treatment Plan Overview for Individuals with Somatization Disorder

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1 COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals with Somatization Disorder Individual Planning: A Treatment Plan Overview for Individuals with Somatization Disorder. Spend at least 1hour developing different treatment Somatization disorder (also Briquet's disorder or, in antiquity, hysteria) is a psychiatric diagnosis applied to patients who chronically and persistently complain of varied physical symptoms that have no identifiable physical origin. One common general etiological explanation is that internal psychological conflicts are unconsciously expressed as physical signs. Patients with Somatization Disorder will typically visit many doctors trying to get the treatment they think they need. However, it must be remembered that this behavior would also occur if the patient had a genuine physical condition that previous physicians had failed to diagnose. The first step for a physician must be to take the patient's claims seriously and consider if their symptoms match any other known condition. Criteria Somatization disorder is a somatoform disorder. The DSM-IV establishes the following five criteria for the diagnosis of this disorder: a history of somatic symptoms prior to the age of 30 pain in at least four different sites on the body two gastrointestinal problems other than pain such as vomiting or diarrhea one sexual symptom such as lack of interest or erectile dysfunction one pseudoneurological symptom similar to those seen in Conversion disorder such as fainting or blindness. Such symptoms cannot be related to any medical condition. The symptoms do not all have to be occurring at the same time, but may occur over the course of the disorder. If a medical condition is present, then the symptoms must be excessive enough to warrant a separate diagnosis. Two symptoms cannot be counted for the same thing e.g.if pain during intercourse is counted as a sexual symptom it cannot be counted as a pain symptom. Finally, the symptoms cannot be being feigned out of an effort to gain attention or anything else by being sick, and they cannot be deliberately induced symptoms. People suffering from temporal lobe epilepsy are often misdiagnosed as having somatization disorder. This occurs because their seizures are not convulsive, sometimes involve hallucinations, and are often difficult to capture on an EEG. Somatization disorder is a hard disorder to diagnose but, there are two tests to determine if you have it. A physical examination of the specified areas that the symptom seems to be in is the first test, along with thorough clinical evaluation of the patients expressed symptoms. This is to determine whether or not the pain is due to a physical cause. Once the physical cause is ruled out, then a psychological test is performed to rule out any other related disorders. Since there is no definite way to determine somatization disorder just from a simple test, those other tests are performed to rule out the other possibilities.

2 Causes Although somatization disorder has been studied and diagnosed for over a century now, there is still little known of what causes it. The basic concept behind it is a misconnection between the mind and the body. Experts really do not know the cause of it or why it occurs. There is a possibility in some cases that the condition is more a factor of the physicians lack of knowledge, or attitude to chronic illness, than any psychological factor in the patient. It seems that the disorder is often familial. Three theories provide the best reasons of this disorder. The first theory and one of the oldest theories is that it is your body s own defense against psychological stress. The mind can only handle so much stress and strain. Therefore, when the brain reaches a point where the stress is too much, it transfers the pain and stress throughout the body but mainly the digestive system, nervous system, and reproductive system. Over the years researchers have found connections between the brain, immune system, and digestive system which may be the reason why somatization affects those systems and that people with Irritable bowel syndrome are more likely to get somatization disorder. This theory also helps explain why depression is related to somatization. The second theory for the cause of somatization disorder is that the disorder occurs due to the heightened sensitivity of internal physical sensations. Some people have the ability to feel even the slightest amount of discomfort or pain within their body. With this hypersensitivity the patient would feel possibly the little pains that the brain normally would not register in the average person such as minor changes in heartbeat. Somatization disorder would then be very closely related to panic disorder under this theory. However, not much is known about hypersensitivity and its relevance to somatization disorder. The psychological or physiological origins of hypersensitivity are still not that well understood by experts. The third theory is that somatization disorder is caused by one s own negative thoughts and overemphasized fears. Their catastrophic thinking about even the slightest ailments such as thinking a cramp in their shoulder is a tumor, or shortness of breath is due to asthma, could lead those who have somatization disorder to actually worsen their symptoms. This then causes them to feel more pain for just a simple thing like a headache. Often the patients feel like they have a rare disease. This is due to the fact that their doctors would not be able to have a medical explanation for their over exaggerated pain that the patient actually thinks is there. This thinking that the symptom is catastrophic also often reduces the activities they normally do. They fear that doing activities that they would normally do on a regular basis would make the symptoms worse. The patient slowly stops doing activities one by one until they practically shut themselves from a normal life. With nothing else to do it leaves more time to think about the "rare disease" they have and consequently ending in greater stress and disability. Prevalence Somatization disorder is not common in the general population. It is thought to occur in 0.2% to 2% of females,and according to the DSM-IV, 0.2% of males. There is usually co-morbidity with other psychological disorders, particularly mood or anxiety disorders. This condition is chronic and has a poor prognosis. Although the disorder occurs most often in women, the male relatives of affected women have an increased risk of substance-related disorders and antisocial personality disorders.phillips, Katherine A. MD. "Somatization Disorder." Certain symptoms of the disorder vary across different cultures as well. For example, the symptom of a sensation of worms in the head or ants crawling under the skin is more prone to those of African and South Asian countries than those in North American countries. Treatment Somatization disorder is usually chronic and difficult to treat as patients are over-focused on the physical symptoms and are lacking insight on their psychological difficulties. However, setting up a physician that screens complaints from patients before they are allowed to see a specialist significantly cuts down on the financial cost of the disorder. Antidepressants and

3 cognitive behavioral therapy have been shown to help treat the disorder. Collaboration between a psychiatrist and primary care physician may help. These will not fully treat the disorder though. The CBT helps with the patient realizing that the ailments are not as catastrophic. Enabling them to slowly get back to doing activities that they once were able to do without fear of "worsening their symptoms." Because the symptoms of somatization disorder can come and go or the severity of the pain can vary drastically, it is often that patients with the disorder usually leave it untreated. If the disorder is left untreated then many serious problems could arise. The main concern if not treated, is the possibility of eventually becoming handicapped. The pain that is caused by somatization disorder may eventually become too much to deal with and the patient would be incapable to work or even do simple everyday things. Another consequence of not properly treated somatization disorder is not as drastic as becoming disabled or handicapped. Since somatization disorder can be difficult to diagnose, in some cases doctors will tell their patients that the symptoms are "just in their heads" or imaginary, leaving the disorder untreated. Doctors may just prescribe medicine for the pain. Since the pain is due to a psychological issue the patient would not feel any better after taking the pain medications. Thus, they would take more and more, leading to an addiction to the medication. Addiction to any medication has a psychological effect on the brain and may interfere with other brain functions. Prevention There is really no way to prevent the acquisition of somatization disorder. However those who are prone to obtaining the disorder should have greater awareness of it. This can be obtained by going to counseling or other psychological conventions. Also having a good relationship with a health care provider is very beneficial. With early knowledge of the disorder, patients will be well aware of how to deal with stressors, which could help keep the symptoms from becoming more severe. Behavioral Definitions for Individuals with Somatization Disorder: Preoccupation with some imagined defect affecting appearance. Excessive concern about a small physical abnormality. A physical symptom caused by a psychosocial stressor linked a psychological conflict. Excessive preoccupation or fear of having a serious physical disease without any medical basis. A number of physical complaints that have no organic foundation causing a change in normal life (such as, seeing doctors often, taking prescriptions, and not been able to complete responsibilities). Excessive worry with chronic pain grossly beyond what is expected for a physical malady or in spite of no known organic cause. One or more physical vague complaints that have no known organic basis. Complaining is in excess of what is expected. Preoccupation with pain or anatomical sites with both psychological factors Poor everyday functioning or impairment due to excessive concern on pain. Long Term Goals for Individuals with Somatization Disorder: Decrease frequency of physical complaints and better the level of independent functioning. Decrease expressions focusing on pain while increasing productive activities. Learn to accept body appearance as normal with insignificant flaws. Learn to accept self as relatively healthy with no known medical illness. Better physical functioning by increasing coping mechanisms for stress management. Short Term Goals for Individuals with Somatization Disorder: Explore negative feelings about his or her body and discuss self-prediction of catastrophized

4 thinking of perceived body abnormality. Probe roots for emotional stress that underlie the focus on physical Explore any secondary gains from physical Increase an understanding of a relationship between emotional conflict and physical Identify and list causes for anger. Learn and practice expressing angry feelings assertively and directly. Identify and list pleasurable and constructive activities that can replace or serve as a diversion from self-preoccupation. Increase social activities that can replace being preoccupied with self and physical Identify and list any family patterns that focus on physical maladies. Identify and list the causes for feelings of low self-esteem and inadequacy. Identify the connection between negative body image and general low self-esteem. Increase acceptance of body and appearance. Teach and encourage the use of relaxation skills to decrease tension in response to stress. Increase or begin daily exercise to decrease tension and increase a sense of confidence in own body. Report any examples of taking active control over events rather than passively reacting like a victim. Set aside time each day to focus on, talk about, and write in a journal details of physical Implement a self-confrontation technique to decrease the focus on physical symptoms. Identify and list coping behaviors that will be used when physical symptoms appear. Probe family and friends about their concern about the patient's physical Decrease physical complaints, doctor visits, and reliance on medication. Increase verbal assessment of self as able to function normally and productively. Learn to begin normal responsibilities without complaints or withdrawal into avoidance using physical problem as excuse. Refer to a pain clinic to learn pain management techniques. Interventions for Individuals with Somatization Disorder: Probe patient's initial complaints without rejection or confrontation. Refocus physical complaints to emotional conflicts. Assess roots of emotional pain: feelings of fear, inadequacy, rejection, or abuse. Increase insight into the secondary gain received from physical illness, Increase understanding of connection between physical complains and avoidance of facing emotional conflicts. Assess causes for anger. Use role-playing and behavioral rehearsal to teach assertiveness, and an assertive expression of angry feelings. Train in assertiveness or refer to an assertiveness-training class. Encourage assertiveness to attain a healthy need to satisfy a need versus to whining helplessness. Define a list of pleasurable activities that can serve as rewards and diversions from physical complains. Implement activities that remove focus from self and redirect toward hobby, social activities, assisting others, completing projects, or returning to work. Assess family history of modeling and reinforcement of physical Explore roots of low self-esteem and fears of inadequacy during childhood. Teach the connection between low self-esteem and preoccupation with self-body image. Increase positive feedback when symptom-free behavior is evident, or accepting of body as

5 normal. Decrease worries by using increased exercise, sex, or joy, along with a plan of how to implement. Teach patient relaxation techniques using biofeedback, deep breathing, and positive imagery techniques. Implement a daily exercise routine to reduce stress and focus on self. Encourage skills to take control of his or her environment rather than continue helplessness, frustration, anger, or self pity. Structure specific times each day for the patient to think about, talk about, and write down his or her physical problems. Structure times that the patient will not focus on physical condition., and discuss and monitor in therapy. Create a system that each time the patient complains she or he must perform a specific task that is necessary but he or she finds unpleasant, monitor for compliance and results. During therapy try to predicting the next attack or physical complain and then plan how it will handle it when it comes. Encourage patient to always questioned those around him or her on their views and concerns about the complain, and what they would recommend to do each time a physical complaint or concern occurs. Report results to therapist. Confront and encourage patient to endure pain and carry on with responsibilities, to increase self-esteem and a sense of empowerment. Identify and list the destructive social impact on friends and family due to his or her verbalization of complains or negative body focus. Monitor the referral to a pain clinic. Copyright 2011 THERAPYTOOLS.US All rights reserved