SUBMITTED TO SUBMITTED BY

MRS.NEETA AMBORE MR.AMIT TAMBOLI

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Somatoform disorders

Are characterized by physical symptoms suggesting

medical disease but without demonstrable organic
pathology or a known pathophysiological mechanism
to account for them. Learn about the nursing
management for somatoform disorders in this nursing
care plan guide.

Types of Somatoform Disorders

 Somatization disorder. Somatization disorder

is a chronic syndrome of multiple somatic
symptoms that cannot be explained medically and are associated with
psychosocial distress and long-term seeking of assistance from health-care
professionals.
 Pain disorder. The essential feature of pain disorder is severe and prolonged
pain that causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 Hypochondriasis. Hypochondriasis is an unrealistic preoccupation with the
fear of having a serious illness.
 Conversion disorder. Conversion disorder is a loss of or change in body
function resulting from a psychological conflict, the physical symptoms of
which cannot be explained by any known medical disorder or
pathophysiological mechanism.
 Body dysmorphic disorder. This disorder, formerly called dysmorphophobia,
is characterized by the exaggerated belief that the body is deformed or
defective in some specific way.

Pathophysiology

The pathophysiology of somatoform

disorders is unknown.

 Primary somatoform disorders may

be associated with a heightened
awareness of normal bodily
sensations.
 This heightened awareness may be
paired with a cognitive bias to interpret any physical symptom as indicative of
medical illness.
 Autonomic arousal may be high in some patients with somatoform disorders.
 This autonomic arousal may be associated with physiologic effects of
endogenous noradrenergic compounds such as tachycardia or gastric
hypermotility.
 Heightened arousal also may induce muscle tension and pain associated with
muscular hyperactivity, as is seen with muscle tension headaches.


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Statistics and Incidences

Prevalence rates for the most restrictive previous diagnosis of somatoform disorder
appear low in community samples (0.1%).

 One review estimates that the prevalence of somatoform disorder in the

general population is approximately 5%-7%.
 A study in Belgium reported that somatoform disorder is the third highest
psychiatric disorder, with a prevalence rate of 8.9%
 Females tend to present with somatoform disorder more frequently than males,
with an estimated F:M ratio of 10:1.
 Somatoform disorders may begin in childhood, adolescence, or early
adulthood

Causes of Somatoform Disorders

Predisposing factors to somatoform disorders include:

 Genetic. Studies have shown an increased incidence of somatization disorder,

conversion disorder, and hypochondriasis in first-degree relatives, implying a
possible inheritable disposition.
 Biochemical. Decreased levels of serotonin and endorphins may play a role in
the etiology of pain disorder.
 Psychodynamic. Some psychodynamics view hypochondriasis as an ego
defense mechanism; the psychodynamic theory of conversion disorder
proposes that emotions associated with a traumatic event that the individual
cannot express because of moral or ethical unacceptability are “converted”
into physical symptoms.
 Family dynamics. Some families have difficulty expressing emotions openly
and resolving conflicts verbally; when this occurs, the child may become ill,
and a shift in focus is made from the open conflict to the child’s illness,
leaving unresolved the underlying issues that the family cannot confront
openly.
 Sociocultural/familial factors. Somatic complaints are often reinforced when
the sick role relieves the individual from the need to deal with a stressful
situation, whether it be within the society or within the family.
 Past experience with physical illness. Personal experience, or the experience
of close family members with serious or life-threatening illness can predispose
an individual to hypochondriasis.
 Cultural and environmental factors. Some cultures and religions carry
implicit sanctions against verbalizing or directly expressing emotional states,
thereby indirectly encouraging “more acceptable” somatic behaviors.

Clinical Manifestations

Symptoms of somatoform disorder include:

 Pain symptoms. Complaints of

headache, pain in the abdomen, head,
joints, back, chest, rectum; pain during

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 urination, menstruation, or sexual intercourse.
 Gastrointestinal symptoms. There is nausea, bloating, vomiting (other than
during pregnancy), diarrhea, or intolerance of several foods.
 Sexual symptoms. Sexual indifference, erectile or ejaculatory dysfunction,
irregular menses, excessive menstrual bleeding, and vomiting through
pregnancy.
 Pseudoneurologic symptoms. Conversion symptoms such as impaired
coordination or balance, paralysis or localized weakness, difficulty swallowing
or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or
pain sensation, double vision, blindness, deafness, and seizures.

Assessment and Diagnostic Findings

If indicated, specific studies used to rule out somatization due to general medical
conditions include the following:

 Thyroid function studies. Thyroid stimulating

hormone (TSH) at 0.4-10 mIU/L and thyroxine at
5.0-12.5 ng/dL.
 Pheochromocytoma screen. Urine catecholamines,
homovanillic acid (HVA) 2-12 mg per 24 hours,
vanillylmandelic acid (VMA) 2-7 mg per 24 hours,
metanephrines less than 1.6 mg per 24 hours, and
norepinephrine plus epinephrine less than 100 mcg
per 24 hours.
 Urine drug screen. Including cannabis, amphetamine, hallucinogens, cocaine,
opioids, and benzodiazepines.
 Blood studies. To screen for occult alcoholism.
 Psychological testing. Minnesota Multiphasic Personality Inventory (MMPI)
may provide insight into the likelihood of a somatic symptom disorder.

Medical Management of Somatoform Disorders

Randomized trials have demonstrated the value of physician education in the

management of the patient with somatoform disorder.

 Cognitive-behavioral psychotherapy. Cognitive-behavioral psychotherapy

strategies may be specifically helpful in reducing distress and high medical
use.
 Psychosocial therapies. Psychosocial interventions directed by phsyicians
form the basis for successful treatment; a strong relationship between the
patient and the primary care physician can assist in long-term management.
 Psychoeducation. Psychoeducation can be helpful by letting the patient know
that physical symptoms may be exacerbated by anxiety or other emotional
problems; however, be careful because patients are likely to resist suggestions
that their condition is due to emotional rather than physical problems.

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Pharmacologic Management

Based on studies of somatoform disorder, medication approaches rarely are successful

for this condition.

 Antidepressants. SSRIs are greatly preferred over the other classes of

antidepressants; because the adverse effect profile of SSRIs is less prominent,
improved compliance is promoted.

Nursing Management of Somatoform Disorders

Nursing management of a patient with somatoform disorders include the following:

Nursing Assessment

The nurse must investigate physical health status thoroughly to ensure there is no
underlying pathology requiring treatment.

 History. Clients usually provide a lengthy and detailed account of previous

physical problems, numerous diagnostic tests, and perhaps even a number of
surgical procedures.
 General appearance and motor behavior. Often, clients walk slowly or with
an unusual gait because of the pain or disability caused by the symptoms; they
may exhibit a facial expression of discomfort or physical distress.
 Mood and affect. Mood is often labile, shifting from seeming depressed and
sad when describing physical problems to looking bright and excited when
talking about how they had to go to the hospital in the middle of the night by
ambulance.
 Thought process and content. Clients who somatize do not experience
disordered thought processes; the content of their thinking is primarily about
often exaggerated physical concerns, for example, when they have a simple
cold they may be convinced it is pneumonia.

Nursing Diagnosis for Somatoform Disorders

Based on the assessment data, the major nursing diagnosis are:

 Chronic pain related to severe level of anxiety, repressed.

 Ineffective coping related to inadequate coping skills.
 Disturbed body image related to low self-esteem, severe level of anxiety.
 Disturbed sensory perception related to regression to, or fixation in, an
earlier level of development.
 Self-care deficit related to paralysis of body part, pain, discomfort.
 Deficient knowledge related to lack of interest in learning, severe anxiety.

Nursing Care Planning and Goals

The major nursing care plan goals for patients with somatoform disorders are:

 The client will identify the relationship between stress and physical symptoms.

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  The client will verbally express emotional feelings.
 The client will follow an established daily routine.
 The client will demonstrate alternative ways to deal with stress, anxiety, and
other feelings.
 The client will demonstrate healthier behaviors regarding rest, activity, and
nutritional intake.

Nursing Interventions

The nursing interventions for somatoform disorders are:

 Providing health teaching. The nurse must help the client establish a daily
routine that includes improved health behaviors.
 Assisting the client to express emotions. Clients may keep a detailed journal
of their physical symptoms; the nurse might ask them to describe the situation
at the time such as whether they were alone or with others, whether any
disagreements were occurring, and so forth.
 Teaching coping strategies. Emotion-focused strategies include progressive
relaxation, deep breathing, guided imagery, and distractions such as music or
other activities; problem-focused coping strategies include problem-solving
methods, applying the process to identified problems, and role-playing
interactions with others.

Evaluation

Treatment outcomes include:

 The client was able to identify the relationship between stress and physical
symptoms.
 The client was able to verbally express emotional feelings.
 The client was able to follow an established daily routine.
 The client was able to demonstrate alternative ways to deal with stress, anxiety,
and other feelings.
 The client was able to demonstrate healthier behaviors regarding rest, activity,
and nutritional intake.

Documentation Guidelines

Documentation in a client with somatoform disorders include the following:

 Individual findings, including factors affecting, interactions, nature of social

exchanges, specifics of individual behavior.
 Cultural and religious beliefs, and expectations.
 Plan of care.
 Teaching plan.
 Responses to interventions, teaching, and actions performed.
 Attainment or progress toward the desired outcome.

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What are sleep disorders?

Sleep disorders are conditions that impair your sleep or prevent you from getting
restful sleep and, as a result, can cause daytime sleepiness
and other symptoms. Everyone can experience problems
with sleep from time to time. However, you might have a
sleep disorder if:

 You regularly experience difficulty sleeping.

 You are often tired during the day even though
you slept for at least seven hours the night before.
 You have a reduced or impaired ability to perform
regular daytime activities.

There are more than 100 million Americans of all ages who are not getting an
adequate amount of sleep. Sleep is very important. Not getting enough sleep can have
untoward consequences on school and work performance, interpersonal relationships,
health and safety.

How common are sleep disorders?

About 70 million people in the all over the world suffer from sleep disorders.

How many types of sleep disorders are there?

There are approximately 80 different types of

sleep disorders. The top ones are:

 Insomnia.
 Sleep apnea.
 Restless legs syndrome.
 Narcolepsy.

How much sleep is necessary?

Experts generally recommend that adults sleep at

least seven to nine hours per night, although some people require more and others
require less.

A recent National Sleep Foundation Sleep in America poll found that adults (ages 18-
54) sleep an average of 6.4 hours per night on weekdays and 7.7 hours on weekends.
The poll showed a downward trend in sleep time over the past several years. People
sleeping less hours tend to use the internet at night or bring work home from the
office.

The National Sleep Foundation also reported that older adults (age 55-84) average
seven hours of sleep on weekdays and 7.1 hours on weekends. Sleep is most often
disturbed by the need to use the bathroom and physical pain or discomfort in older
adults.

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A downward trend in sleep time has also been observed in children. Optimal sleep
time varies by age. An earlier Sleep in America poll found a discrepancy between
recommended and actual sleep time in children, with actual sleep time 1.5 to two
hours less than recommended. Caffeine consumption caused a loss of three to five
hours of sleep and having a television in the bedroom contributed to a loss of two
hours of sleep each week in children.

What happens when a person doesn’t get enough sleep?

Not getting the proper amount or quality of sleep leads to more than just feeling tired.
Sleepiness interferes with cognitive function, which can lead to learning disabilities in
children, memory impairment in people of all ages, personality changes and
depression.

People who are deprived of sleep experience difficulty making decisions, irritability,
have problems with performance, and slower reaction times, placing them at risk for
automobile and work-related accidents. Sleep loss can also adversely affect life by
contributing to the development of obesity, diabetes and heart disease.

Who is more likely to have a sleep disorder?

Disorders associated with daytime sleepiness affect females more than males.

Symptoms and Causes

What causes sleep disorders?

Sleep problems can be caused by various factors. Although causes might differ, the
end result of all sleep disorders is that the body's natural cycle of slumber and daytime
wakefulness is disrupted or exaggerated. Eight factors include:

 Physical (such as ulcers).

 Medical (such as asthma).
 Psychiatric (such as depression and anxiety
disorders).
 Environmental (such as alcohol).
 Working the night shift (this work schedule
messes up “biological clocks.”)
 Genetics (narcolepsy is genetic).
 Medications (some interfere with sleep).
 Aging (about half of all adults over the age of 65 have some sort of sleep
disorder. It is not clear if it is a normal part of aging or a result of medicines
that older people commonly use).

What are the symptoms of sleep disorders?

You might have a sleep disorder if you experience one or more of the following
symptoms. Do you:

 Fall asleep while driving?

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  Struggle to stay awake when inactive, such as when watching television or
reading?
 Have difficulty paying attention or concentrating at work, school, or home?
 Have performance problems at work or school?
 Often get told by others that you look sleepy?
 Have difficulty with your memory?
 Have slowed responses?
 Have difficulty controlling your emotions?
 Need to take naps almost every day?

What is insomnia?

Insomnia is a sleep disorder where people have difficulty falling or staying asleep.
People with insomnia have one or more of the following symptoms:

 Difficulty falling asleep.

 Waking up often during the night and having trouble going back to sleep.
 Waking up too early in the morning.
 Having unrefreshing sleep.
 Having at least one daytime problem such as fatigue, sleepiness, problems
with mood, concentration, accidents at work or while driving, etc. due to poor
sleep.

Insomnia varies in how long it lasts and how often it occurs. About 50% of adults
experience occasional bouts of insomnia and one in 10 suffer from chronic insomnia.
Insomnia can occur by itself or can be associated with medical or psychiatric
conditions. Insomnia can be short-term (acute or adjustment insomnia) or can last a
long time (chronic insomnia). It can also come and go, with periods of time when a
person has no sleep problems. Acute or adjustment insomnia can last from one night
to a few weeks. Insomnia is called chronic when a person has insomnia at least three
nights a week for a month or longer.

Short-term or acute insomnia can be caused by life stresses (such as job loss or
change, death of a loved one, or moving), an illness, or environmental factors such as
light, noise, or extreme temperatures.

Long-term or chronic insomnia (insomnia that occurs at least three nights a week for
at least three months or longer) can be caused by factors such as depression, chronic
stress and pain or discomfort at night.

A common cause of chronic insomnia is a conditioned emotional response. Thoughts

about the sleep problem (e.g., "What if I don’t fall asleep tonight?") and behaviors
that develop around the sleep problem (e.g., sleeping in and napping, ruminating in
bed) tend to prolong insomnia symptoms.

What is sleep apnea?

Sleep apnea is a potentially serious sleep disorder that occurs when a person's
breathing is interrupted during sleep. People with untreated sleep apnea stop breathing
repeatedly during their sleep.

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There are two types of sleep apnea: obstructive and central.

 Obstructive sleep apnea (OSA) is the more common of the two. It is caused
by a blockage of the airway, usually when the soft tissue in the back of the
throat collapses during sleep. Symptoms of OSA may include snoring,
daytime sleepiness, fatigue, restlessness during sleep, gasping for air while
sleeping and trouble concentrating.
 In central sleep apnea (CSA), the airway is not blocked, but the brain fails to
tell the body to breathe. This type is called central apnea because it is related
to the function of the central nervous system. People with CSA may gasp for
air but mostly report recurrent awakenings during night.

What is restless legs syndrome?

Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often
irresistible urge to move the legs. This sensation is brought on by resting such as lying
down in bed, sitting for prolonged periods such as while driving or at a theatre. RLS
typically occurs in the evening, making it difficult to fall asleep and stay asleep. It can
be associated with problems with daytime sleepiness, irritability and concentration.
Often, people with RLS want to walk around and shake their legs to help relieve the
uncomfortable sensation.

What is narcolepsy?

Narcolepsy is a neurological disorder of sleep regulation that affects the control of

sleep and wakefulness. People with narcolepsy experience excessive daytime
sleepiness and intermittent, uncontrollable episodes of falling asleep during the
daytime. These sudden sleep attacks may occur during any type of activity at any time
of the day. Some patients with narcolepsy experience sudden muscle weakness with
laughter or other emotions.

Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent
at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.

Diagnosis and Tests

How are sleep disorders diagnosed?

If you suspect that you may have a sleep disorder, discuss your symptoms with your
healthcare provider. He or she can perform a physical exam and help you identify the
difficulties you are having with sleep. Keeping a sleep diary for two weeks may be
helpful to your healthcare provider. Some illnesses can cause disturbed sleep, so your
healthcare provider may order tests to rule out other conditions.

If your healthcare provider suspects that you have a sleep disorder, he or she may
refer you to a sleep disorder clinic. A sleep specialist will review your symptoms and
may suggest that you undergo a sleep study.

A sleep study or polysomnogram (PSG) is a test that electronically transmits and

records specific physical activities while you sleep. A sleep study can be done at

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home (home sleep apnea testing) for select patients. The recordings become data that
is analyzed by a qualified healthcare provider to determine whether or not you have a
sleep disorder.

In order to determine if you have a sleep disorder, it is important to pay attention to

your sleep habits by keeping a sleep diary and discussing patterns and characteristics
of your sleep with your healthcare provider. Many common sleep problems can be
treated with behavioral treatments and an increased attention to proper sleep hygiene.
Consult your healthcare provider if you have any concerns about your sleep patterns.

What questions might my healthcare provider ask to diagnose a sleep disorder?

 How many hours do you sleep at night?

 Do you toss and turn in your sleep?
 Do you take naps?
 How long does it take you to fall asleep?
 Do you wake up in the middle of the night?
 Do you work a night shift?
 How sleepy do you feel during the day?

Management and Treatment

How are sleep disorders treated?

There are a variety of treatments recommended by healthcare providers:

 Counseling: Some sleep specialists recommend cognitive behavior therapy.

Such counseling helps you “recognize, challenge and change stress-inducing
thoughts” that can keep you awake at night.
 Medications and/or supplements.
 Practice sleep hygiene such as keeping a regular sleep schedule.
 Get regular exercise.
 Minimize noise.
 Minimize light.
 Manage the temperature so that you’re comfortable.

Your healthcare provider will recommend treatments based on your unique situation.

What medicines may help with sleep disorders?

Your healthcare provider may recommend some of the following medications and
supplements:

 Sleep aids may be helpful in some cases of insomnia, including melatonin,

zolpidem, zaleplon, eszopiclone, ramelteon, suvorexant, lamborexant, or
doxepin.
 Restless legs syndrome can be treated with gabapentin, gabapentin enacarbil,
or pregabalin.
 Narcolepsy may be treated with a number of stimulants or wake-promoting
medications, such as modafinil, armodafinil, pitolisant and solriamfetol.

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Ask your healthcare provider for a referral to a sleep specialist, if necessary.

What are some tips for getting a good night's sleep?

 Create an optimal sleep environment by making sure that your bedroom is

comfortable, cool, quiet and dark. If noise keeps you awake, try using
background sounds like "white noise" or earplugs. If light interferes with your
sleep, try a sleep mask or blackout curtains.
 Think positive. Avoid going to bed with a negative mind set, such as "If I
don't get enough sleep tonight, how will I ever get through the day
tomorrow?"
 Avoid using your bed for anything other than sleep and intimate relations.
Do not watch television, eat, work, or use computers in your bedroom.
 Try to clear your mind before bed time by writing things down or making a
to-do list earlier in the evening. This is helpful if you tend to worry and think
too much in bed at night.
 Establish a regular bedtime and a relaxing routine each night by taking a
warm bath, listening to soothing music, or reading. Try relaxation exercises,
meditation, biofeedback, or hypnosis. Wake up at the same time each morning,
including days off and vacations.
 Stop clock watching. Turn the clock around and use only the alarm for
waking up. Leave your bedroom if you cannot fall asleep in 20 minutes. Read
or engage in a relaxing activity in another room.
 Avoid naps. If you are extremely sleepy, take a nap. But limit naps to less
than 30 minutes and no later than 3 p.m.
 Avoid stimulants (coffee, tea, soda/cola, cocoa and chocolate) and heavy
meals for at least four hours before bedtime. Light carbohydrate snacks such
as milk, yogurt, or crackers may help you fall asleep easier.
 Avoid alcohol and tobacco for at least four hours before bedtime and during
the night.
 Exercise regularly, but not within four hours of bedtime if you have trouble
sleeping

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Impulse control disorders?

Impulse control disorders are conditions

where people have impulses that are
difficult or impossible to resist. These can
range from emotional reactions, which may
include taking things that do not belong to
them (kleptomania), or an urge to set fires
(pyromania).

This article explores what impulse control

disorders are, the different types, signs and
symptoms, causes, treatments, and how to
prevent them.

These impulse control disorders can negatively impact a person’s quality of life, but
people can manage symptoms with treatment.

Types

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes five
formal disordersTrusted Source that fall under the definition of an impulse control
disorder.

Oppositional defiant disorder

Oppositional defiant disorder (ODD) is commonly a childhood behavior disorder.

Those with this condition find it difficult to controlTrusted Source their emotions or
behaviors. Around 2–11% of children in the United States have this disorder, and it is
more common in preadolescent males than females.

People with ODD usually start experiencing symptoms between the ages of 5–10, and
symptoms may go away as they get older.

Intermittent explosive disorder

Intermittent explosive disorder (IED) occurs most commonly in late childhood or the
teenage years. People with this condition have brief moments of anger and aggression
that appear to be disproportionate to the trigger. The cause may not be noticeable to
anyone other than the person with IED.

Conduct disorder

Conduct disorder (CD) is an impulse

control disorder that usually develops
during childhood or adolescenceTrusted
Source. People with this condition tend
to be rebellious, disobedient, and
aggressive.

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Around 2–10% of children and teens in the U.S. have this disorder, and it is more
common in males than females. People with this condition are also more likely to
have attention deficit hyperactive disorder (ADHD), mood disorders, and
developmental disorders.

Kleptomania

People who have kleptomania have an impulse to take possessions that do not belong
to themTrusted Source. The condition can present at any age and is more likely to
affect females than males.

Pyromania

Pyromania is a rare impulse control disorder where people become fascinated by fire
and all things related to fire. They often have a compulsion to set things alight.
Pyromania is more common in teenagers and adults, while males are more likely to
have this condition than females.

People with pyromania are more likely to have mood disorders and learning
disabilities.

Signs and symptoms

The following are the indications and symptomsTrusted Source of impulse control
disorders by type:

ODD

Signs and symptoms of ODD include:

 being disagreeable and disruptive

 becoming irritable and defiant
 defiant behavior that is often due to being asked to do chores or obey rules

IED

Signs and symptoms of IED include:

 becoming easily frustrated

 being often well-behaved outside of explosive outbursts
 multiple verbal or physical outbursts that can result in injury or physical
damage

CD

Signs and symptoms of CD include:

 destruction of property
 lying to people
 illegal or criminal activity

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  appearing manipulative or unemotional

Kleptomania

Signs and symptoms of kleptomania include:

 stealing items that are not needed or

items of little to no value
 feeling a compulsion to steal
 often feeling guilty or depressed
after stealing
 experiencing feelings of relief after
stealing

Pyromania

Signs and symptoms of pyromania include:

 tension just before setting a fire

 feeling a compulsion to set fires
 fire-setting that is not a response to anger or vengeance

Causes

Researchers are not sure what triggers the development of an impulse control disorder.
However, evidence suggests that genetic and environmental factors may increase the
risk.

Children with ODD often have parents who have mood disorders. People with CD are
more likely to have parents who have schizophrenia, ADHD, antisocial personality
disorder, or parents who misuse substances.

However, it is possible that this family makeup causes an unstable environment,

which increases the risk of children developing an impulse control disorder, rather
than being a genetic factor.

Environmental factors that can increase the likelihood of developing impulse control
disorders include:

 coming from a family with low socioeconomic status

 coming from a place with community violence
 a lack of structure in the home and school
 neglectful or abusive environment
 having friends that partake in deviant or illegal activities

Treatment

Parents and caregivers can use strategies to manage symptoms of impulse control
disorders. These includeTrusted Source:

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  not giving positive reinforcement for impulse control disorder behaviors
 encouraging children and teenagers to take an interest in helping their
community and society
 avoiding physical discipline
 remaining consistent when parenting

Several types of therapy can help parents and children with these strategies, such as
parent management training, multisystemic therapy, and cognitive behavioral therapy
(CBT).

Some doctors may prescribe mood stabilizers, antidepressants, or other medications to

manage symptoms.

Prevention

As impulse control disorders could occur due to genetic and environmental factors,
prevention is not certain.

However, parents and caregivers could minimize symptoms from becoming worse by
taking a child or teenager with a suspected impulse control disorder to a healthcare
professional. Doctors will be able to suggest a treatment plan.

Summary

There are five specific types of impulse control disorder recognized by the DSM-5,
each with their own signs and symptoms.

People with these conditions struggle to keep their impulses in check, which may
negatively impact their quality of life.

However, they can work with healthcare professionals to manage their symptoms.
Treatment options usually involve some form of therapy, such as CBT, to help
counteract behaviors around impulse control.

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RESEARCH

Explanatory models of somatoform disorder patients attending a

psychiatry outpatient clinic: A study from North India
Abstract
Background: The symptoms of somatoform disorders are very distressing to the
sufferer as well as pose significant burden on the health-care delivery system.
Although the nature of symptoms is physical, the underlying mechanisms are not
clearly understood.
Objective: The purpose of this study was to assess the explanatory models of patients
with somatoform disorders presenting to a tertiary care hospital in Northern India.
Method: A total of 99 consecutive adult patients (≥18 years) with diagnosis of
somatoform disorders according to the
International Classification of Diseases–10th Revision (ICD-10) were evaluated for
their explanatory models using the causal models section of Explanatory Model
Interview Catalogue (EMIC).
Results: The mean age of the study sample was 36.52 years, and the mean duration of
illness was 59.39 ± 57.68 months.
The most common clinical diagnosis was that of persistent somatoform pain disorder.
The most common explanations given belonged to the category of psychological
factors (68.7%) followed by weakness (67.7%), social causes (51%) and
karma–deed–heredity (53.5%) category. The mean number of etiological categories
reported were 2.6 (standard deviation (SD) = 1.7). Among the various specific causes,
the commonly reported explanations by one half of the sample in
decreasing order were general weakness (63.6%), mind–thoughts–worry category
(59.6%) and loneliness (53.5%). The mean number of specific etiologies was 4.9 (SD
= 3.83).
Conclusion: Most of the patients with somatoform disorder attribute their symptoms
to psychological factors. It also becomes imperative to understand the physical
symptoms in somatoform disorders from the sociocultural aspects of
patients.

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