What is Somatoform disorders (Briquet’s syndrome)

A somatoform disorder is a clinical complaint of symptoms made by a patient for which there is no physical exidence of disease. There are five main types of somatoform disorder: 1. Hypochondriasis 2. Conversion Disorder 3. Body Dysmorphic Disorder 4. Pain Disorder 5. Somatisation disorder

Statistics on Somatoform disorders (Briquet’s syndrome)

In general, these conditions most commonly occur in females. and those of low education and economic status. More detailed incidence figures are outlined below: 1. Somatisation disorder: It is estimated that 0.1-0.5% of the general population are affected with somatisation disorder throughout their lives. It is more common in females than males, and affects those of lower education and economic status. 2. Conversion Disorder: This condition may affect up to 10% of hospital patients and between 5-15% of psychiatric outpatients. Females are more commonly affected than males. Those of low economic status and low education are also more frequently affected. 3. Body Dysmorphic disorder: This condition is most common in adolescence and young adults. It occurs equally in both men and women. 4. Pain Disorder: Usually occurs between the ages of 30 and 40 years and is more commonly found in women. 5. Hypochondriasis: This condition affects 10% of all medical patients, and normally occurs between the ages of 30 and 40 years. Men and women are equally affected by this condition.

Risk Factors for Somatoform disorders (Briquet’s syndrome)

The somatoform disorders are more likely to occur in patients with a family history of any one of the five conditions. Patients who also suffer from personality disorders and major psychiatric illness such as depression are also at greater risk of somatoform disorders and associated behaviour.

Progression of Somatoform disorders (Briquet’s syndrome)

The course of somatoform disorders depends on the type of disorder in question. 1. Hypochondriasis: These patients will often have a history of signficant disease, and therefore most commonly present in middle age. Mild cases require little more than gentle re-assurance whereas severe cases may require treatment of an underlying psychiatric disorder such as depression, anxiety or psychotic illness. Patients will frequently seek medical attention for their apparent symptoms, which will fail to provide long-term re-assurance about their medical complaint. 2. Conversion Disorder: This condition usually begins in adolescence, with the development of neurological symptoms such as paralysis, numbness or “fake” seizures. This condition classically occurs in episodes, with long periods without symptoms between symptomatic episodes. 3. Body Dysmorphic Disorder: Most commonly present in adolescence, when the affected individual develops the belief that one part of their body is ugly or undesirable. The most common body parts of concern in the nose and the ears. Patients with this condition will visit many doctors including plastic surgeons and dermatologists to rectify their “abnormality.” Depression may result if the patient cannot achieve adequate results through dermatology and plastic surgery. 4. Pain Disorder: May begin at any age, most commonly occurring in middle age. This condition is usually long-term, with patients complaining of headache and lower backache most frequently without physical evidence of disease. 5. Somatisation disorder: Most commonly begins in adolescence and usually adopts a long-term course. This condition rarely resolves, but the symptoms do fluctuate, creating the illusion of an episodic illness. The cause of the patient’s symptoms is usually heavily investigated prior to the diagnosis, leading to unnecessary surgery and investigations upon affected patients.

How is Somatoform disorders (Briquet’s syndrome) Diagnosed?

These conditions are often over-investigated, owing to the fact that investigations are invariably normal in the presence of physical symptoms. Extensive investigation of any somatoform condition may re-assure the patient in the short run, but does not provide long-term satisfaction for most patients.

Prognosis of Somatoform disorders (Briquet’s syndrome)

1. Hypochondriasis: In its mild form, the condition is usually benign, responding to simple re-assurance. In its severe form, the natural history may take the path of an underlying psychiatric illness such as depression, anxiety or schizophrenia. 2. Conversion Disorder: This condition tends to persist throughout life, with patients experiencing episodes of neurological symptoms that require repeated re-assurance by their treating doctor. 3. Body Dysmorphic Disorder: Many patients will seek surgical correction of their imagined deformity throughout the course of their condition. Few will find satisfaction with plastic surgery, resulting in multiple procedures and an increased potential for complications. Depression will usually occur when surgery has failed to correct their deformity. 4. Pain Disorder: This condition has a poor prognosis, with many patients complaining of pain throughout their entire lives. In the long-term, prolonged use of pain-killers increases the risk of kidney and liver disease, as well as increased accidental death with the use of opioid analgesics such as codiene and morphine preparations. 5. Somatisation disorder – This form of somatoform disorder carries the poorest prognosis. The condition will most often become long-term, with patients carrying “imagined” symptoms for a great proportion of their lives. Depression may develop in response to the patient’s helplessness to obtain relief from the “apparently” medical condition.

How is Somatoform disorders (Briquet’s syndrome) Treated?

The most important principle in the management of these conditions is the formation of a contract between the patient and doctor. The patient must agree that they will not seek further medical attention for their symptoms, in return for the doctor to see them regularly and provide supportive care for their symptoms. On regular attendance, the patient’s symptoms should be reviewed, along with any factors both social and psychological that make dealing with the symptoms more difficult. The patient should also have their medications reviewed, stopping any unnecessary drugs which may cause the symptoms they describe. Psychotherapy is also a useful mode of treatment, provided the patient is willing to consider that their symptoms have a psychological origin. Cognitive behavioural therapy has now been shown an effective form of therapy for this condition as well. The use of antidepressants and analgesia may provide relief from symptoms in some cases. The patient and doctor must be mindful of the potential side-effects of certain drugs.

Somatoform disorders (Briquet’s syndrome) References

[1] Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002. [2] Sadock BJ, Sadock VA. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry 3rd Edition. Lippincott Williams and Wilkins, Philadelphia USA.