Bodily Distress Disorder

Somatization Disorder [Bodily Distress Disorder] Briquet’s syndrome [Somatoform Disorders]

Hysteria [medically unexplained syndrome] somatic symptom and related disorders Somatic
symptom disorder also called as somatization disorder Somatization Disorder means in
which the physical pain and symptoms a person feels are related to psychological factors.
These symptoms can’t be traced to a specific physical cause. In people who have a somatic
symptom and related disorders, medical test results are either normal or don’t explain the
person’s symptoms. Symptoms of somatic symptom disorder may be:
 Specific sensations, such as pain or shortness of breath, or more general symptoms,
such as fatigue or weakness
 Unrelated to any medical cause that can be identified, or related to a medical
condition such as cancer or heart disease, but more significant than what's usually
expected
 A single symptom, multiple symptoms or varying symptoms
Mild, moderate or severe
 Pain is the most common symptom, but whatever your symptoms, you have
excessive thoughts, feelings or behaviors related to those symptoms, which cause
significant problems, make it difficult to function and sometimes can be disabling.
Patients report of thoughts, feelings and behaviors can include: Constant worry about
potential illness Viewing normal physical sensations as a sign of severe physical illness
Fearing that symptoms are serious, even when there is no evidence Thinking that physical
sensations are threatening or harmful Feeling that medical evaluation and treatment have
not been adequate Fearing that physical activity may cause damage to your body Repeatedly
checking your body for abnormalities Frequent health care visits that don't relieve your
concerns or that make them worse Being unresponsive to medical treatment or unusually
sensitive to medication side effects Having a more severe impairment than is usually
expected from a medical condition The exact cause of somatic symptom disorder isn't clear,
but any of these factors may play a role: Genetic and biological factors, such as an increased
sensitivity to pain Family influence, which may be genetic or environmental, or both
Personality trait of negativity, which can impact how you identify and perceive illness and
bodily symptoms Decreased awareness of or problems processing emotions, causing
physical symptoms to become the focus rather than the emotional issues Learned behavior
— for example, the attention or other benefits gained from having an illness; or "pain
behaviors" in response to symptoms, such as excessive avoidance of activity, which can
increase your level of disability Treatment People who have this disorder may have several
medical evaluations and tests to be sure that they don’t have another illness. They often
become very worried about their health because they don’t know what’s causing their
health problems. Their symptoms are similar to the symptoms of other illnesses and may
last for several years. People who have a somatoform disorder are not faking their
symptoms. The pain that they feel is real Treatment seeks to enhance a person’s daily
functioning by reducing stress, mitigating physical symptoms and improving overall
functioning. Somatoform disorder treatment options include various forms of psychotherapy
and pharmacological interventions when co-occurring conditions like depression or anxiety
are present. Pharmacological Interventions Pharmacological interventions alone are not
effective in treating. However, medication for a somatoform disorder may be helpful if
concurrent depression or anxiety disorders are present. Pharmacological interventions are
most helpful when paired with therapy. Several types of antidepressants are generally
prescribed to people with somatoform disorders and co-occurring mental health conditions
that can exacerbate symptoms. Antidepressant medications work indirectly on somatoform
disorder by easing symptoms of anxiety and depression that can increase concern and worry
about physical symptoms. Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT)
has been shown to effective in some cases, though additional research is needed to confirm
these claims. CBT helps individuals reduce fixation on their health, pain and physical
symptoms. This treatment method also teaches stress reduction techniques and coping skills
to manage physical symptoms and emotional reactions.

In the ICD-11 (International Classification of Diseases, 11th Revision), Somatic Symptom

Disorders are categorized under Chapter 06: Mental, Behavioral, and Neurodevelopmental
disorders. They are classified as a group of disorders that involve the experience of
significant physical symptoms that are distressing or disruptive to a person’s life, but the
symptoms cannot be fully explained by medical conditions or other psychiatric disorders.
Somatic Symptom Disorder (SSD) in ICD-11
The main disorder in this category is Somatic Symptom Disorder (SSD). It is characterized
by:
1. Somatic symptoms that are distressing or result in significant disruption of daily life.
2. The excessive thoughts, feelings, or behaviors related to these symptoms, which
might include:
o Persistent thoughts about the seriousness of the symptoms.
o High levels of anxiety about health.
o Excessive time and energy spent on health concerns.
In ICD-11, SSD is further characterized by the following:
 The somatic symptoms are medically unexplained or cannot be fully explained by a
clear medical condition.
 Excessive focus on the symptoms, often resulting in disproportionate levels of
distress or functional impairment.
Other Disorders Related to Somatic Symptoms
ICD-11 also includes other related disorders in this group, such as:
1. Bodily Distress Disorder (BDD)
 This is essentially the ICD-11 equivalent of what was once known as somatization
disorder in ICD-10. It focuses on excessive bodily distress due to multiple symptoms
that cannot be fully explained by a medical condition.
 It involves repeated medical visits, concern over health issues, and worry about the
severity of physical complaints.
 There are also recurrent episodes of somatic complaints that might not correspond
to a diagnosable physical condition.
2. Conversion Disorder (Functional Neurological Symptom Disorder)
 This disorder involves neurological symptoms (e.g., paralysis, blindness, or non-
epileptic seizures) that cannot be explained by any neurological or medical condition.
 Symptoms are not intentionally produced, and they can cause significant distress or
disability.
3. Factitious Disorder
 This involves intentionally producing or feigning symptoms of illness for the purpose
of assuming the sick role, but without external incentives (such as financial gain).
 The person may induce symptoms or exaggerate existing symptoms for attention,
sympathy, or other psychological reasons.
Key Features of Somatic Symptom Disorders (SSD)
 Duration: The symptoms typically persist for 6 months or more.
 Excessive focus on health: This involves frequent medical visits, frequent checking of
bodily sensations, and anxiety over health, despite the absence of a clear medical
diagnosis.
 Functional impairment: The disorder often leads to significant distress or
impairment in various areas of life (e.g., social, occupational).
Diagnostic Criteria for Somatic Symptom Disorder in ICD-11
To be diagnosed with Somatic Symptom Disorder, the following criteria are typically met:
 Somatic symptoms are present and cause distress or dysfunction.
 There is an excessive focus on these symptoms, leading to either:
o Persistent worry about the seriousness of the symptoms.
o Excessive time or energy spent on health concerns.
  Duration: The symptoms and the focus on them persist for 6 months or longer.
Treatment Approaches
Treatment for Somatic Symptom Disorders may involve a combination of:
 Cognitive-behavioral therapy (CBT) to help address unhealthy thoughts and
behaviors regarding the symptoms.
 Psychotherapy to explore underlying psychological factors or stressors.
 Medication (such as antidepressants) to address any co-occurring mental health
conditions, like depression or anxiety.
Conclusion
ICD-11 takes a more holistic and nuanced approach to somatic symptom disorders compared
to earlier editions of the ICD. It emphasizes the significance of the psychological aspects
(e.g., anxiety, preoccupation, distress) and the impact of these disorders on a person's daily
life. The aim is not only to classify these disorders but also to guide treatment, which often
involves addressing both the physical complaints and the emotional or cognitive processes
that exacerbate them.

Conversion Disorder (also called Functional Neurological Symptom Disorder)

Conversion Disorder (also called Functional Neurological Symptom Disorder in ICD-11) is a
condition in which a person experiences neurological symptoms (such as paralysis,
blindness, or non-epileptic seizures) that cannot be explained by any medical or neurological
condition. These symptoms are not intentionally produced, and they often cause significant
distress or impairment in the individual's daily life.
In ICD-11, Conversion Disorder is classified under "Functional Neurological Symptom
Disorder" to emphasize the functional and psychological nature of the disorder, rather than
being a purely neurological condition.
Key Features of Conversion Disorder (Functional Neurological Symptom Disorder)
1. Neurological Symptoms without a Clear Medical Explanation:
o Symptoms are neurological in nature, such as:
 Paralysis or weakness in a limb or part of the body (e.g., hemiplegia,
monoplegia).
 Non-epileptic seizures (often called psychogenic seizures).
 Abnormal gait (walking problems).
 Visual or sensory disturbances (e.g., blindness, double vision, or
numbness).
  Speech difficulties (e.g., aphonia or dysphonia).
 Tremors or abnormal movements.
o Medical tests do not show any clear cause for these symptoms.
2. Involuntary Symptoms:
o Unlike factitious disorder (where symptoms are intentionally produced),
Conversion Disorder involves involuntary symptoms that are not
intentionally feigned or under the person’s conscious control. The symptoms
are real to the person, and they are not faked or made up for external
reasons.
3. Functional Impairment:
o The symptoms cause significant distress or impairment in the person's social,
occupational, or other important areas of functioning.
o The individual might experience significant disruption in their ability to
perform everyday tasks due to the symptoms.
4. Psychological Stress or Trauma:
o In many cases, conversion disorder is thought to be related to psychological
stress, emotional conflicts, or trauma. For example, the onset of symptoms
might coincide with or follow a stressful life event (e.g., physical or emotional
trauma, loss, or other significant stressors).
o The symptoms are thought to be a psychological response to these conflicts
or stressors, with the body “converting” emotional or psychological distress
into physical symptoms.
Diagnostic Criteria (ICD-11)
To diagnose Conversion Disorder (Functional Neurological Symptom Disorder), the
following criteria should be met:
1. Presence of neurological symptoms that suggest a neurological or medical condition,
but which cannot be explained by medical or neurological tests or findings.
2. The symptoms cause significant distress or impairment in the individual’s
functioning.
3. The symptoms are involuntary and not consciously produced (i.e., the person is not
faking them).
4. There may be psychological factors (such as stress or trauma) that are thought to be
contributing to the onset or course of the symptoms.
5. The symptoms are not better explained by another mental disorder, such as
malingering or factitious disorder.
Examples of Symptoms
Symptoms in Conversion Disorder can vary greatly, but common manifestations include:
 Motor symptoms:
o Paralysis or weakness (e.g., a limb is paralyzed and cannot move, or a person
may be unable to walk properly).
o Abnormal gait (uncoordinated or jerky movements).
o Abnormal posturing or stiffening of the body.
o Tremors or shaking that are not due to neurological disease.
 Sensory symptoms:
o Blindness or double vision without an underlying eye disease.
o Numbness or loss of sensation in parts of the body.
o Loss of the sense of touch.
o Abnormal sensations (e.g., tingling or “pins and needles” that have no
physical cause).
 Seizures or convulsions:
o Non-epileptic seizures (also called psychogenic seizures), which can look like
real epileptic seizures but are not caused by abnormal brain electrical activity.
These episodes are often related to psychological stress and can mimic true
seizure-like behaviors.
 Speech and swallowing issues:
o Difficulty speaking, hoarseness, or inability to speak (aphonia).
o Difficulty swallowing (dysphagia).
Causes and Risk Factors
The exact cause of Conversion Disorder is not fully understood, but it is thought to result
from the interaction of psychological stress and neurological dysfunction. Some possible
contributing factors include:
1. Psychological stress or trauma:
o Conversion disorder is often associated with stressful or traumatic events,
particularly childhood abuse or other significant emotional distress.
o The disorder may act as a psychological defense mechanism, in which the
body “converts” emotional pain into physical symptoms as a way of coping.
2. Neurobiological factors:
 o Some research suggests that dysfunction in the brain areas responsible for
motor and sensory functions could play a role. The brain might misinterpret
signals or experience difficulties in translating emotional states into physical
responses.
3. Genetic and environmental factors:
o Family history, stress tolerance, and environmental factors such as a history of
psychiatric disorders or certain types of personality traits might increase the
risk of developing the disorder.
Treatment
Treatment for Conversion Disorder often involves a multidisciplinary approach combining
medical, psychological, and sometimes physical therapy. Common treatment strategies
include:
1. Cognitive Behavioral Therapy (CBT):
o CBT is one of the most effective treatments, helping individuals to reframe
negative thinking patterns, reduce anxiety about their symptoms, and address
underlying psychological distress or trauma.
2. Physical Therapy:
o In cases where the disorder causes motor symptoms (e.g., weakness or
paralysis), physical therapy can help the individual regain motor function and
mobility, even though the symptoms are not due to an underlying
neurological condition.
3. Psychotherapy:
o Psychotherapy can be beneficial in addressing emotional conflicts, past
traumas, and stressors that might be contributing to the disorder.
4. Medication:
o Although there is no specific medication for conversion disorder itself,
medications like antidepressants or anti-anxiety medications may be
prescribed if there is co-occurring depression or anxiety.
5. Stress management techniques:
o Learning to manage stress through techniques such as mindfulness,
meditation, and relaxation exercises can help reduce the frequency and
severity of symptoms.
Prognosis
The prognosis for Conversion Disorder can vary widely:
 In some cases, symptoms resolve on their own or with short-term treatment.
  However, in other cases, symptoms can be chronic or may recur, particularly if the
underlying psychological stress or trauma is not addressed.
 Early diagnosis and intervention can improve outcomes, as the symptoms are often
easier to treat when recognized early.
Conclusion
Conversion Disorder (Functional Neurological Symptom Disorder) is a complex and often
misunderstood condition in which psychological stress is converted into physical neurological
symptoms. Although the symptoms are real and distressing for the person affected, they are
not due to an underlying medical or neurological condition. Treatment typically focuses on
addressing both the physical manifestations of the disorder and the psychological factors
that contribute to it.

Factitious Disorder in ICD-11

Factitious Disorder in ICD-11 is classified under Mental, Behavioral, or

Neurodevelopmental Disorders, specifically within the category of Disorders Specifically
Associated with Stress. This disorder involves the intentional production or feigning of
physical or psychological symptoms, without external incentives (such as financial gain or
avoiding work), in order to assume the "sick role" and gain attention, sympathy, or care from
others, especially healthcare providers.
ICD-11 Classification of Factitious Disorder
In ICD-11, Factitious Disorder is divided into two types:
1. Factitious Disorder Imposed on Self
o This is the more common form of the disorder, in which the individual feigns
or deliberately produces symptoms of illness in themselves. The person may:
 Report symptoms (e.g., pain, dizziness, nausea).
 Fake or exaggerate medical conditions (e.g., pretending to be ill,
manipulating lab results).
 Engage in self-harm or self-injury to create or amplify symptoms (e.g.,
injecting substances, cutting themselves).
o The individual’s motivation is not to achieve any obvious external gain (e.g.,
financial gain, avoiding work), but rather to be seen as sick or to gain
attention from healthcare providers, friends, or family.
 2. Factitious Disorder Imposed on Another (also known as Munchausen Syndrome by
Proxy)
o In this type, an individual produces or feigns symptoms in another person,
typically a child or dependent person. The caregiver (often a parent)
deliberately causes harm or reports symptoms in the person they are caring
for in order to receive attention, sympathy, and validation as a caregiver.
o The individual may falsify or induce medical symptoms in the other person
(e.g., causing the child to become ill or reporting false symptoms to medical
professionals).
Key Features of Factitious Disorder (ICD-11)
1. Intentional Fabrication of Symptoms:
The hallmark of Factitious Disorder is the intentional production or exaggeration of
symptoms. These symptoms can be either physical (e.g., faked injury or illness) or
psychological (e.g., feigned psychiatric conditions such as depression or psychosis).
2. Absence of External Incentives:
Unlike malingering (where symptoms are feigned for external benefits such as
financial gain or avoiding responsibilities), individuals with Factitious Disorder are
not motivated by material or external rewards. The primary motivation is the
psychological need to assume the sick role, to receive attention and sympathy from
others.
3. Psychological and Behavioral Indicators:
People with Factitious Disorder may:
o Lie about medical history, symptoms, or personal experiences.
o Manipulate medical records (e.g., altering lab results or self-reporting false
symptoms).
o Engage in self-destructive behaviors (e.g., causing harm to themselves to
produce symptoms, such as injecting themselves with substances or inducing
vomiting).
o Be very knowledgeable about medical conditions and treatments in order to
deceive healthcare providers.
4. Chronic Nature:
Factitious Disorder tends to be chronic in nature, with individuals repeatedly seeking
medical attention for symptoms that they have fabricated or exaggerated. This can
lead to multiple hospitalizations or medical procedures that may not be necessary.
5. Significant Distress and Impairment:
The disorder causes significant distress or impairment in the individual's life,
including disrupted relationships, financial strain (from ongoing medical expenses),
 and potential harm from unnecessary medical treatments. Additionally, there may be
psychological distress related to the need to constantly seek attention as a patient.
Diagnostic Criteria (ICD-11)
To diagnose Factitious Disorder, the following criteria are typically considered:
1. Intentional production or exaggeration of symptoms:
o The person falsifies or induces symptoms (either physical or psychological) in
themselves or in another person.
2. Absence of external rewards:
o The behavior is not motivated by external incentives (e.g., avoiding work or
receiving financial compensation), distinguishing it from malingering.
3. Deceptive medical history:
o The individual may provide false information about their medical history or
symptoms, or alter medical records to reflect a more severe illness.
4. Significant impact on the individual’s life:
o The disorder causes significant distress, impairment, or functional difficulties
in various life domains (e.g., relationships, work, social life).
5. Chronic course:
o The disorder often has a chronic course, leading to recurrent episodes of
seeking medical attention over time.
Symptoms of Factitious Disorder
The symptoms of Factitious Disorder can vary widely, as individuals may create or
exaggerate a wide range of conditions. Some common symptoms may include:
 Physical Symptoms:
o Fabricated or exaggerated pain (e.g., reporting severe back pain when there is
no physical cause).
o Self-inflicted wounds (e.g., creating cuts, burns, or injecting substances to
induce infection).
o Fake or exaggerated symptoms like nausea, dizziness, or fainting.
o Manipulation of medical tests to create abnormal results (e.g., contaminating
lab samples).
o Falsifying or exaggerating neurological or gastrointestinal symptoms.
 Psychological Symptoms:
 o Reporting psychological symptoms that are exaggerated or fabricated (e.g.,
feigning symptoms of depression or anxiety).
o Claims of hallucinations or dissociative experiences that are not real.
o Fabricating a history of psychiatric illness or distress to justify psychiatric
treatment.
 Factitious Disorder Imposed on Another:
o The caregiver may induce or fabricate symptoms in the victim, often leading
to unnecessary medical treatments, procedures, or hospitalizations for the
person being “cared for” (typically a child, elderly adult, or other vulnerable
individual).
Treatment of Factitious Disorder
Treatment for Factitious Disorder is challenging and requires a comprehensive and often
multidisciplinary approach. Key elements of treatment include:
1. Psychotherapy:
o Cognitive Behavioral Therapy (CBT) is commonly used to help individuals
recognize and change the behaviors and cognitive patterns that contribute to
their need to assume the sick role.
o Psychodynamic therapy may also be helpful to explore underlying emotional
conflicts or personality issues that contribute to the disorder.
2. Psychiatric Care:
o Many individuals with Factitious Disorder may have co-occurring personality
disorders (such as borderline personality disorder) or mood disorders (such
as depression), which may require separate treatment with medication (e.g.,
antidepressants or mood stabilizers).
o Psychiatric evaluation and long-term monitoring are often necessary, as
people with this disorder may repeatedly seek medical attention or try to
manipulate care systems.
3. Building a Therapeutic Relationship:
o Establishing a trusting relationship between the individual and the healthcare
provider is critical. These patients may be defensive and resistant to therapy,
and interventions must be conducted in a non-confrontational, empathetic
way.
4. Avoiding Enabling Behavior:
o Healthcare providers must avoid enabling behaviors, such as providing
unnecessary treatments, tests, or procedures. Careful documentation and
 coordinated care between providers are essential to prevent unnecessary
interventions.
5. Family Therapy (for Factitious Disorder Imposed on Another):
o In cases where the disorder involves imposing symptoms on another person,
family therapy or counseling may be necessary to address the dynamics and
prevent further harm to the victim.
Prognosis
The prognosis for Factitious Disorder can be challenging:
 The disorder tends to be chronic, and individuals may have repeated episodes of
feigning illness or seeking medical care.
 Treatment success depends on early recognition, psychotherapeutic intervention,
and addressing any underlying mental health issues.
 Factitious Disorder Imposed on Another may require legal intervention in cases of
harm to vulnerable individuals.
Conclusion
Factitious Disorder in ICD-11 involves the intentional production or exaggeration of
symptoms for the primary psychological gain of being seen as ill or gaining attention as a
patient. It is distinct from malingering, as there is no external incentive. The disorder can be
chronic and may require a combination of psychotherapy, psychiatric care, and careful
medical management to address both the psychological motivations behind the behavior
and any co-occurring mental health issues.