2유형 수준 6에서 나타나는 somatization disorder, 7수준에서 나타나는 hypochondriasis

[문형철]

에니어그램 2유형의 특성

의식 수준 6레벨에서 발생하는 문제는 신체증상장애

의식 수준 7레벨에서 발생하는 문제는 건강염려증

Somatization Disorder.pdf

A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.

B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

1. four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back,

joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)

2. two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)

3. one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)

4. one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (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, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)

C. Either (1) or (2):

1. after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general

medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication).

2. when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings.

D. The symptoms are not intentionally produced or feigned (as in Factitious Disorder or Malingering).

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.

(Copyright 2000). American Psychiatric Association. 

somatization의 원인

치료 Table 3 Management of somatization disorder

1. General principles

a) Comprehensive clinical assessment (history, mental state, and physical examination).

b) Interview key family member.

c) Minimize number of clinicians involved. Ensure a consistent, coordinated management plan.

d) Minimize invasive diagnostic and therapeutic proceedures.

e) Ensure regular, structured sessions. Avoid as-needed visits to doctors and emergency departments.

f) Recognize reality of symptoms and provide diagnostic feedback to both patient and family member. 

    Where appropriate, link symptoms to stressful life events.

g) Identify and minimize secondary reinforcers.

h) Treat associated medical and psychiatric conditions appropriately.

2. Cognitive-behavioural therapy

a) Develop treatment contract (listing agreed approximate frequency, duration, and number of sessions).

b) Set realistic short- and long-term goals. Review these regularly.

c) Focus on practical ways of coping with symptoms and limitations.

d) Encourage patient to keep a daily log of thoughts, feelings, and coping behaviours. Review these regularly.

e) Promote daily physical, social, recreational, and occupational activities.

f) Promote daily relaxation activities and exercises.

g) Promote patient control and autonomy.

3. Pharmacotherapy

a) Minimize use of habit-forming drugs.

b) Avoid as-needed medication.

c) Use antidepressant medication where appropriate.

hypochondriasis(건강염려증)

Hypochondriasis.pdf

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms.

B. The preoccupation persists despite appropriate medical eval‎uation and reassurance.

C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).

D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The duration of the disturbance is at least 6 months.

F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

somatization disorder와 hypochondriasis의 차이점

Hypochondriasis and Somatization.pdf

In DSM-IV hypochondriasis is defined as “preoccupation with fear of having . . . a serious disease, based on the person’s misinterpretation of bodily symptoms,” whereas somatization disorder (as well as subthreshold

somatization syndromes) is characterized by a specified number of medically unexplained somatic complaints. As a consequence of diagnostic criteria fear of disease in hypochondriasis has to be related to physical symptoms, while conversely medically unexplained symptoms might cause fear of disease or at least serious doubt about one’s health status.

Both phenomena could be dependent on each other or even two aspects of the same disorder (Escobar, Schwarz, Rubio-Stpec, & Manu, 1991; Murphy, 1990; Schmidt, 1994), and boundaries are indistinct.