What are somatoform disorders?
Somatoform disorders are a group of psychiatric disorders that cause physical pain without a physical explanation that can be seen by a physician. Someone with a somatoform disorder may experience severe physical pain without any medical cause or could possibly have regular aches and pains without a physiological reason.
Somatoform disorders are extremely frustrating for both patients and doctors. Patients are frustrated because they have pain or discomfort and there is no known explanation. Doctors are frustrated because they can't help the patients and they are searching for explanations that aren't physically explained.
Many times people with somatoform disorders enter into a terrible cycle of searching for diagnoses and then imagining that they have diseases they do not have. Patients with somatoform disorders are not making up their symptoms. Their pain is real. These patients will often become preoccupied with their health, demanding unnecessary tests and becoming displeased with doctors and medical professionals. They often become non-compliant with the doctor's orders, as well.
Causes of Somatoform Disorders:
The cause of most of the somatoform disorders is not known. In some, there may be issues with the nerve impulses that send the signals of pain or pressure to the brain.
There are no definitive reasons for these groups of disorders but the following can be considered:
- Genetic and environmental factors
- Sexual abuse
- Parental somatization
- Alexithymia (poor ability to express emotions)
Types of Somatoform Disorders:
Somatization Disorder: This is defined by several somatic symptoms that can't be explained by laboratory testing or physical exams. The guidelines for somatization disorder is precise. They include:
- At least two digestive system problems, such as diarrhea, constipation, abdominal pain and nausea.
- Pain in at least four places on the body.
- A history of symptoms that cannot be explained, before the age of 30.
- At least one sexual symptom, such as erectile dysfunction, lack of interest, painful menstruation, or pain during sex.
- At least one pseudo-neurological symptom such as fainting or blindness.
Hypochondriasis: The fear of having a serious disease because the patient misinterprets normal bodily functions. Characteristics of a person suffering from hypochondria are:
- The fear of having a serious medical problem becomes a preoccupation.
- Regardless of medical opinion from a doctor or other medical professional, this preoccupation remains.
- This fear lingers for at least six months.
- An example of hypochondriasis is when a person has a headache and believes they have a brain tumor even when medical evidence has proven they do not.
Conversion disorder: When physical symptoms that are characteristic of a neurological disorder develop without the presence of an actual neurological disorder. Attributes of this disorder can include:
- Hearing loss
- Paralysis of either a leg or arm
- Loss of vision
- Becoming mute
- Inability to walk
Body Dysmorphic Disorder: Obsession of a physical imperfection or flaw in appearance. These imperfections or flaws are either non-existent or negligible. Attributes of this disorder include:
- Preoccupation with perceived appearance flaws, such as wrinkles, weight, hair loss, size of breasts or nose.
- Possibly associated with having several plastic surgeries to correct what they perceive as imperfections.
Pain Disorder: Having physical pain without any apparent medical cause. Symptoms include:
- Pain that is not being "faked". The pain is real to the person experiencing it.
- Chronic pain for a long period of time and disrupts the patient's life.
- Sometimes associated with a medical problem, but not always.
Risks for Developing Somatoform Disorders:
The cause of somatoform disorders is unknown. It is thought that in certain people, there is an issue with nerve impulses that send the pain/pressure signals to the brain. It is known that the symptoms are real and not imagined.
Somatoform disorders often run in families and can come and go over a period of time.
Symptoms of Somatoform Disorders
The above types of somatoform disorders carry with them a variety of symptoms. Each one has it's own unique signs and symptoms. They include:
- Pain that is unable to be explained by medical testing. (Pain disorder)
- The feeling that the patient's body has a defect or imperfection that is either minute or not there at all. (Body dysmorphic disorder-more information above)
- Conversion disorder. Seizures, hearing loss. (Additional symptoms listed above)
- Hypochondriasis which is when a person believes that they have a serious illness, (i.e. cancer, tumors, etc.) when there is no medical evidence to go along with it. This preoccupation can lead to a disruption of the person's life. (More information listed above).
- Somatization disorder. Digestive system problems, among other symptoms that are listed above.
Diagnosis of Somatoform Disorders:
In order to diagnose a patient with a somatoform disorder a thorough medical evaluation is required. This may include laboratory workups and scans from radiology. An MRI, x-ray, ultrasound, or CT may be included in the physical examination.
Ruling out other possible reasons for the patient's symptoms is key. An illness or injury that causes similar symptoms, must be ruled out first. Once those reasons are eliminated, the doctor could order a psychological evaluation if they suspect somatoform disorder is a possibility.
Two disorders must be ruled out in order to diagnose a person with a somatoform disorder.
Factitious Disorder: When a person takes on physical symptoms in order to make themselves feel better inside. When someone craves sympathy, they may invent or overemphasize their physical pain in order to get that attention.
Malingering: When someone feigns physical pain in order to get an external satisfaction. This could be insurance money from faking an injury in a car accident, for example. They could also exaggerate or fabricate an illness so that they can get out of doing something, like going to work.
These two related disorders must first be eliminated before a diagnosis of somatoform disorder is reached. There are no motives for the patient who is experiencing the above symptoms. Their pain is real and the patients are scared and anxious when they approach their doctors.
Treatment for Somatoform Disorders:
Treatment will depend upon what type of somatoform disorder the patient has. Pain medications generally do not achieve good results. When the patient is experiencing chronic pain, treatment with anti-depressants along with therapy is often the preferred route. These medications help with pain and anxiety associated with their disorder. The classes of anti-depressants that may be used are:
- SSRIs (Selective serotonin reuptake inhibitors)
- Tricyclic anti-depressants
Often no medications are needed at all, however.
Cognitive behavioral therapy (CBT), which is a form of talk therapy, can help patients to deal with their pain by teaching them to develop coping mechanisms, understand what makes the pain increase, and how to become more physically active while still in pain.
CBT is thought to be the best form of treatment in most cases. Stress reduction, hypnosis, massage and physical therapy are other forms of therapy that may also be beneficial to the patient.
Additional Information on Somatoform Disorders:
There are potential complications that arise when dealing with somatoform disorders, such as:
- Addiction to pain medications if they are prescribed
Be aware of these possible difficulties and be sure to talk to a physician or psychiatrist who is familiar with and has experience with somatoform disorders.
Tips for Living With Somatoform Disorders:
- Be sure to get plenty of exercise and get plenty of sleep at night. This will help manage any stress or anxiety you may be feeling.
- Try using hot and/or cold packs applied to any areas of pain to assist in pain relief.
- Ask your physician if physical therapy will be useful in your case.
- Do stress reduction exercises. Ask your doctor to provide you with some exercises that will help manage your stress and/or anxiety.
- Keep all appointments with your health care providers and do what they instruct you to do.
- Take any medications as directed by your health care provider.
- Keep up with your social life. Interacting with friends and other people is a good way to boost your mood.
- Consider joining a support group. Knowing that you are not alone and that there are other people who understand what you are going through, can be an invaluable source of comfort.
Additional Resources for Somatoform Disorders:
Sidran Institute: A non-profit that helps people all over the world to understand and cope with traumatic stress as well as dissociative disorders.
National Alliance on Mental Illness (NAMI): The largest grassroots mental health organization in America. They are committed to helping improve the lives of millions of Americans who are affected by mental illness. They advocate for patient's to have access to services, treatments, supports and research.
The Mayo Clinic: is a nonprofit worldwide leader in medical care and research for people from all walks of life. Their mission is to inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.