Somatoform disorder

Somatoform disorder: description

A somatoform disorder is the result of several repeated physical symptoms that persist despite multiple negative test results. The physical symptoms can be very different and affect every part of the body or organ. The patients are mostly convinced of a physical illness and always demand further examinations and medical measures. The possibility of a mental cause is often not accepted by the patient, which leads to frequent changes of doctor. In this context, terms such as “doctors hopping” or a “patient career” are used, but the disease pressure of the patient is not fair. Often the somatoform disorder is associated with another psychiatric illness such as anxiety and depression.

Somatoform disorders

There are several somatoform disorders. Among them are:

Hypochondriacal Disorder
This somatoform disorder affects men and women equally frequently. They are objectively physically healthy, but they are convinced that they are suffering from a serious illness. The patients are intensively concerned with their complaints. The main feature of the hypochondriacal disorder is not the physical complaint symptoms but the above-average mental involvement with it. This persistent fear and dealing with one’s own suffering affects the social and professional lives of those affected. The duration of this somatoform disorder is at least six months.

somatization disorder
Women are affected more often. Characteristics are different, over at least two years existing complaints without adequate physical explanation. This somatoform disorder presents with different symptoms from at least two symptom groups, such as frequent fatigue, loss of appetite, heart, stomach, or bladder complaints. Somatization disorders include persistent somatoform disorder, somatoform autonomic dysfunction and undifferentiated somatization disorder. A persistent somatoform disorder is present if the symptoms persist for at least six months (most days).

A somatoform autonomic dysfunction occurs when an organ is affected that receives its commands from the autonomic (autonomic) nervous system. The cardio-pulmonary system and the digestive tract are particularly common. Somatoform autonomic dysfunction is most commonly diagnosed. 25 percent of German citizens are affected once in their lives. There is no difference between men and women for this somatoform disorder. Although the physical complaints persist in numerous and persistent form, but the typical clinical criteria for a somatization disorder (see above) are not met, there is an undifferentiated somatization disorder.

Somatoform pain disorder
This somatoform disorder is characterized by chronic, severe pain without adequate physical explanation over a period of at least six months. Pain location and character change frequently and without a regular pattern. The everyday life of the patients is completely dominated by the pain. Those affected deny, however, that the symptoms could also have emotional causes. The diagnosis “somatoform disorder” patients do not want to admit. Men and women are equally affected, with a familial accumulation of this somatoform disorder.

Somatoform disorder: symptoms

The main feature of the somatoform disorder is physical symptoms that the patient does not deliberately control or pretend, but for which there is no medical, physical explanation. The somatoform disorder can occur in all organ systems and shows various symptoms. The most common symptoms that the somatoform disorder brings are:

• Symptoms in the cardiovascular system: Chest pain, pressure, heart piercing or heart stumbling

• Symptoms of the gastrointestinal tract: Abdominal pain, digestive problems with constipation and / or diarrhea, nausea, feeling of fullness

• Symptoms in the urogenital area: Painful urination, frequent urination, pelvic pain

• Symptoms in the area of ​​breathing: Feeling of shortness of breath, shortness of breath

• Symptoms in the area of ​​the muscles and joints: Back pain, pain in arms and legs

Somatoform disorder: causes and risk factors

The causes of the somatoform disorder are complex, experts suspect the interaction of several factors. There are several approaches that explain the somatoform disorder in its development.

The psychoanalytic model assumes that inner psychological conflicts are carried out on the “stage of the body” and thus express themselves externally in the form of physical complaints and organic suffering. Often, the somatoform disorder manifests as a generalized anxiety that can not be attributed to a specific cause by the patient. The inner tension is relocated by the treatment of external discomfort and is experienced as relief.

Of the learning theory explanatory approach presupposes a learned, recurring and thus increasing pattern of behavior for the somatoform disorder. The result is a vicious circle that can hardly be broken by the patient on his own. For example, if the patient is worried that his heart is beating irregularly, he will begin to feel the pulse and direct his attention to the physical symptoms. The breathing and the pulse rate can then really change, whereby the patient feels again confirmed in his fear and the somatoform disorder further solidifies.

Various neurobiological models are currently being discussed. Since one or the other somatoform disorder increasingly affects first-degree relatives, some heredity can not be excluded. However, it has not yet been clearly demonstrated that in patients with somatoform disorder, the immune system and the nervous system as well as their hormones show a stronger response in stressful situations than healthy persons.

Risk factors for the somatoform disorder include emotional stress situations, unconscious conflicts and inner mental stress processes such as anger, anger, despair, traumatic experiences or dissatisfaction with oneself. Certain personality types are also more susceptible to somatoform disorder than others. The anxious-self-uncertain personality structure often suffers from a feeling of helplessness and worthlessness and is therefore additionally endangered for the somatoform disorder. Through its obvious suffering the affected person experiences a secondary illness gain. He thereby receives the attention of the fellow man and it is created a framework in which the patient may concede weakness.

Individuals who have difficulty expressing their emotions are also at a higher risk of undergoing the somatoform disorder. A permanent additional burden in daily life or the feeling of being overstrained also make it more vulnerable. A transient high level of tension in stressful lives often relieves the somatoform disorder and its symptoms, and subsequent relaxation often makes the somatoform disorder more pronounced. Why exactly which organ is affected by the somatoform disorder is different in every human being. The cultural background, previous illnesses and the identification with disease symptoms play a role in this.

Somatoform disorder: examinations and diagnosis

It is not always easy to differentiate the somatoform disorder from other physical illnesses. It is very important to exclude other physical causes before the somatoform disorder is used as a work diagnosis. Depending on the condition, this includes blood tests, ECG, x-rays and other diagnostic tests. The somatoform disorder, however, is not just an exclusion diagnosis. Decisive for the diagnosis somatoform disorder is the occurrence of many different physical symptoms that are usually not limited to an organ system and for which there is no medical education. The somatoform disorder can also be identified by the presence of symptoms over an extended period of time. The somatoform disorder is particularly common among patients of general practice.

Somatoform disorder: treatment

There is no single therapy for every single somatoform disorder. Therapy and treatment plans vary. Psychiatric and physical disorders associated with the somatoform disorder must be co-treated. Because their relief can also improve the somatoform disorder. A strengthened doctor-patient relationship is considered to be particularly important in the treatment, because patients have often lost confidence in doctors.

Somatoform disorder: therapy prerequisites

The physical symptoms must be taken seriously by the treating therapist and the possibility of psychological causes should be addressed openly. An explanation of the possible mental processes behind the disease (psychoeducation) is considered the foundation of successful treatment of a somatoform disorder. Only then can the therapeutic work bear fruit.

Above all, the most important goals for the therapy are to prevent the patient from perceiving himself as chronically ill, and that the somatoform disorder dominates his life. The psychosocial stress should be permanently reduced. The numerous examinations and treatment attempts are extremely expensive, which is why unnecessary diagnostics should be prevented. Relaxation techniques such as progressive muscle relaxation according to Jacobson often have a positive, supportive effect, since the somatoform disorder is often associated with stress and overwork.

Hypochondriacal Disorder – Therapy: So far, there is no single drug therapy for this somatoform disorder. Therapy plans vary individually depending on the severity of the symptoms. When psychic comorbidities occur, anxiolytics and antidepressants are used. Psychotherapy should be initiated early to counteract the development of a chronic course. It seeks to give the patient a sense of security that he is not suffering from a serious illness, yet he is being taken seriously for the somatoform disorder.

When trust has been established between the therapist and the patient, an attempt is made to change the patient’s attitude towards his or her body perception. The goal is to identify the patient’s problems and stress factors in order to work on them and manage the somatoform disorder.

Somatization disorder – therapy: For the somatization disorder also no uniform drug therapy is known, but antidepressants are often used successfully. The guidelines for this somatoform disorder indicate that concomitant diseases always have to be co-treated, as their relief can lead to an improvement in the somatization disorder. A psychotherapeutic treatment is also recommended so that the patient manages to distance himself from the supposed symptoms and get some distance from the suffering. This should facilitate the coping with everyday life and the handling of one’s own problems. Relaxation procedures are helpful for permanently overcoming the somatoform disorder.

Somatoform pain disorder – Therapy: Before beginning therapy, organic causes must be excluded. Medically, the somatoform pain disorder is treated with analgesic drugs or antidepressants. Psychotherapeutically, there are so-called multimodal therapy programs. They are performed on an outpatient basis to cure this somatoform disorder. The patient becomes the expert of his own pain. The patient is taught basic knowledge about the development of pain, the processing and the triggering conditions. He is asked to carefully observe himself and his somatoform disorder and to keep a pain diary and a pain scale. It helps to assess the course and the triggering factors better. The goals of multimodal therapy are to change the patient’s perception of pain, promote healthy patient behavior, and cure the somatoform disorder.

Somatoform disorder: disease course and prognosis

If the somatoform disorder remains untreated, excessive diagnostic measures can be taken, which rather damages the patient. If psychotherapy is started in time, the prognosis for the somatoform disorder is good. There is a great interest on the part of the health care system in researching the somatoform disorder. The scientists, however, are faced with a great task, since the somatoform disorder represents a complex clinical picture.