Somatoform disorders are psychiatric illnesses that result in physical symptoms, often pain. Patients are diagnosed with a somatoform disorder when their symptoms are severe enough to interfere with daily functioning, not fabricated, not found to have a medical origin, and are not the result of another type of mental disturbance or of substance abuse.
In order to be diagnosed with a somatoform disorder, a patient must have a thorough medical examination, including any necessary blood or imaging tests, to rule out physical illness. Once this is done, the patient should be evaluated by a psychiatrist or other mental health care professional who specializes in somatoform disorders. Although the precise causes of somatoform disorders are unknown, they are believed to result from a confluence of genetic, stress, parental and cultural factors.
Types of Somatoform Disorders
There are several types of somatoform disorders, differentiated by various criteria, such as age of onset, duration, and specific symptoms. Symptoms of somatoform disorders usually worsen under stress.
Also known as Briquet's syndrome, somatization disorder is diagnosed in patients who have a history of years of ongoing medical problems beginning before the age of 30. These patients have chronic pain and physical symptoms involving several body systems. Patients with somatization disorder have two or more gastrointestinal symptoms, one or more neurological symptoms and one or more reproductive or sexual symptoms. Frequently these individuals also suffer with an anxiety disorder.
Undifferentiated Somatoform Disorder
This is a less specific version of somatization disorder. Diagnosis requires one or more unexplained physical symptoms for at least 6 months.
Patients with hypochondriasis, also known as hypochondria, are convinced that they have a serious disease, castastrophizing even small symptoms as indications of grave disorders. They are preoccupied with their symptoms and presumed ill health.
Body Dysmorphic Disorder
Patients with body dysmorphic disorder obsess about a perceived bodily flaw. Their response to the defect may be wildly exaggerated or the flaw may not even be perceptible to anyone else. No matter, it worries the patient constantly and interferes with the ability to relax, work, or relate to other people. The patient with body dysmorphic disorder may focus on any part of the body. Frequent obsessions may involve hair or baldness, wrinkles or sagging skin, or the size or shape of facial features, breasts or genitalia.
Conversion disorders involve disturbing, often disabling, neurological symptoms for which no medical cause can be found. During the time of Freud, conversion disorders were referred to as hysterical symptoms. Symptoms of conversion disorder may include:
- Loss of sensation
Pain disorder is usually precipitated by psychological trauma. Patients typically develop a blinding headache or terrible back pain after a very stressful event and the pain becomes a chronic condition.
Somatoform Disorder Not Otherwise Specified
As with other "not otherwise specified" disorders, this condition is a bit of a catchall for individuals with psychogenic physical disorders whose symptoms do not meet the criteria for other somatoform disorders. One of the varieties included in this category is pseudocyesis, or false pregnancy. Patients diagnosed with this disorder experience many or all of the following symptoms: enlargement of breasts and abdomen, nausea and vomiting, cessation of menstruation, sense of fetal movement and labor pains.
Treatment of Somatoform Disorders
In the somatoform disorder patients, antidepressants have proven more effective and pain medications. Supportive psychotherapy is also helpful, especially group therapy, cognitive behavioral therapy, and teaching of distraction techniques. Alternative treatments may also provide assistance. These include the following:
- Application of hot or cold packs
- Massage therapy
- Physical therapy
- Stress reduction exercises
It may be difficult to treat somatoform disorders since patients frequently have difficulty attributing their physical symptoms to psychological causes. The prognosis for patients with somatoform disorders is considerably better when treatment is begun early.