Somatization disorder
Encyclopedia
Somatization disorder is a psychiatric diagnosis
applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin. The disorder must begin before the patient turns 30 years of age and could last for several years, resulting to either medical seeking behavior or significant treatment. One common general etiological
explanation is that internal psychological conflicts are unconscious
ly expressed as physical signs. Patients with somatization disorder will typically visit many doctors in pursuit of effective treatment.
Examples of manifestations of Pychosomatic disorder are as such: a child itches in response to family issues, and experiencing repressed anger and/or fear. Thus, The child grows and wakes up itching in the same locations, though not aware of the repressed memory causing the suffering in later life, or the patient is engaged in seeking psychotherapy for somatization.
. The DSM-IV
establishes the following five criteria for the diagnosis of this disorder:
Such symptoms cannot be fully explained by a medical condition or substance. The symptoms do not all have to occur at the same time, but may occur over the course of the disorder. A somatization disorder itself is chronic but fluctuating that rarely remits completely. If a medical condition is present, then the symptoms must be excessive enough to warrant a separate diagnosis. Two symptoms cannot be counted for the same thing e.g. if pain during intercourse is counted as a sexual symptom it cannot be counted as a pain symptom. Finally, symptoms cannot be intentionally feigned/produced to get some sort of conscious benefit from the illness.
Somatization disorder is difficult to diagnose but there are two tests that may help to determine if a patient has the condition:
Once the physical cause is ruled out, then a psychological test
is performed to rule out any other related disorders. Since there is no definite way to determine somatization disorder from a simple test, other tests are performed to rule out the other possibilities.
The first and one of the oldest theories is that the symptoms of somatization disorder represent the body’s own defense against psychological stress. This theory states that the mind has a finite capacity to cope with stress and strain. Therefore, increasing social or emotional stresses beyond a certain point are experienced as physical symptoms, principally affecting the digestive, nervous, and reproductive systems. In recent years, researchers have found connections between the brain, immune system, and digestive system which may be the reason why somatization affects those systems and that people with Irritable bowel syndrome
are more likely to get somatization disorder. This theory also helps explain why depression is related to somatization. It is also experienced in very high levels in women with a history of physical, emotional or sexual abuse
The second theory for the cause of somatization disorder is that the disorder occurs due to heightened sensitivity to internal physical sensations. Some people have the ability to feel even the slightest amount of discomfort or pain within their body. With this hypersensitivity, the patient would sense pain that the brain normally would not register in the average person such as minor changes in one's heartbeat. Somatization disorder would then be very closely related to panic disorder under this theory. However, not much is known about hypersensitivity and its relevance to somatization disorder. The psychological or physiological origins of hypersensitivity are still not well understood by experts.
The third theory is that somatization disorder is caused by one’s own negative thoughts and overemphasized fears. Their catastrophic thinking about even the slightest ailments such as thinking a cramp in their shoulder is a tumor, or shortness of breath is due to asthma, could lead those who have somatization disorder to actually worsen their symptoms. This then causes them to feel more pain for just a simple thing like a headache. Often the patients feel like they have a rare disease. This is because their doctors would not be able to have a medical explanation for their unconsciously exaggerated pain that the patient actually thinks is there. This thinking that the symptom is catastrophic also often reduces the activities they normally do. They fear that doing activities that they would normally do on a regular basis would make the symptoms worse. The patient slowly stops doing activities one by one until they practically shut themselves from a normal life. With nothing else to do it leaves more time to think about the “rare disease” they have and consequently ending in greater stress and disability.
s. Certain symptoms of the disorder vary across different cultures as well. For example, the symptom of a sensation of worms in the head or ants crawling under the skin is more prone to those of African and South Asian countries than those in North American countries.
s and cognitive behavioral therapy have been shown to help treat the disorder. Collaboration between a psychiatrist and primary care physician may help. The CBT helps with the patient realizing that the ailments are not as catastrophic. Enabling them to slowly get back to doing activities that they once were able to do without fear of “worsening their symptoms.” Psychologists recommend addressing a common difficulty in patients with somatization disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner (see link: http://www.lenus.ie/hse/bitstream/10147/121822/1/SomatizationDis.pdf).
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin. The disorder must begin before the patient turns 30 years of age and could last for several years, resulting to either medical seeking behavior or significant treatment. One common general etiological
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
explanation is that internal psychological conflicts are unconscious
Unconscious mind
The unconscious mind is a term coined by the 18th century German romantic philosopher Friedrich Schelling and later introduced into English by the poet and essayist Samuel Taylor Coleridge...
ly expressed as physical signs. Patients with somatization disorder will typically visit many doctors in pursuit of effective treatment.
Examples of manifestations of Pychosomatic disorder are as such: a child itches in response to family issues, and experiencing repressed anger and/or fear. Thus, The child grows and wakes up itching in the same locations, though not aware of the repressed memory causing the suffering in later life, or the patient is engaged in seeking psychotherapy for somatization.
Criteria
Somatization disorder is a somatoform disorderSomatoform disorder
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...
. The DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
establishes the following five criteria for the diagnosis of this disorder:
- a history of somatic symptoms prior to the age of 30
- painPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
in at least four different sites on the body - two gastrointestinal problems other than pain such as vomiting or diarrhea
- one sexual symptom such as lack of interest or erectile dysfunction
- one pseudoneurological symptom similar to those seen in Conversion disorderConversion disorderConversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric...
such as fainting or blindness.
Such symptoms cannot be fully explained by a medical condition or substance. The symptoms do not all have to occur at the same time, but may occur over the course of the disorder. A somatization disorder itself is chronic but fluctuating that rarely remits completely. If a medical condition is present, then the symptoms must be excessive enough to warrant a separate diagnosis. Two symptoms cannot be counted for the same thing e.g. if pain during intercourse is counted as a sexual symptom it cannot be counted as a pain symptom. Finally, symptoms cannot be intentionally feigned/produced to get some sort of conscious benefit from the illness.
Somatization disorder is difficult to diagnose but there are two tests that may help to determine if a patient has the condition:
- a physical examination of the specified areas that the symptom seems to be in is the first test, along with
- thorough clinical evaluation of the patient's expressed symptoms. This is to determine whether or not the pain is due to a physical cause.
Once the physical cause is ruled out, then a psychological test
Psychological testing
Psychological testing is a field characterized by the use of samples of behavior in order to assess psychological construct, such as cognitive and emotional functioning, about a given individual. The technical term for the science behind psychological testing is psychometrics...
is performed to rule out any other related disorders. Since there is no definite way to determine somatization disorder from a simple test, other tests are performed to rule out the other possibilities.
Causes
Although somatization disorder has been studied and diagnosed for more than a century, there is debate and uncertainty regarding its pathophysiology. Most current explanations focus on the concept of a misconnection between the mind and the body. Widely held theories on this troublesome, often familial disorder fit into three general categories.The first and one of the oldest theories is that the symptoms of somatization disorder represent the body’s own defense against psychological stress. This theory states that the mind has a finite capacity to cope with stress and strain. Therefore, increasing social or emotional stresses beyond a certain point are experienced as physical symptoms, principally affecting the digestive, nervous, and reproductive systems. In recent years, researchers have found connections between the brain, immune system, and digestive system which may be the reason why somatization affects those systems and that people with Irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
are more likely to get somatization disorder. This theory also helps explain why depression is related to somatization. It is also experienced in very high levels in women with a history of physical, emotional or sexual abuse
The second theory for the cause of somatization disorder is that the disorder occurs due to heightened sensitivity to internal physical sensations. Some people have the ability to feel even the slightest amount of discomfort or pain within their body. With this hypersensitivity, the patient would sense pain that the brain normally would not register in the average person such as minor changes in one's heartbeat. Somatization disorder would then be very closely related to panic disorder under this theory. However, not much is known about hypersensitivity and its relevance to somatization disorder. The psychological or physiological origins of hypersensitivity are still not well understood by experts.
The third theory is that somatization disorder is caused by one’s own negative thoughts and overemphasized fears. Their catastrophic thinking about even the slightest ailments such as thinking a cramp in their shoulder is a tumor, or shortness of breath is due to asthma, could lead those who have somatization disorder to actually worsen their symptoms. This then causes them to feel more pain for just a simple thing like a headache. Often the patients feel like they have a rare disease. This is because their doctors would not be able to have a medical explanation for their unconsciously exaggerated pain that the patient actually thinks is there. This thinking that the symptom is catastrophic also often reduces the activities they normally do. They fear that doing activities that they would normally do on a regular basis would make the symptoms worse. The patient slowly stops doing activities one by one until they practically shut themselves from a normal life. With nothing else to do it leaves more time to think about the “rare disease” they have and consequently ending in greater stress and disability.
Prevalence
Somatization disorder is uncommon in the general population. It is thought to occur in 0.2% to 2% of females, and, according to the DSM-IV, 0.2% of males. There is usually co-morbidity with other psychological disorders, particularly mood or anxiety disorders. This condition is chronic and has a poor prognosis. Although the disorder occurs most often in women, the male relatives of affected women have an increased risk of substance-related disorders and antisocial personality disorderAntisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...
s. Certain symptoms of the disorder vary across different cultures as well. For example, the symptom of a sensation of worms in the head or ants crawling under the skin is more prone to those of African and South Asian countries than those in North American countries.
Treatment
AntidepressantAntidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s and cognitive behavioral therapy have been shown to help treat the disorder. Collaboration between a psychiatrist and primary care physician may help. The CBT helps with the patient realizing that the ailments are not as catastrophic. Enabling them to slowly get back to doing activities that they once were able to do without fear of “worsening their symptoms.” Psychologists recommend addressing a common difficulty in patients with somatization disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner (see link: http://www.lenus.ie/hse/bitstream/10147/121822/1/SomatizationDis.pdf).
Prevention
While there is no known way to prevent the acquisition of somatization disorder, those who are prone to it should benefit from greater awareness of the condition. This can be obtained by going to counseling or other psychological conventions. In addition, having a good relationship with a health care provider is very beneficial. With early knowledge of the disorder, patients will be well aware of how to deal with stressors, which could help keep the symptoms from becoming more severe.See also
- Culture-bound syndromeCulture-bound syndromeIn medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture...
- Psychosomatic illnessPsychosomatic illnessPsychosomatic medicine is an interdisciplinary medical field studying the relationships of social, psychological, and behavioral factors on bodily processes and well-being in humans and animals...
- Hypochondriasis
- Body-centred countertransferenceBody-centred countertransferenceBody-centred countertransference or 'somatic countertransference refers to feelings that a psychological practitioner has about a client. Referring to the psychologists sensation in the gut, changes to breathing, to heart rate and to tension in muscles'....