Somatoform disorders are characterized by physical sensations and bodily pain caused by mental illness. These symptoms cause a significant amount of distress and may or may not be linked to a medical condition, mental disorder, or other substance abuse condition. Symptoms of somatic disorder also tend to trigger stress and anxiety and lead the individual to spend a great deal of time thinking about or acting in response to them.
Somatoform disorders are characterized by excessive focus on physical ailments, such as pain or tiredness. These physical symptoms cause an individual extreme mental distress and significant impairment in everyday functioning. A person with a somatoform disorder will constantly obsess over their symptoms while frantically searching for a plausible explanation for them.
Causes Of Somatoform Disorders
Different somatoform disorders are distinguished by thoughts, emotions and actions related to somatic symptoms. There are seven types of somatoform disorders where individuals present with a multitude of clinically significant symptoms that cannot be explained, including:
Like the specific somatic symptom and related disorders diagnosis, undifferentiated somatoform disorder applies to individuals who have symptoms characteristic of somatic disorders that do not meet full criteria for any somatoform disorder. However, the unspecified somatic symptom and related disorder diagnosis should only be given in unusual situations, or in situations where there is insufficient information to make a more specific diagnosis.
Somatoform disorder symptoms cannot be explained by a concrete medical or neurological cause or condition. They may range from mild to severe and can present as single or multiple symptoms. Pain is the most frequent symptom experienced in somatoform disorders and is usually accompanied by pervasive thoughts, emotions and actions related to the pain. These beliefs, feelings and behaviors can be debilitating and disruptive to normal functioning.
It is not precisely clear what causes somatoform disorders, but it is believed that there are several contributing factors. Genetic and hereditary factors, such as hypersensitivity to pain sensations, may be involved. Family influences can be another contributing factor.
An individual who possesses a personality trait of negativity can influence how illness and physical symptoms are perceived. Increased attention to bodily symptoms and sensations when a person has difficulty identifying, discussing or processing emotions is often involved. In other cases, a somatoform disorder may develop in a subconscious effort to garner extra attention because of their perceived illness.
To be diagnosed with a somatoform disorder, a person must display at least one somatic symptom, such as pain or sleepiness that causes distress and negatively impacts daily functioning. They must also have extreme and unrelenting thoughts about the severity of their symptoms, experience elevated levels of anxiety about their health and spend an excessive amount of time on symptoms or health. Symptoms must last for longer than six months, though the intensity of symptoms may fluctuate during this time.
Somatoform disorders often co-occur with mental health conditions, such as anxiety and depression. Co-occurring mental health conditions need to be addressed simultaneously for treatment to be effective. In some cases, co-occurring mental health conditions are the underlying cause of somatoform disorders.
Psychotherapy is beneficial in the treatment of a somatoform disorder because physical symptoms are usually related to underlying psychological conditions. The most commonly used somatoform disorder treatment option is cognitive behavioral therapy (CBT), which focuses on helping people change their thoughts and behaviors related to the condition. CBT can help individuals learn how to decrease preoccupation with their symptoms while teaching them how to cope with physical symptoms and other emotional and mental concerns.
If you or someone you know is struggling with a somatoform disorder and co-occurring substance abuse disorder, help is available at the Recovery Village. Trained staff can assist you in choosing a treatment program that is right for you. Reach out to a representative today for more information.
The somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms. They include somatization disorder (involving multisystem physical symptoms), undifferentiated somatoform disorder (fewer symptoms than somatization disorder), conversion disorder (voluntary motor or sensory function symptoms), pain disorder (pain with strong psychological involvement), hypochondriasis (fear of having a life-threatening illness or condition), body dysmorphic disorder (preoccupation with a real or imagined physical defect), and somatoform disorder not otherwise specified (used when criteria are not clearly met for one of the other somatoform disorders). These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing. Treatment success can be enhanced by discussing the possibility of a somatoform disorder with the patient early in the evaluation process, limiting unnecessary diagnostic and medical treatments, focusing on the management of the disorder rather than its cure, using appropriate medications and psychotherapy for comorbidities, maintaining a psychoeducational and collaborative relationship with patients, and referring patients to mental health professionals when appropriate.
The somatoform disorders are a group of psychiatric disorders in which patients present with a myriad of clinically significant but unexplained physical symptoms. They include somatization disorder, undifferentiated somatoform disorder, hypochondriasis, conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder not otherwise specified.1 These disorders often cause significant emotional distress for patients and are a challenge to family physicians.
Little is known about the causes of the somatoform disorders. Limited epidemiologic data suggest familial aggregation for some of the disorders.1 These data also indicate comorbidities with other mental health disorders, such as mood disorders, anxiety disorders, personality disorders, eating disorders, and psychotic disorders.1,3
The challenge in working with somatoform disorders in the primary care setting is to simultaneously exclude medical causes for physical symptoms while considering a mental health diagnosis. The diagnosis of a somatoform disorder should be considered early in the process of evaluating a patient with unexplained physical symptoms. Appropriate nonpsychiatric medical conditions should be considered, but over-evaluation and unnecessary testing should be avoided. There are no specific physical examination findings or laboratory data that are helpful in confirming these disorders; it often is the lack of any physical or laboratory findings to explain the patient's excessive preoccupation with somatic symptoms that initially prompts the physician to consider the diagnosis.
Two related disorders, factitious disorder and malingering, must be excluded before diagnosing a somatoform disorder. In factitious disorder, patients adopt physical symptoms for unconscious internal gain (i.e., the patient desires to take on the role of being sick), whereas malingering involves the purposeful feigning of physical symptoms for external gain (e.g., financial or legal benefit, avoidance of undesirable situations). In somatoform disorders, there are no obvious gains or incentives for the patient, and the physical symptoms are not willfully adopted or feigned; rather, anxiety and fear facilitate the initiation, exacerbation, and maintenance of these disorders.
There are three required clinical criteria common to each of the somatoform disorders: The physical symptoms (1) cannot be fully explained by a general medical condition, another mental disorder, or the effects of a substance; (2) are not the result of factitious disorder or malingering; and (3) cause significant impairment in social, occupational, or other functioning. The additional characteristics of each disorder are discussed briefly in the following and are listed in Table 1.1
The diagnosis of undifferentiated somatoform disorder is a less-specific version of somatization disorder that requires only a six-month or longer history of one or more unexplained physical complaints in addition to the other requisite clinical criteria. Chronic fatigue that cannot be fully explained by a known medical condition is a typical symptom. The highest incidence of complaints occurs in young women of low socioeconomic status, but symptoms are not limited to any group.1
Somatoform disorder not otherwise specified is a psychiatric diagnosis used for conditions that do not meet the full criteria for the other somatoform disorders, but have physical symptoms that are misinterpreted or exaggerated with resultant impairment. A variety of conditions come under this diagnosis, including pseudocyesis, the mistaken belief of being pregnant based on actual signs of pregnancy (e.g., expanding abdomen without eversion of the umbilicus, oligomenorrhea, amenorrhea, feeling fetal movement, nausea, breast changes, labor pains).
The initial steps in treating somatoform disorders are to consider and discuss the possibility of the disorder with the patient early in the work-up and, after ruling out organic pathology as the primary etiology for the symptoms, to confirm the psychiatric diagnosis. A psychiatric diagnosis should be made only when all criteria are met.
The physician should review with the patient the diagnostic criteria for the suspected somatoform disorder, explaining the disorder as for any medical condition, with information regarding etiology, epidemiology, and treatment. It should also be explained that the goal of treatment for somatoform disorders is management rather than cure. 2ff7e9595c
Comments