Befindlichkeitsstörungen are widespread in the population. The multiple symptoms can occur in virtually all organ systems, which often makes it difficult to assign them to specific clinical pictures and to make a clear diagnosis. Befindlichkeitsstörungen without objective organic findings have no disease value in medicine.
What is a mood disorder?
Befindlichkeitsstörungen, also known as functional dysfunction, occur at any age. Even small children and schoolchildren complain of mood disorders. Thus, on the one hand, the complaint pattern is very common in general medical practice; on the other hand, the multitude of complaints are often difficult to classify, which sometimes results in a large number of visits to the doctor by those affected. Typical are the collection of a multitude of borderline findings with physical examinations, blood tests or imaging procedures, without a medical explanation for the symptoms being found in the end. For this reason, functional disorders or disorders of well-being are also very significant in economic terms, because they occur very frequently and cause enormous costs for the health care system. The transition from mood disorders to so-called somatoform disorders is fluid. In almost all cases, however, patients suffer from a vegetative lability associated with a misguided body perception. These psychovegetative complaints should be treated despite the absence of a clear cause so that they do not become chronic.
Causes
The exact causes of mood disorders that manifest as vegetative lability or as vegetative dystonia are not known to date. However, it is assumed that there is an imbalance in the complicated interaction of body, mind and spirit in each mood disorder. In psychiatry today, it is assumed that every so-called functional disorder is maintained and triggered by unresolved, inner conflicts. Thus, the symptoms of a mood disorder would be nothing more than an inadequate attempt to cope on a somatic, i.e. physical level. Sensitivity disorders of any kind are therefore always psychosomatic; if no diagnosis is made despite multiple visits to the doctor, the doctor-patient relationship will suffer considerably over time. Patients with such mood disorders are not malingerers, but experience the symptoms as real. Chronic somatic disorders should also be examined in detail psychiatrically. Not infrequently, the causes can be found in the direct social environment of an affected person. Experts have also long discussed whether hereditary components must also be taken into account in the development of mood disorders.
Symptoms, complaints, and signs
The complaints from which affected individuals suffer are extraordinarily varied and difficult to classify. First of all, it is important that the attending physician, despite the absence of organic findings, takes all complaints seriously in any case. The patient must not have the feeling that nothing concrete can be done, just because nothing concrete has been found. The character of the complaint corresponds to unspecific general symptoms and therefore raises corresponding diagnostic and therapeutic problems. The age focus of people with mood disorders is from 20 to about 40 years, in older age the number of patients decreases significantly, but the reasons for this are unknown. Typical complaints and signs of mood disorders are always psychological or unspecifically physical. In concrete terms, this can manifest itself as listlessness, general malaise, breathing problems, urinary urgency, a feeling of pressure on the chest or the sensation of having a lump in the throat. Muscle tension, headaches, joint problems and itchy skin are also frequently reported. Those affected also report an increased occurrence of indecisiveness or a decrease in concentration with forgetfulness. Because most symptoms of a functional disorder can also be an expression of an organic condition, careful differential diagnosis is so important.
Diagnosis and course
The most important diagnostic criterion for mood disorders of any kind is an intensive consultation with the physician.Based on the patient’s description and the collection of objective findings by means of blood tests, ECG, X-ray or functional tests, it quickly becomes clear that no organic disease is present. Typical embarrassment diagnoses, as they are then made in the doctor’s office, are for example vegetative dystonia, functional disorder, larvierte depression, multiple complaint syndrome or psychovegetative exhaustion. The course of the disease is often chronic with a tendency to worsen, with a progressive decline in psychological resilience and physical performance.
Complications
Mood disorders encompass a broad spectrum, with a fluid transition to disease. As a result, a mood disorder usually has the potential to worsen into a clinical manifestation. For example, depressed mood can develop into full-blown (major) depression without treatment or self-help. If the depressed mood persists for a long time without reaching the severity of a depressive episode, dysthymia may also be considered as a diagnosis. The same applies to physical mood disorders. They may precede physical illness or occur as a consequence of it. There is no diagnostic equivalent for most social mood disorders. However, a social mood disorder may contribute to psychological distress and, accordingly, may be reflected in either a physical or a psychological mood disorder. For example, social stress and bullying often lead to depression, anxiety disorders, or somatic disorders. Stress also affects the body and can cause or promote organic diseases. If a mood disorder has not yet crossed the threshold into illness, treatment is often difficult. Preventive measures are useful to avoid complications and deterioration. These include personal psychological hygiene and careful handling of one’s own body. In addition, the statutory health insurance funds in Germany offer various preventive services such as relaxation courses, nutritional counseling or stress management.
When should you go to the doctor?
Persistent physical complaints should always be checked by a doctor – even if they are only mild. However, it is difficult to set a concrete time limit. In the case of episodically recurring disorders of well-being, a visit to the doctor is often also advisable, even if the complaints disappear again and again in the meantime. Patients suffering from severe symptoms should not delay a visit to the doctor for too long. There may be a specific cause for the complaints and rapid treatment may be necessary. Diagnostic clarification is also advisable in the case of psychological mood disorders. Cognitive, emotional or behavioral symptoms may not only indicate a mental disorder or a mental mood disorder, but may also occur in the context of a physical illness. For this reason, affected individuals can first consult their family doctor or a general practitioner to determine a possible physical cause. Both physical and psychological mood disorders do not always represent diagnosable diseases. If no organic reason can be found for the mental mood disorders, a visit to a psychotherapist or psychiatrist may be informative. Diagnosis is particularly advisable if the psychological symptoms occur for a longer period of time (for example, two weeks) or are also severe. Somatoform disorders can also be treated psychotherapeutically. In this context, the recommendation of psychological or psychotherapeutic treatment does not mean that a simulation of the symptoms is suspected.
Treatment and therapy
Causal, i.e., cause-related therapy, is not possible because of the complexity of the complaints as well as the lack of objective physical findings. From a psychosomatic point of view, the long-term consequences of a functional disorder are serious; therefore, it is imperative to provide therapy, also to alleviate the often considerable suffering of those affected. However, timely prevention has proven to be the best therapy for mood disorders. A person with psychosomatic disorders is neither mentally ill in the classical sense, nor does he suffer from psychosis, neurosis or hypochondria.Because psychological repression problems are the main cause of mood disorders, certain psychotherapeutic methods are suitable for long-term improvement of the symptoms. Talking psychotherapy over a longer period of time, depth psychological methods and behavioral therapies have proven to be particularly effective. Mood disorders that have gone untreated for years or decades can also lead to manifest depression.
Outlook and prognosis
Depending on the type of mood disorder, the prognosis varies widely. A mood disorder may last for a very long time and persist for several months or years. However, it can be equally transient. Studies on the prognosis of mood disorders are difficult to compare because the results depend on the exact definition. In the medium and long term, both improvement and worsening of symptoms are conceivable. In addition, there is the possibility that the mood disorder remains the same. Even in individual cases, a clear prognosis cannot always be determined. The complaints can change both in their nature and in their intensity. A sensitivity disorder does not have to be treated by a doctor in every case. In some cases, it subsides without external intervention or improves with general stress-reducing measures and simple home remedies. However, a mood disorder can also develop into another disease. For example, many infectious diseases begin with a general feeling of malaise before the specific symptoms of the respective disease develop. If a sensitivity disorder persists over a longer period of time, a detailed clarification is often advisable. This also applies to psychological complaints, as some psychological disorders can be very inconspicuous. This includes dysthymia, for example. It is characterized by a chronic depressive mood that lasts at least two years. Accordingly, the transition between a mood disorder and other illnesses can be fluid.
Prevention
Everyone can do a lot with an active lifestyle to prevent somatoform disorders from occurring in the first place. A healthy social environment with plenty of opportunities to talk things out already offers some protection. The general well-being can also be influenced by diet, and stimulants such as nicotine and alcohol should be avoided. Physical measures such as sauna, alternating showers or dry brushing have also proven helpful for prevention. New approaches to the prevention of mood disorders promise so-called psychagogic therapy concepts, which are a synthesis of educational instructions for everyday life and psychotherapy.
Aftercare
In the case of mood disorders, aftercare is similar to prevention. Because mood disorders can refer to very different organic and psychological complaints, the focus here is on general aftercare options. There are three core areas of health promotion that can be useful in the aftercare of mood disorders. A healthy diet contributes to physical and psychological well-being and can help prevent future illness and mood disorders. This does not only apply to complaints that are clearly caused by malnutrition. Food provides the body with the basis for all metabolic processes and therefore takes on a very high value. An appropriate amount of exercise also improves health. Exercise should be adapted to personal strengths and weaknesses. Specific arrangements with the doctor, a physiotherapist or a qualified health trainer are useful here. Reducing stress represents the third pillar of health promotion. Stress reduction is particularly important in the aftercare of mental health disorders such as depressive moods, in order to prevent the symptoms from returning. However, psychological stress can also affect physical health. In most cases, mood disorders are mild, so follow-up care transitions smoothly into a healthy daily routine. Long-term lifestyle changes in diet, exercise and stress management are useful in many cases.
Here’s what you can do yourself
A mood disorder should be diagnosed and treated by a doctor or therapist.In addition to conventional medical and therapeutic measures, psychosomatic disorders can be alleviated by various self-help measures. Depending on the cause, a change in lifestyle can already help. For example, mood swings and psychologically induced pain can at least be reduced by exercise and a healthy, balanced diet. A change of environment or moving to a new place of residence can also alleviate the many complaints associated with a mood disorder. For this, however, it is necessary for those affected to clearly recognize their mood disorder as such. A complaints diary helps to record and analyze one’s own mood and state of mind during the day. Discussions with friends and family also support self-diagnosis. An important step in the treatment of mood disorders is the resolution of inner conflicts. This is possible both in self-help groups and in psychological counseling sessions. In the long term, the psychosomatic triggers must be medically clarified and treated. Through psychological counseling on the one hand and an increase in quality of life on the other, dealing with a mood disorder can be made much easier.
