A somatoform disorder represents a symptom complex which cannot be explained, or cannot be adequately explained, by organic causes. It involves functional complaints that are related to psychological stress and strain on the patient. Somatoform disorders are very common and in most cases occur only temporarily.
What is a somatoform disorder?
A somatoform disorder is a physically felt discomfort for which no organic cause can be found. All organs can be affected by functional disorders caused by a dysregulation of the autonomic nervous system. If no organic changes are found after extensive examination of the patient, the diagnosis “somatotropic disorder” must be made. Most people (over 80 percent) suffer from somatotropic disorders at least temporarily in the course of their lives. In most cases, this condition lasts only for a short time and is usually associated with extraordinary life situations. In 5 to 20 percent of all cases, however, the symptoms become chronic. Such symptoms as exhaustion, fatigue, gastrointestinal problems, cardiovascular complaints or sexual problems are frequently observed. To make a diagnosis, however, it is necessary to exclude all other possible causes of the symptoms in order to offer patients psychotherapeutic treatment.
Causes
The causes of somatoform disorders are diverse. They arise from the life situation of the patient concerned. The interaction of psychological, social and biological factors is assumed to be the trigger. There may also be a genetic basis. In most cases, it is psychosocial reasons that lead to characteristic complaints. One cause can be long-lasting negative stress, which in the long term causes functional disorders of certain organs. Also, too much attention to harmless symptoms coupled with the fear that it could be something worse, often leads to significant discomfort without organic causes being apparent. Frequently, mental processes and conflicts associated with the emotions of anger, resentment, fear or dissatisfaction manifest themselves as physical symptoms. Early childhood traumatic experiences often also play a role.
Symptoms, complaints, and signs
Somatoform disorders manifest themselves in many different symptoms. For example, breath clamping, globus sensation, or shortness of breath often occur. In the chest, there may be feelings of tightness, stinging, a feeling of pressure or palpitations. Furthermore, many patients suffer from digestive problems such as nausea, stomach pain, upper abdominal pain, bloating, flatulence, diarrhea or constipation. Women may also experience gynecological complaints. Frequent urination as well as pain disorders are also observed. Overall, somatoform disorders are divided into somatization disorders, hypochondriacal disorders, and somatoform autonomic dysfunction. Somatization disorders include many changing physical symptoms that persist for at least two years and cannot be explained by organic causes. These include pain, digestive problems, neurological symptoms, and sexual dysfunction. The clinical picture of hypochondria is characterized by the fact that the affected person is convinced that he or she is suffering from a serious illness and cannot be convinced otherwise. The affected patients consistently observe themselves and strongly valorize harmless symptoms. If no physical causes are found, the doctor is changed. Somatotropic autonomic dysfunctions are symptoms of organs that are directly supplied by the autonomic nervous system. Here, cardiac neuroses, stomach complaints, hyperventilation, frequent urination or an irritable bowel are frequently observed. Again, organic causes cannot be found.
Diagnosis and course of the disease
To diagnose a somatoform disorder, it is very important to exclude an organic cause for the complaints beyond doubt. In addition to the usual laboratory tests, this also includes imaging procedures. Again, it would be fatal to carry out too intensive diagnostics if a somatoform disorder is already suspected. The patient would concentrate even more on finding an organic cause and would be even more reluctant to work through his problems psychotherapeutically.Of course, the diagnosis must also be differentially diagnosed from other mental disorders such as depression. However, the diagnosis should also take into account that somatoform disorder is often also associated with such mental disorders as addictions, anxiety disorders, depression, obsessive-compulsive disorder, and personality disorders. An important criterion for somatoform autonomic disorder is the presence of at least six symptoms from two organ groups that are not organically related and have been present for at least two years.
Complications
In somatoform autonomic dysfunction, the major challenge for the physician and for the patient is to distinguish between psychosomatic and physical causes of the symptoms. Difficulties arise not only in the initial diagnosis. Various complications are possible if an additional physical illness is not recognized in time. In addition, it is conceivable that an actual worsening of an existing physical dysfunction may be misinterpreted as psychosomatic. Some people suffering from somatoform autonomic dysfunction experience symptoms related to a specific organ. An example of this is cardiac neurosis. A patient with cardiac neurosis may not only develop actual heart problems, but may also develop another organ condition. Conversely, a person suffering from physical cardiac complaints may additionally struggle with somatoform autonomic dysfunction related to the heart or other autonomic functions. Therefore, thorough examinations are required to rule out physical complications. For the treatment of somatoform autonomic dysfunction, however, this presents a catch-22 situation: medical examinations can (and must) rule out physical causes for the symptoms – but at the same time, these examinations may exacerbate the psychological sense of illness. Furthermore, it is possible that medical examinations and treatments may cause direct harm or that the physically healthy patient may become infected with a pathogen via other patients. Possible complications of somatoform autonomic dysfunction also include psychological distress such as depression and anxiety.
When should you see a doctor?
With this condition, the patient is in need of treatment. Serious discomfort and complications can occur, which in the worst case can also reduce the life expectancy of the affected person. In order to prevent further complaints, a doctor should be consulted. Only in very rare cases does this disorder heal itself. A doctor should be consulted if the affected person suffers from severe digestive discomfort. There is significant pain in the stomach or even severe nausea. Severe pain in the upper abdomen or a permanent feeling of fullness can also indicate the disease and must be examined by a doctor. In many cases, constipation also occurs. Furthermore, psychological upsets or other psychological complaints may also indicate the disease. In the first instance, a general practitioner or an internist can be consulted for this disease. However, further treatment depends strongly on the exact causes and the exact manifestation of the disorder. As a rule, the disease does not result in a reduced life expectancy of the affected person.
Treatment and therapy
The therapy of a somatoform disorder is often very difficult. A prerequisite is the development of a relationship of trust between patient and physician. However, this is often not given because the patient is ostensibly looking for an organic cause for his complaints. Thus, there are constant changes of doctors in the hope that the diagnosis, sometimes made by the patient himself, will be confirmed at some point. However, the doctor must be able to explain the patient plausibly about the illness in order to be able to follow up with successful psychotherapy. The patient must be motivated to work on his or her problems based on this knowledge.
Prevention
Prevention of a generalized and chronic form of somatoform disorder begins in early childhood. Thus, behavioral structures are learned from parents and adopted for coping with one’s own problems later in life.In the process, it is also possible to learn how to deal with physical symptoms that always occur. When physical discomfort evokes the attention of others that would not otherwise take place, the growing person learns a wrong coping strategy for his or her life problems. Therefore, a positive and life-oriented education can contribute a lot to the health of the person.
Aftercare
Somatoform disorders affect different parts of the body, for example, the female abdomen or the cardiovascular system. Therefore, the form of follow-up care appropriate for a somatoform disorder depends on the patient’s particular symptoms. The individual condition of the sufferer must also be taken into account when considering the appropriate follow-up care. However, follow-up care is advisable in any case in order to bring physical and mental health back into harmony. The patient must become aware of the interaction (both positive and negative) between the physical and the psychological during the aftercare. Moreover, the prevention of a relapse and the long-term stabilization of the patient are the goals of aftercare treatment. This is especially true if the patient was previously treated in a clinic for somatoform disorders and is to return to his or her familiar environment. It is useful to give the affected person the address of a local family doctor or psychologist. The patient can turn to this point of contact if, after treatment has been completed, there is an acute crisis situation and intervention is required. Seeing a specialist in an emergency should be strongly urged, as the risk of deterioration of the condition or relapse in such a situation is very high.
What you can do yourself
If existing health impairments cannot be clarified despite numerous examinations, the affected person should remain calm. If there is no proven organic disorder, emotional factors should be given greater consideration. Further changes of doctors are often not recommended. An unhappy lifestyle, a diminished sense of well-being or unfulfilled desires of various kinds can lead to health disorders. If goals in life have not been achieved or if one’s life is not developing according to plans or guidelines that have been worked out, this should be examined more closely. Depending on the personality, these issues can be self-critically questioned and changed. However, it is advisable to seek therapeutic help. It has proven effective for many of those affected if a neutral person can provide an additional impetus for the reappraisal of cognitive patterns. Stressors of everyday life should basically be reduced. In addition, daily routines should be optimized and adapted to the organism’s requirements. Improvements can be achieved in many cases with a healthy and balanced diet. In addition, social contacts should be established and maintained. Sufficient leisure time activities are also important so that an appropriate balance to everyday life can be achieved. Cognitive training and relaxation techniques have proven effective for many sufferers. They help to alleviate existing symptoms and promote a sense of well-being.