Brief overview
- Symptoms:Various physical symptoms for which there is no organic cause; frequent “doctor hopping” (= frequent change of doctor); various syndrome manifestations (hypochondriasis, chronic pain disorder and others)
- Treatment: Depending on the severity, usually psychotherapy, possibly medication such as antidepressants or anxiolytics.
- Diagnosis: Usually lengthy, concrete organic causes of the stated physical complaints must be excluded (with various examination methods); psychological diagnostics, including questionnaires.
- Prognosis: Good if correctly diagnosed in time; often too much diagnostics due to frequent change of doctor, for example with too many X-ray examinations
What is a somatoform disorder?
Patients are often firmly convinced of a physical illness and always request further examinations and medical measures. The possibility of a psychological cause is often not accepted by the patient, which leads to frequent changes of doctor. In this context, terms such as “doctor hopping” or “patient career” are also used, but these do not do justice to the patient’s illness pressure.
Expressions
There are various somatoform disorders. The classification system of the World Health Organization WHO (International Statistical Classification of Diseases and Related Health Problems) ICD-10 counts the following expressions among them under the code F45.-:
Hypochondriacal disorder
The main characteristic of hypochondriacal disorder is not the physical symptoms, but the above-average mental preoccupation with them. This persistent anxiety and preoccupation with one’s own suffering interferes with the social and professional life of the affected person. The duration of this somatoform disorder is at least six months.
Somatization disorder
Forms of somatization disorder include:
- Persistent somatoform disorder: persistent somatoform disorder is when symptoms are present for at least six months (on most days).
- Undifferentiated somatization disorder: this is present when the physical complaints are numerous and persistent in various forms, but the clinical criteria for somatization disorder (see above) are not met.
Persistent somatoform pain disorder.
However, those affected deny that psychological causes are also possible for the complaints – they often do not want to accept the diagnosis of “somatoform disorder”. Men and women are affected equally often, although there is a familial clustering with regard to this somatoform disorder.
What are the symptoms?
The main characteristic of a somatoform disorder are physical symptoms which the patient does not control or feign voluntarily, but for which there is also no physical explanation. The complaints are basically possible in all organ systems. Most commonly, a somatoform disorder is associated with the following symptoms:
- Symptoms in the area of the cardiovascular system: chest pain, feeling of pressure, stabbing or stumbling of the heart.
- Urogenital symptoms: pain during urination, frequent urination, lower abdominal pain
- Symptoms in the respiratory area: feeling of shortness of breath, shortness of breath
- Symptoms in the area of muscles and joints: back pain, pain in arms and legs, tingling sensation
A temporarily high level of tension in stressful phases of life often alleviates the somatoform disorder or its symptoms. However, subsequent relaxation often causes the disorder to become more pronounced again.
How can a somatoform disorder be treated?
A good, trusting relationship between doctor and patient is also important for treatment – after all, people with somatoform disorders have often lost trust in doctors.
Depending on the severity, it is possible that somatoform disorders lead to inability to work. In some cases, somatoform disorders go away on their own without treatment. In other cases, therapy is advisable, which may include treatment with medication.
The foundation for successful treatment of somatoform disorders is psychoeducation: the therapist or physician explains to the patient the psychological processes that may be causing the somatoform disorder. Only with this understanding on the part of the patient will the therapeutic work bear fruit.
Hypochondriacal disorder – Therapy
To date, there is no single drug therapy for this somatoform disorder. Therapy plans vary individually depending on the severity of symptoms. When concomitant mental illnesses occur, the therapist often applies anti-anxiety medications and antidepressants.
It is also important to change the patient’s attitude towards his body perception. The goal is to identify the patient’s problems and stressors in order to work on them and manage the somatoform disorder.
Somatization disorder – therapy
Psychotherapeutic treatment is also recommended so that the patient manages to distance himself from the alleged symptoms and gain some distance from the suffering. This helps him to cope better with everyday life again and makes it easier for him to deal with his own problems.
Relaxation techniques are also helpful in overcoming somatization disorder permanently.
Somatoform pain disorder – therapy
Within the framework of psychotherapy, so-called multimodal therapy programs are available. These are carried out on an outpatient basis. The patient becomes an expert on his or her own pain: the therapist teaches him or her basic knowledge about the development of pain, the processing of pain stimuli and the triggering conditions.
The goals of multimodal therapy are to change the patient’s perception of pain, to promote healthy behavior in the patient, and to cure the somatoform disorder.
Causes and risk factors
The causes of somatoform disorder are complex, and experts suspect an interplay of several factors here. There are various explanations for the development of a somatoform disorder:
The learning theory approach to explanation presupposes a learned, recurring and thus reinforcing behavioral pattern for the somatoform disorder. A vicious circle develops, which is difficult for the patient to break out of on his own.
Various neurobiological models are also currently being discussed. Since some somatoform disorders often affect first-degree relatives, a certain heritability cannot be excluded. In addition, it is possible that in patients with somatoform disorders, the immune system and the nervous system as well as their hormones react more strongly in stressful situations than in healthy individuals. However, this has not yet been clearly demonstrated.
Risk factors for somatoform disorders
Certain personality types are also more prone to somatoform disorder than others: The anxious-self-insecure personality type often suffers from a sense of helplessness and worthlessness. Due to his obvious suffering, the affected person experiences a secondary gain of illness. This attracts the attention of others, and a framework is created in which the patient is allowed to admit weakness.
Examinations and diagnosis
It is not always easy to distinguish a somatoform disorder from physical illness. Therefore, careful examinations to rule out physical causes of the symptoms are necessary (such as blood tests, ECG, X-ray) before the physician assumes a somatoform disorder as a working diagnosis.
A psychological diagnosis with standardized questionnaires, among other things, often secures the diagnosis.
Course of the disease and prognosis
If the somatoform disorder remains untreated, repeated visits to the doctor and changes of doctors can lead to excessive diagnostic measures – for example, too frequent X-ray examinations. This does more harm than good to the patient.
If the diagnosis is unclear, incidental findings are possible, which may be overestimated and possibly overtreated.
