Brief overview
- Symptoms: Many different symptoms; usually complaints without a specific diagnosable organic cause.
- Treatment: Many complaints disappear on their own. In case of persistent complaints: Psychotherapy, physical activity such as sports, yoga or relaxation training; in some cases medication.
- Causes and risk factors: Interaction of physical, emotional and social circumstances, psychosomatic causes, stress, grief, fears.
- Diagnosis: Physical examination, anamnesis of medical history and life circumstances; under certain circumstances specific examinations depending on the complaints
- Prognosis:Depending on the circumstances, usually improvement on its own, in other cases therapy; spontaneous improvement possible at any stage.
What is vegetative dystonia?
A vegetative dystonia literally means a “misregulated tension (dystonus) of the vegetative nervous system”. This system coordinates many important bodily functions that can hardly or not at all be influenced voluntarily – such as the heartbeat, breathing or digestion. Accordingly, various symptoms can be summarized under the umbrella term of vegetative dystonia – from cardiovascular complaints and headaches to trembling hands and diarrhea.
If patients suffer permanently from symptoms for which no physical causes can be found, doctors generally speak of somatoform disorders or functional syndromes.
However, vegetative dystonia should not be confused with dystonia: this is a collective term for various movement disorders, such as a crooked head posture or cramps in various parts of the body (for example, in the finger, the so-called musician’s spasm).
What is the autonomic nervous system?
The term vegetative dystonia refers to the autonomic, so-called vegetative nervous system. This system controls all automatic body functions: For example, it regulates blood pressure, activates sweat glands, and constricts pupils in bright light. However, when a person makes a conscious decision to move or perceive something, the somatic nervous system is active. Most of the time, both systems work closely together.
The autonomic nervous system is divided into two functional counterparts:
- Sympathetic nervous system (sympathetic nervous system)
- Parasympathetic nervous system (parasympathetic)
The complaints depend on whether the tension ratio has shifted in favor of the sympathetic or the parasympathetic nervous system: People with increased sympathetic activity (sympathicotonia) tend to be nervous, have a racing heart, increased blood pressure and diarrhea. If, on the other hand, the parasympathetic nervous system is dominant (vagotonia), this is more likely to be associated with low blood pressure, cold hands and feet, listlessness and constipation.
However, vegetative dystonia as a diagnosis is controversial; critics describe it as a “diagnosis of embarrassment” that is made when the doctor is at a loss for other advice. As a rule, physicians classify such physical complaints without an identifiable diagnosable organic cause as somatoform disorders.
Somatoform disorders are considered widespread in the population, but often the complaints disappear on their own.
How can vegetative dystonia be recognized?
A variety of very different symptoms can be associated with the term vegetative dystonia. The symptoms are often difficult to classify.
Possible symptoms of vegetative dystonia are:
- Headache
- Dizziness
- Diarrhea
- Constipation
- Sleep disorders
- Cramps
- increased sweating
- Increased or decreased pulse rate
- slight trembling of the hands
- Tingling in the limbs
One example is hyperkinetic heart syndrome, which is associated with frequent palpitations and large fluctuations in blood pressure. Irritable bowel syndrome refers to chronic digestive disorders, often associated with abdominal pain and flatulence. An overactive bladder (irritable bladder) often leads to a constant urge to urinate and frequent urination.
Symptom complexes of this type are called functional syndromes. Chronic pain with an unclear cause also belongs to this complex of topics, for example fibromyalgia. However, these are not usually classified under the term vegetative dystonia.
Under certain circumstances, sporadically occurring panic attacks, which often have no specific cause, are also classified as vegetative dystonia. In this case, it must be clarified whether a panic disorder with recurring attacks is present, which can be easily treated.
How can vegetative dystonia be treated?
How vegetative dystonia is best treated depends on its particular trigger and its severity. If the physical diagnosis remains without results, doctors often advise waiting and observing the course of the symptoms – somatoform disorders often subside on their own after a while.
Some psychotherapists specialize in somatoform disorders or vegetative dystonia. With this support, many sufferers learn to better classify their complaints and deal with them in everyday life – this happens, for example, in the context of cognitive behavioral therapy.
It is particularly helpful to work through the reasons and feelings behind the symptoms. If stressful feelings such as stress, worry or sadness can be eliminated or dealt with in a different way, the physical symptoms usually improve in the long term.
Many sufferers are also stuck in a kind of “vicious circle of avoidance”. They keep avoiding situations in which their symptoms intensify. In the end, they intensify the suffering that vegetative dystonia brings with it. A psychotherapist is a good contact person for breaking through this behavior.
Physical exercise, i.e. sports or walks, has a positive influence on some somatoform disorders. Some sufferers are helped by relaxation exercises such as progressive muscle relaxation, autogenic training, tai chi or yoga.
Some patients are helped by homeopathy as an alternative healing method. However, the effectiveness of homeopathy itself has not yet been scientifically proven.
Do medications help in therapy?
These include, for example, pain medication and various modern antidepressants. The doctor discusses the procedure in detail with the patient and tailors the medication to the individual case. As a rule, the doctor does not treat vegetative dystonia permanently, but only temporarily with medication.
Causes and risk factors
Vegetative dystonia often has no clearly definable cause (doctors then sometimes speak of “idiopathic”). Not infrequently, several physical, psychological and social circumstances play a role. Thus, it is difficult to find a concrete trigger for vegetative dystonia.
If a purely physical, organic cause for the respective symptoms can be excluded after all necessary medical examinations, the physician considers a psychosomatic cause. Body and psyche are in constant interaction with each other. And so it is not unusual for severe mental stress to affect various bodily functions.
Hormonal changes, for example due to menopause or pregnancy, are also possible triggers for unclear physical complaints, which are diagnosed by the doctor as vegetative dystonia or somatoform disorder.
This does not mean that the corresponding complaints are imaginary or “not real”! The vegetative dystonia often brings partly frightening symptoms (such as palpitations) and represents a great burden in the long run. Somatoform disorders should therefore be taken just as seriously as those that clearly have physical causes. Both require careful diagnosis and, if the symptoms do not resolve themselves, treatment.
Examinations and diagnosis
Vegetative dystonia is not a diagnosis in the sense of a specific disease, but encompasses an uncharacteristic condition in which various functions of the autonomic nervous system are obviously disturbed.
First, the physician inquires about the patient’s medical history (anamnesis). He asks what previous illnesses are present, whether the patient is taking medication, how long the symptoms have been present, in what situations they occur, and whether there are any other symptoms that could cause distress. The patient’s life situation and alcohol and drug consumption also usually provide important information.
- A physical examination already provides information about some symptoms. In a patient with frequent gastrointestinal problems, for example, the doctor palpates the abdominal wall. If there are complaints in the heart area, he listens to the heart sounds with a stethoscope.
- A pulse and blood pressure measurement is particularly informative in the case of circulatory complaints. Fluctuations during the course of the day can be checked by the patient himself, if necessary, with a manual blood pressure monitor.
- A blood test can be used, for example, to check whether inflammatory processes are taking place in the body, whether various nutrient deficiencies are present, or whether there is an excess or deficiency of certain hormones. In this way, possible physical causes such as a thyroid dysfunction or an iron deficiency can be ruled out.
- If a physical disease cannot yet be ruled out and the symptoms persist for a long time, special examinations follow depending on the symptoms. Examples include an electrocardiography (ECG), a stool or urine examination, and imaging procedures such as ultrasound and X-ray examinations. However, the physician usually tries to avoid unnecessary and possibly stressful examinations.
There is no specific test for vegetative dystonia because of the variety of possible symptoms.
Course and prognosis
How vegetative dystonia progresses depends on a variety of circumstances. As a rule, the prognosis is good. Vegetative dystonia does not limit life expectancy. In 50 to 75 percent of cases, somatoform disorders run a mild course and symptoms improve with time.
The prognosis is worse for patients with a very anxious and negative view of their symptoms, strong avoidance behavior, and parallel mental illnesses (such as depression or anxiety disorders). This is also true for severe psychosocial distress that cannot be resolved.
Likewise, it seems to have a negative effect on the course if the affected person is out of work for more than a month or withdraws from friends and family.
Vegetative dystonia with a “severe course” means that the symptoms become more severe over time and are permanent (chronification). However, this does not mean that the symptoms will persist forever just because they cannot be successfully treated initially. There is always the possibility that the vegetative dystonia will regress on its own.