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Somatoform Disorders

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There are several disorders that fall under the category of somatoform disorders; to understand their symptoms and causes, we should first examine these disorders as a group. The basis of all somatoform disorders are physical symptoms that seem to have no physical basis. They can affect any body organ or system and can include intense or chronic pain, nausea and/or vomiting, dizziness, fatigue, loss of appetite, diarrhea, allergic reactions to certain foods, problems with menstruation and erectile dysfunction. It’s important to note that individuals diagnosed with a somatoform disorder are not being deceitful to avoid fulfilling their responsibilities (malingering).  They fully believe the symptoms are real.

What are somatoform disorders?

The difference between somatization disorder and other somatoform disorders lies in its number of disparate symptoms and the fact that it affects more than one body system. Diagnosis is complex; for a person to be diagnosed with somatization disorder, he/she must have reported at least four occurrences of pain in different areas of the body, two symptoms involving digestion, one symptom affecting sexual function, and one symptom that imitates a disease of the central nervous system. A wide range of lab testing and physical examinations must be completed to rule out physical causes of the symptoms.

As with other forms of somatoform disorders, there is no known cause of somatization disorder, although some psychologists believe that it is symbolic, serving as a form of unspoken communication or expressing repressed emotions. Others point to upbringing, examples set by parents, or childhood abuse as possible reasons that this disorder develops in childhood, adolescence or early adulthood.

What are the prevalence of Somatoform Disorders?

There is some disagreement as to the prevalence of this disorder, with estimates ranging from 0.1 to 0.5 percent of the population. It is known that up to twenty times more women than men are diagnosed; doctors in family or general practice report that 5 to 10 percent of their client base could be suffering from somatization disorder.

How are somatoform disorders treated?

While it is vital that any physical cause of complaints be fully addressed, it is suggested that medical professionals consider the emotional basis of reported physical symptoms that exist within the context of this somatoform disorders. Excellent rates of recovery have been found when psychotherapy is used to assist clients in expressing their feelings verbally and cope with their symptoms of somatoform disorders.

Types of Somatoform Disorders:

What is pain disorder?

somatoform disordersPain disorder is a type of the somatoform disorders where an individual must be suffering pain in a single or multiple areas of the body, their symptoms must not be the result of physical injury or disease and must be causing significant difficulties in function. Mood disorders such as depression and/or anxiety or any psychotic disorder must be ruled out, as are any chance that the client is either intentionally causing themselves pain or being dishonest (such as with Munchausen syndrome). Symptoms of pain disorder usually begin suddenly and become increasingly severe over a period of weeks or months. 

What is the best treatment for pain disorder?

While over-the-counter or prescription pain medications are usually not effective, antidepressants have proved successful for reducing pain. Biofeedback is especially helpful for migraines or headaches caused by tense muscles.

What is conversion disorder?

The original name for conversion disorder was “hysteria”, a disorder that has appeared in medical literature dating back to the time of Hippocrates.  The symptoms of conversion disorders, just like other somatoform disorders, can be very frightening, both to individuals with conversion disorder and to their families and friends. The symptoms occur abruptly and may disappear just as quickly; however, there is a strong likelihood that the disorder will reoccur with the same or different symptoms.

A person diagnosed with conversion disorder can lose their ability to see, experiencing total or partial blindness or tunnel vision or find themselves unable to speak above a whisper. They may suffer partial or complete paralysis of arms or legs, be insensitive to pain, or lose their sense of smell.

The groups in which this form of somatoform disorder is most frequently found are adolescents or young adults, although the numbers, at less than 1% of the population, are very small. It should be noted, however, that those numbers increased dramatically during both World War I and II, with many combat veterans suffering the symptoms of conversion disorder.

Depression, substance abuse, and borderline and histrionic personality disorders are frequently seen as co-morbid diagnoses.

Is there an effective treatment for conversion disorder?

It is very important that family and medical professionals when dealing with somatoform disorders, avoid mentioning that symptoms may be imaginary rather than the result of disease or injury. Such a straightforward approach, while tempting, can cause symptoms to worsen.

The symptoms of conversion disorder usually disappear naturally and without any necessary intervention. However, the process of recovery and the changes of a reoccurrence can be improved through the use of behavioral therapy. Therapy can help patients learn new and better ways of coping with the stress that may have precipitated the disorder.

What is hypochondriasis?

“Hypochondriasis” is a form of somatoform disorders taken from a medical term meaning ‘below the ribs’.  It is appropriate because individuals with this disorder frequently center on abdominal symptoms such as pain or digestive problems. Hypochondriasis does not involve imaginary or exaggerated new symptoms, but rather the person’s interpretation of those symptoms as being indications of serious disease or injury. However inaccurate or baseless their beliefs, those beliefs can reduce an individual’s ability to function,  and affect their relationships, their employment and their happiness.  They can also cause anxiety, panic attacks, depression and chronic fatigue.

Within this type of somatoform disorder,l diagnosis is usually make between the ages of 20 and 30, with those numbers are divided equally between men and women. Hypochondriasis is an equal opportunity somatoform disorder, occurring regardless of education level, income or social status. It can last for months, years, or decades or appear and disappear quickly, often following the death or serious illness of a person important to the patient. The stress and fear of a serious or life-threatening illness or injury can cause hypochondriasis even after the danger has passed.

What is body dysmorphic disorder?

In a culture obsessed with physical attractiveness and a youthful appearance, it should come as no surprise some people develop body dysmorphic disorder, a preoccupation with what they imagine to be a defective body part or a distorted view of some small and insignificant defect.

Women are diagnosed with this type of somatoform disorder a bit more frequently than men, and, for most, the onset of the disorder occurs when they are in their mid-teens or early twenties.

Convinced that others are staring at the offending body part, many attempt to conceal their supposed shortcoming with make-up or clothing; they may avoid mirrors or, conversely, obsessively check their appearance in any reflective surface.

Out of all somatoform disorders,body dysmorphic disorder does more than improve the income of personal trainers and plastic surgeons; fear of ridicule causes people to sequester themselves in their homes, avoiding social interaction and limiting relationships. It is very common for those suffering from this disorder to also be diagnosed with depression and anxiety; it is possible that up to 20 percent will attempt suicide.

What treatment is used for body dysmorphic disorder?

As with all somatoform disorders, the key to the treatment of body dysmorphic disorder lies in the management of symptoms, with the goal being as normal a life as is possible. Antidepressant and anti-anxiety medications can help, as can support both from family and friends.