Somatoform Disorders: Symptoms And Treatment

Somatoform disorders highlight how difficult it is to separate the effects of the body and the mind on a person’s health. The strong interconnection between these two dimensions considerably complicates the diagnosis and treatment of these types of disorders.

Before continuing, it is convenient to distinguish them from psychosomatic disorders. Although in both the trigger is psychological and there are physical symptoms, in psychosomatic disorders there is damage to the corresponding physiological system, while in somatoform there is no demonstrable organic pathology. Therefore,  we speak of somatoform disorders when there are physical symptoms but no organic symptoms or demonstrable physiological mechanisms. In addition, there is evidence of psychological conflicts linked to this symptomatology.

People with these types of disorders make their symptoms the epicenter of their lives. Even the discomforts they feel come to absorb them completely. However, in many cases their concern is disproportionate in relation to the symptoms they present. 

Excessive magnification

As we have seen, patients suffering from somatoform disorders  present physical symptoms that are psychological in origin. These conditions are accompanied by high levels of anguish, concern and difficulties in their daily functioning. Its clinical picture could be summarized in the following key points:

• Excessive worry about your symptoms and / or disruption of your normal life.
• Recurring, constant, and obsessive thoughts about the possible severity of your symptoms.
• Extreme anguish for their health and for the catastrophic consequences that the symptoms they suffer from can have.

• Investing a disproportionate amount of time and energy in your health problems.

They generate dependency

The chronicity of the physical symptoms and the belief in the catastrophic consequences that their regrets can have, makes them develop dependence on others. These patients generate in their environment the need to be cared for and constantly cared for.  So on the one hand, they avoid their responsibilities and on the other, they demand dedication, help and support in an overwhelming way from the people around them.

In addition, they tend to get angry if they believe that they are not being given enough time and attention that they deserve or their needs are underestimated. They may threaten and in some more complex cases, attempt suicide. As we can see, somatoform disorders are really serious if they are not detected in time.

They are difficult to detect

How to detect a disorder for which there are physical symptoms but no organic lesion? That is, what is the diagnosis of a set of complaints that afflict the patient, but whose cause is not found in a conclusive physical disorder? The answers to these questions lie in the psychological component of these disorders. Therefore, to diagnose it “there should not be a somatic basis that justifies the symptoms” (DSM-IV).

However, it would be inappropriate for doctors to diagnose this condition as a mental disorder when they cannot find a physical cause for the patient’s symptoms. Before they have to make sure that the tests they have carried out have been the most appropriate and that the results of them are correct.

Some people are also likely to overreact to their symptoms because their pain threshold is lower than normal. But this does not mean that they are to be assumed to be mentally ill.

This type of disorder has to be diagnosed once possible physical or organic disorders have been ruled out as a cause. And only if the response to the symptoms you present is abnormally strong.

Types of somatoform disorders

To categorize a disorder as a somatoform, one must be  guided by the response that the person emits to their symptoms or health problems. That is, their concern, anguish and the degree of interference that their discomforts have in their daily tasks and obligations. Therefore, depending on these reactions, the following specific disorders are distinguished (DSM-IV and ICD-10):

• Somatization: usually detected after years of suffering. Symptoms can appear anywhere on the body, but the most frequent are gastrointestinal discomfort (pain, bloating, vomiting, nausea, etc.) and dermal (burning, tingling, numbness, redness, etc.). Sometimes there are also signs of depression or anxiety.
• Undifferentiated somatoform: it is characterized by the appearance of multiple, variable and persistent physical complaints, but little explained. That is, its symptoms are insufficient to establish the diagnosis of somatization disorder.
• Hypochondriac : probably the best known of the types of somatoform disorders. Its main symptoms are worry and fear of developing or having one or more serious progressive diseases. Often, the patient categorizes normal or frequent sensations as exceptional and annoying phenomena.

• Somatoform vegetative dysfunction : its symptoms are manifested in the organs innervated by the vegetative nervous system. These are cardiovascular, gastrointestinal or respiratory, among others. A combination of objective signs of hyperactivity (palpitations, sweating, flushing and trembling) and other individual, subjective and nonspecific signs.
• Of persistent somatoform pain : it is characterized by intense pain, which occurs mainly in circumstances of conflict or problems.
• Others : sensory disturbances not due to somatic disorders and related to stressful events or problems. For example, the hysterical balloon or the gnashing of teeth, among others.

Cognitive-behavioral treatment

Although there are studies on the pharmacological treatment of pain, there is currently not a sufficient scientific basis to make reliable therapeutic recommendations. However, it is convenient for the patient to go to psychotherapy and, specifically, a cognitive-behavioral approach. It can help decrease worry and anxiety about your symptoms.

An integrative approach that combines cognitive behavioral therapy with interpersonal therapy is also effective.  This contemplates the two main characteristics of patients with somatizing tendencies: the maladjusted way of perceiving and evaluating how they are at the health level and the inadequate form of communication to express their discomfort to others.

These types of diseases have a high prevalence in our society. Although it is not necessary to obsess, in some cases the physical symptoms can be the product of a mental illness. This, as we said at the beginning of the article, is the result of the interrelation that exists between body and mind. Now,  where is the boundary between physical and mental symptoms?