Understanding Somatoform Disorder

A person with somatoform disorder sometimes referred to as somatic symptom disorder (SSD) or psychosomatic disorder, would exhibit physical symptoms in reaction to psychological discomfort.

Since it might be particularly difficult for young individuals to articulate their emotions, psychological discomfort may manifest as somatic (physical) symptoms. A diagnosis of “medically unexplained symptoms (MUS)” is reportedly given to up to 10% of youngsters in the UK who complain of aches and pains (stomach aches, joint problems, headaches, etc.). Many adults who visit their general practitioner are also affected.

There are numerous ways in which physical and psychological symptoms might interact because of how closely the mind and body are connected. It is crucial to take underlying psychological problems into account for individuals who consistently present with somatoform disorder symptoms that are medically unexplained. This may include the existence of co-existing conditions like:

• Anxiety disorders
• Separation anxiety
• School phobia
• Eating disorders
• Depression
• Selective mutism

You may learn more about the various types of somatoform disorders, such as dissociative (conversion) disorder and chronic fatigue syndrome (CFS), in this article. Psychosomatic disorders can be treated in a variety of methods, including:

• Individual psychological work
• Family therapy
• Sleep hygiene management and dietary advice
• Medication

Please read our entire post to learn more about the most effective treatment for the somatoform disorder. We also go through typical warning signs and symptoms and how to recognize a patient who may require additional testing.

Types of somatoform disorder

It’s crucial to keep in mind that this mental health problem might manifest itself in several ways. This comprises:

Persistent somatoform pain disorder

• Pain that is constant, strong, and upsetting is the main complaint.
• A physiological mechanism or a physical illness cannot entirely account for it.
• It happens in conjunction with emotional strife or psychosocial issues.
• A significant boost in support and attention—personal or medical—is typically the outcome.

Dissociative/conversion disorder

• a partial or whole lack of the integration that normally exists between present-day feelings, identity awareness, and prior memories.
• No known physical or neurological disorders are found during a medical evaluation.
• There is proof of a direct correlation between problems and stressful life events over time.
• Always be aware of the potential for major physical or psychiatric issues to develop later.

Chronic fatigue syndrome (neurasthenia)

• Complaints of greater exhaustion after mental work that are distressing and persistent.
• symptoms of physical heaviness and tiredness that persist and are distressing even after little effort.
• Muscle aches or pains, lightheadedness, tension headaches, disturbed sleep, inability to unwind, irritability, and dyspepsia are at least two of the symptoms.
• The presence of autonomic or depressive symptoms does not meet the requirements for any of the more specific illnesses since they are not persistent enough or severe enough.
• There are significant cultural differences in how this illness manifests.

A person may develop a somatoform disorder for a variety of causes. Three categories can be made from them:

Individual

physical disease, a tendency toward vulnerability and sensitivity, worries about connections with peers, and a focus on high achievement.

Family

includes issues with one’s physical and mental health, parental somatization, excessive emotional involvement, and a limited emotional “vocabulary.”

Environment

includes peer pressure, bullying, and academic pressure.

Recognizing a patient with somatoform disorder

The primary clinical characteristics of this disease include:

• persistent headaches, joint pain, stomachaches, etc.
• Lack of focus, lightheadedness, and moodiness.
• persistent anxiety over deteriorating physical health.
• beginning of a severe flu-like condition or glandular fever.
• complete loss of movement or sensation in the body.
• motor function loss or impairment as well as false seizures (seizures that do not have the typical features of an epileptic fit and are not accompanied by an abnormal EEG).
• After a stressful occurrence, symptoms typically appear and linger for a few weeks or months.
• affects women more frequently than men, on average.
• Typically, symptoms appear in early adolescence or youth.

Younger children are more likely to experience abdominal discomfort than older or adolescent children or adults; conversion symptoms typically start around the age of 16.

Numerous studies have revealed that one in four kids has at least one set of physical symptoms on a weekly or fortnightly basis.

Assessment

A kid may have the somatoform disorder if:

• Psychosocial pressures and physical ailments are correlated over time.
• The type and severity of the symptom or the impairment it causes are inconsistent with the pathogenesis.
• There is an associated mental illness.

For the majority of kids, family doctors or pediatricians are likely to be their first port of call. Having the comfort that there is no diagnosable medical condition will frequently allay worries long enough for the youngster to become better without more assistance. However, signs might sometimes linger.

As many children and families in these situations may think that they are not being taken seriously and that referral to mental health services means their physical symptoms are not believed, it is important to refer to a mental health service sensitively while acknowledging the symptoms.

A psychiatric evaluation would consist of:

• taking a medical and developmental history.
• Investigating the full history of the school.
• There is a mental health examination.

It is crucial to take into account sending a patient for a psychiatric evaluation if:

• Physical symptoms point to a medical issue, but no physical illness, substance abuse, or other mental disorder can be identified to explain the symptoms.
• Significant distress or impairment in social, occupational, or other areas of functioning is brought on by the symptoms.
• Physical symptoms are not purposefully brought on.
• When psychological causation is brought up, the patient frequently objects.

General management strategies for GPs

• Make an effort to comprehend the family’s perspectives on the condition, their level of conviction, and their feelings around referral to mental health care.
• Do not wonder whether the symptoms are real.
• Recognize how the patient’s sickness is interfering with their life and their family’s ability to function.
• Discuss physical issues, the findings of physical tests, and physiological factors that may be causing the symptoms, such as contractures brought on by immobility.
• Share with the family the high rate of MUS (up to 10%), as this may reassure them that an organic cause is not the cause.
• When alerting parents of the diagnosis of a somatoform disorder or another psychiatric disease, be comforting and nonjudgmental.
• Stress that while recovery may take time, most young people fare extremely well if they receive the right care.

The GP or pediatrician typically starts the initial evaluation and treatment. The bio-psycho-social framework is advised, and if the symptoms do not go away, a psychiatric referral should be made.

Specific management strategies

• Individual psychological work
• inspirational methods.
• promoting self-observation.
• establishing active, problem-focused coping mechanisms and attitudes, as well as methods to address particular symptoms and impairments.

Family therapy

• promoting pain self-monitoring.
• encouraging positive behavior
• acquiring healthy coping mechanisms like relaxation and encouraging self-talk
• abilities to solve problems.
• refocusing parents’ attention away from physical problems and onto enjoyable shared activities and symptom-free times.
• liaison with social services and the school.
• nutritional guidance and sleep hygiene.
• No medicine is expressly approved for treating the somatoform disorder, but some medications may be used to treat co-occurring diseases, such as selective serotonin reuptake inhibitors (SSRIs) for co-occurring depression or anxiety.

Creating a collaboration with the kid, family, and all experts involved is the goal of the treatment. Only in extreme circumstances and after unsuccessful outpatient treatment should hospitalization be considered.

For any doctor, managing patients with FuSS (Functional Somatic Symptoms) is a difficult responsibility. Accepting the true nature of the symptoms is essential first and foremost, except for fictitious diseases. It is crucial to provide the patient with an explanation for his symptoms.

A patient with somatic symptoms that are medically undiagnosed frequently struggles to comprehend the causes and mechanisms of his symptoms. He receives ambiguous and contradictory explanations rather frequently, which may not be in line with his beliefs and way of thinking. Without a strong justification, a patient is very likely to view a prescription for a psychotropic drug as dishonest.

It is also possible to provide valid justifications for these situations by pointing to abnormal signal transmission and processing in the neurological system. Pharmacological medicines should not be referred to as tranquilizers when given; rather, they should be described as agents to address these abnormalities. While it is unrealistic to expect all doctors to be proficient in individual psychotherapies, everyone in the medical field can benefit from learning the fundamentals of behavioral management, counseling, and communication.