Somatoform mental disorders are physical symptoms that do not arise from problems with the body, but from stress and personal problems. A person suffers for a long time, but not a single somatic doctor (therapist, neurologist, surgeon) can make a diagnosis. A psychotherapist diagnoses and treats the disorder.
Important
In case of somatoform disorders, it is useless to be examined - the test results will be normal or with minor changes. The problem is mental, which means a psychotherapist should treat it.
The main causes of somatoform neurosis:
- Stress, conflicts, indifference of loved ones. For example, lonely old people can often suffer from the disorder. On a subconscious level, illness is a way for them to attract attention;
- Personality characteristics - the disease is more common in people who keep their emotions to themselves. As a result, internal problems result in mental illness.
A person who suffers from such a disorder experiences emotional and physical suffering, which can only be overcome by treatment from an experienced specialist.
Somatoform disorder (psychosomatic illness) - symptoms and treatment
Patients with this disorder do not see a connection between psychological experiences and clinical manifestations of the disease. They are fixated on physical (somatic) symptoms and are focused mainly on drug treatment from therapists.
Most often, people with somatoform disorder are bothered by various pains (algias), while painful manifestations are not always symptoms of organ pathology. Such painful sensations caused by mental disorders are encountered quite often. As a rule, they are not relieved even by strong analgesics. This is especially true for psychogenic headaches, which are more common than other headaches combined. The most common headaches are cephalgia (in the area from the eyebrows to the back of the head).
Gastrointestinal disorders, particularly constipation and diarrhea, often occur. From a psychoanalytic point of view, a tendency to constipation may indicate greed, a person’s reluctance to part with something. Diarrhea (we are not talking about a single diarrhea, but about a protracted or frequently recurring problem) can be a reaction to severe fear and severe anxiety. Diarrhea is an “escape” from a problem that cannot be comprehended.
The emotional manifestation of somatoform disorder includes depression. It is associated with self-directed aggression. Physical manifestations mainly include coronary heart disease, surges in blood pressure, and peptic ulcers of the stomach or duodenum. The latter is more often typical for people who do not know how to recognize aggressive emotions in themselves, such as irritation, anger, anger. Trying to prohibit oneself from experiencing them, not knowing how to express them in an “ecological” way, a person destroys himself from the inside.
Suppression of feelings of anxiety and fear, especially when their causes are unclear, cause a cascade of psychophysiological reactions (previously this was called a sympathoadrenal crisis).
In the primitive world, the source of the threat that caused fear was obvious - for example, an encounter with a bear. In this case, there were only two response options - hit or run. In modern society, the threat is not so obvious, and social norms and attitudes impose their own “prohibitions” on the manifestation of reactions. In this regard, panic and horror unfold inside a person, causing a cascade of vegetative reactions - cold sweat breaks out, the heartbeat quickens, blood pressure jumps against the background of the production of stress hormones, breathing becomes shallow and frequent. And here secondary anxiety arises, and with it the fear of loss of control, the onset of a heart attack, stroke and death. Often such patients call an ambulance, are repeatedly examined by therapists, cardiologists, neurologists and endocrinologists, undergo a series of diagnostic and laboratory tests and, not finding the cause of fear in diseases of the internal organs, are referred to a psychotherapist with a diagnosis of “Panic attack”.
Frequent throat diseases (sore throat or tonsillitis) may indicate a person’s fear of saying something or asking for something very important. Sometimes such people are afraid to raise their voice in their own defense and thereby “lose” it.
Bronchial asthma, like some other diseases associated with respiratory failure, occurs more often in people (mainly children) who are pathologically strongly attached to their mother. Their love is literally “suffocating.” Another option is parents’ strictness when raising a son or daughter. If a person is taught from a very early age that it is forbidden to cry, that laughing loudly is indecent, that jumping and running in the street is the height of bad form, then the child grows up afraid to express his true feelings and needs: they gradually begin to “strangle” him from the inside.
Neurodermatitis, psoriasis, atopic dermatitis, urticaria, like most diseases related to allergies, may indicate a rejection of something. The skin is the first protective psychological barrier, so its disease indicates a violation of a person’s psychological boundaries.
1.What is somatoform disorder?
Somatoform disorder is a mental disorder that causes physical symptoms, such as pain. However, physical symptoms cannot be associated with any disease, other mental disorder, or alcohol or drug abuse.
People with somatoform disorder are not faking it. The pain and other problems they experience are real. And these symptoms can significantly affect your usual lifestyle.
Doctors, in turn, must conduct a variety of tests and tests in order to rule out other possible causes of symptoms and diagnose somatoform disorder.
The procedure for diagnosing somatoform disorders can cause a lot of inconvenience and stress for the patient, because Many people don't like hearing over and over again that their symptoms have no explanation. Stress again leads to more health anxiety, creating a vicious cycle that can last for years.
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Causes of BPD
Among the possible reasons for the development of borderline disorder are violence of a different nature (verbal, sexual, physical) in childhood, the lack of necessary protection and support from one or both parents, the loss of a person who served as a teacher, the fact that the child cannot separate himself and others (in the psychological aspect). The causal links to the development of BPD are the subject of ongoing debate among psychologists. But stable relationships in the family where the child grows up have been proven to inhibit the development of the disorder.
Neurological characteristics based on differences in brain activity (responsible for increasing and suppressing emotional pain) have a stronger connection with borderline disorder.
To make a diagnosis, a psychological assessment or questioning of the patient about the nature of the symptoms, the degree of severity, and how they affect the patient’s life is used. In general, borderline personality disorder is manifested by emotional instability, disturbance or uncertainty of self-identification, impulses and preferences (also of the sexual type), a constant feeling of emptiness, a tendency to become involved in unstable and stressful relationships (leading to repeated affective crises), repeated attacks bodily harm and suicide threats.
The official diagnostic criteria according to ICD-10, adopted in the Russian Federation, classify borderline personality disorder as an emotionally unstable disorder and define it as follows:
- behavioral and personal imbalance affecting the emotional sphere (external manifestations of emotions and feelings, control of motivation, perception and thought process, manner of relating to other people);
- abnormal behavior of a chronic nature that arose a long time ago;
- abnormal behavior is complete and disrupts socialization;
- occurs in childhood or adolescence and continues into adulthood;
- the disorder leads to distress, which becomes apparent only in the later stages;
- usually (but not always) leads to significant deterioration in social and professional areas.
To be diagnosed with a disorder according to the criteria of one of the subtypes defined by ICD-10, it must meet at least three of the listed criteria.
According to the criteria of DSM-IV, DSM-IV-TR and DSM-5 (diagnosis adopted in the USA and some English-speaking countries), borderline personality disorder is expressed in instability of interpersonal relationships, identification of the “I”, affective instability, and obvious impulsivity. Symptoms first appear at a young age and are observed in many situations. In addition to the general personality disorder criteria, a diagnosis of borderline disorder requires five or more of the following:
- Extreme persistence to avoid the fate (real or imagined) of abandonment.
- The tendency to be involved in relationships characterized by tension, instability and extreme intensity, ranging from enthusiastic idealization to severe disappointment and loss of value.
- Splitting of identity, obvious instability of the image and sense of “I”.
- Impulsive actions observed in at least two areas where self-harm is expected (embezzlement, promiscuity, substance abuse, dangerous driving, eating disorders).
- Recurrent suicide, threats or insinuations of suicide, causing bodily harm.
- Emotional instability, sudden changes in mood.
- Constant feeling of being lost.
- Uncontrollable attacks of anger, constant irritability, inappropriate aggressiveness (fights).
- Constant attacks of paranoia, clear signs of dissociation.
Treatment for Borderline Personality Disorder
The diagnosis of borderline personality disorder is recognized as extremely difficult to choose a treatment method. Psychotherapy is considered the main therapeutic treatment approach for BPD.
The main difficulty is establishing a correct patient-psychotherapist relationship. For the patient, due to the symptoms of the disorder and the tendency to enter into unstable, tense relationships, having behavioral extremes and mood swings, it is extremely difficult to establish relationships and maintain them within certain limits. There are often cases when psychotherapists themselves do not undertake to work with such a disorder, protecting themselves from possible problematic situations.
As a treatment option, third wave psychotherapy is used - dialectical behavior therapy, the fundamental principle of which is the patients’ awareness of the variability in the perception of the situation. It is an eclectic approach that uses cognitive behavioral therapy techniques, effective communication techniques and meditation. Pharmacotherapy can also offer several second-generation drugs that are effective in stopping impulsivity and outbursts of uncontrollable anger.
2.Types of disorders
Symptoms and their severity depend on the type of somatoform disorder. There are several types of somatoform disorders:
Somatization disorders (also known as Briquet syndrome).
Patients with somatization disorder have a long history of illnesses that began before the age of 30. Symptoms of somatization disorders can involve several organs and systems of the body. Symptoms include:
- Pain;
- Neurological problems;
- Digestive problems;
- Sexual symptoms.
Most patients with somatization disorders also have an anxiety disorder.
Hypochondriacal syndrome or hypochondria.
People suffering from hypochondria always think that they have some serious illness. They also believe that small changes in the body are a sign of severe disorders. For example, hypochondriacs may think that a common headache is a sign of brain cancer.
Dysmorphophobia.
People suffering from body dysmorphic disorder think that they have some kind of serious physical disability. Dissatisfaction with this shortcoming is usually permanent. Common “flaws”: hair, wrinkles, breasts (in women), excess weight, shape of nose or ears.
Conversion disorders.
People with conversion disorder have neurological symptoms (hearing loss, blurred vision, numbness) that doctors cannot link to other illnesses.
Pain disorder.
People suffering from pain disorders have usually suffered some kind of severe life shock or physical trauma. For example, they may develop chronic headaches.
Unclassified somatoform disorders.
There are other disorders that do not fit into this classification. For example, some women constantly think that they are pregnant, given secondary signs of pregnancy (nausea or swelling).
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3. Treatment of the disease
Patients suffering from somatoform disorders always think that their physical symptoms are caused by a very real illness. They also often don't believe that mental factors can also play an important role in physical health.
A friendly, trusting relationship between doctor and patient is the key to understanding the treatment of somatoform disorders. In addition, meeting with one such doctor will help save a lot of time, nerves and money on unnecessary tests to look for non-existent diseases.
Unlike many other diseases, treatment for somatoform disorders does not focus on symptoms, but on increasing daily activity. Reducing stress also helps treat somatoform disorders.
Cognitive therapy can help relieve symptoms of somatoform disorders. With the help of therapy the following is corrected:
- Altered vision of reality;
- Unrealistic expectations;
- Behavioral factors.
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