Somatoform Disorders
WHAT ARE SOMATOFORM DISORDERS?
Somatoform disorders are a group of psychological disorders in which the patient has physical symptoms that are not completely explained by a physical cause. The disorders in this group are very distressing, causing patients to limit their normal functioning. These disorders may result in a person being unable to work or maintain normal social relationships and may seriously damage one’s self-esteem. Among patients with these disorders is a high rate of suicide attempts. Somatoform disorders include somatization disorder, conversion disorder, hypochondriasis, psychogenic pain disorder, and body dysmorphic disorder.
SOMATIZATION DISORDER
Symptoms.
Recurring physical symptoms not attributed to a physical disorder. Pain may affect any part of the body and is described as intense and persistent. Symptoms, affecting mostly the gastrointestinal and reproductive systems, may include abdominal pain, headaches, bloating, vomiting, diarrhea, constipation, fatigue, or other symptoms. The patient may also suffer from depression or anxiety.
Causes.
The physical symptoms have psychological causes; however, the underlying cause of somatoform disorders is unknown. These disorders often run in families, and they occur mostly in women.
Treatment.
This disorder is difficult to treat. The use of medication is rarely effective. Most patients find it difficult to accept that the cause of their symptoms is psychological. The goal of treatment is to help the patient understand his/her symptoms and learn ways to control them.
Most patients find it difficult to accept that the cause of their symptoms is psychological.
The underlying cause of somatoform disorders is unknown.
CONVERSION DISORDER
Symptoms.
In conversion disorder, the patient has the physical symptoms of a neurological disorder but no physical cause. Symptoms usually involve paralysis, loss of feeling, impaired balance or coordination, blindness, difficulty in swallowing, or convulsions.
Causes.
The cause is a psychological conflict that is unconsciously converted to symptoms resembling those of a physical (neurological) disorder. The cause of the psychological conflict is usually an extremely stressful event in the patient’s life.
Treatment.
The goal of treatment is to help the patient understand his/her symptoms and learn ways to control them. The most effective methods are psychological counseling, hypnotherapy, behavior modification therapy, and relaxation training.
HYPOCHONDRIASIS
Symptoms.
A person with hypochondriasis is preoccupied with his/her bodily functions and strongly fears having or contracting a serious disease.
People with this disorder pay extremely close attention to ordinary physical sensations and mistake them for signs of a serious illness. They may be alarmed by abdominal discomfort, heart activity, sweating, and bowel sounds. Even after a physical examination and with reassurance of a physician, the person with hypochondriasis is certain of being very sick.
Causes.
The causes are uncertain.
Treatment.
This disorder is difficult to treat. The goal of treatment is to help the patient understand his/her symptoms and learn ways to control them.
PSYCHOGENIC PAIN DISORDER
Symptoms.
Patients with this disorder have pain in a specific body location, such as the back or chest. The pain is a source of extreme distress for the patient, who may be disabled for long periods as a result.
Causes.
The pain may be associated with psychological disorder such as anxiety or depression. The pain may have a physical cause, but it is more severe and long-lasting than would normally be the case. There are often specific stressors in the patient’s life that may be the source of the disorder.
Treatment.
The patient needs a thorough medical examination and psychological counseling to identify the stressors that may contribute to the disorder.
BODY DYSMORPHIC DISORDER
Description.
A person with body dysmorphic disorder believes that there is a serious defect in his/her appearance. The defect may be real or imagined. The patient becomes severely distressed by and preoccupied with the defect. Gradually, this preoccupation interferes with his/her ability to live a normal life. This disorder differs from normal concerns about one’s appearance because it causes extreme distress and interferes with the person’s quality of life and ability to function.
"A person with body dysmorphic disorder believes that there is a serious defect in his/her appearance. The defect may be real or imagined."
Symptoms.
Symptoms involve preoccupation with a variety of physical attributes—including facial hair; size of nose, ears, or breasts; concerns about hair thinning; and presence of acne, scars, or wrinkles. The patient may spend hours focusing on a perceived defect, looking in mirrors (or avoiding them), searching for ways to hide the problem, or even seeking surgery to eliminate the problem. Because the patient feels self-conscious, he/she may avoid going out in public and stop going to work or social activities. Some patients are so distressed by the disorder that they become suicidal and must be hospitalized.
Treatment.
Very little information is available about the treatment of this disorder. The goal of treatment is to help the patient understand his/her symptoms and learn ways to control them.
WHERE CAN I GO FOR MORE INFORMATION?
Cash, Thomas. The Body Image Workbook. New York: Fine Communications, 1998.
Kellner, Robert. Somatization and Hypochondriasis. Westport, CT: Praeger Publishing, 1986.
Phillips, Katharine. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press, 1998.