Somatoform disorder
Updated onDr. med. Julia Schwarz is a freelance writer in the medical department.
More about the experts All content is checked by medical journalists.A somatoform disorder (psychosomatic syndrome) refers to the repeated occurrence of various physical (somatic) complaints for which no clear physical cause can be found. Mental stress, emotional stress and conflicts play an essential role in the occurrence and maintenance of the disease. The somatoform disorder is treated psychotherapeutically. Learn more about the triggers, symptoms, and treatment of the disease here.
Patients with a somatoform disorder often wander from one doctor to the next because they look in vain for an explanation for their physical complaints. But only a look into the soul provides help.
Marian Grosser, doctor
Somatoform disorder: description
A somatoform disorder is when someone repeatedly has various physical symptoms that persist despite multiple tests with negative test results. The physical complaints can be very different and affect every part of the body or organ.
The patients are usually firmly convinced of a physical illness and always demand further examinations and medical measures. The possibility of a psychological cause is often not accepted by the patient, which leads to frequent changes of doctor. In this context, terms such as “doctor hopping” or “patient career” are also used, but they do not do justice to the patient's disease pressure.
Often the somatoform disorder is accompanied by another psychiatric illness such as anxiety or depression.
Somatoform disorders
There are several somatoform disorders. They include, among others:
Hypochondriac Disorder
This somatoform disorder is equally common in men and women. Those affected are objectively physically healthy, but firmly convinced that they suffer from a serious illness and deal intensively with their complaints. The main characteristic of the hypochondriac disorder is not the physical symptoms, but the above-average mental preoccupation with it. This persistent fear and preoccupation with one's own suffering affects the social and professional life of those affected. The duration of this somatoform disorder is at least six months.
Somatization disorder
Women are usually more often affected than men. This somatoform disorder is characterized by various symptoms that have existed for at least two years without adequate physical explanation. These are different complaints from at least two symptom groups such as frequent persistent fatigue, loss of appetite, heart, gastrointestinal or bladder problems.
Forms of somatization disorder are:
- Persistent somatoform disorder: Persistent somatoform disorder is when the symptoms have been present for at least six months (most days).
- Somatoform autonomic dysfunction: Here an organ / organ system is affected that is controlled by the autonomic (autonomic) nervous system (especially the cardiopulmonary system or the digestive tract). This somatization disorder is more common than the other forms and is equally common in men and women.
- Undifferentiated somatization disorder: This is the case when the physical complaints appear numerous and persistently in various forms, but the clinical criteria for a somatization disorder (see above) are not met.
Somatoform pain disorder
This somatoform disorder is characterized by the presence of chronic, severe pain without adequate physical explanation for a period of at least six months. The location and character of the pain change frequently and without a regular pattern. The everyday life of the sick is completely dominated by the pain. Those affected deny, however, that the complaints could also have emotional causes - they do not want to admit the diagnosis “somatoform disorder”. Men and women are affected equally often, although there is a familial cluster with regard to this somatoform disorder.
Somatoform disorder: symptoms
The main characteristic of a somatoform disorder are physical symptoms that the patient does not willingly control or pretend, but for which there is no physical explanation. In principle, the complaints can affect any organ system. Most commonly, a somatoform disorder is accompanied by the following symptoms:
- Symptoms related to the cardiovascular system: chest pain, feeling of pressure, palpitations or palpitations
- Symptoms related to the gastrointestinal tract: abdominal pain, digestive problems with constipation and / or diarrhea, nausea, bloating
- Urogenital symptoms: painful urination, frequent urination, pelvic pain
- Respiratory symptoms: feeling short of breath, shortness of breath
- Symptoms in the muscles and joints: back pain, pain in arms and legs
When which organ or organ system is affected by the somatoform disorder is different for each patient. The cultural background, previous illnesses and the identification with symptoms of illness in fellow human beings play a role here.
A temporarily high level of tension in times of stress in life often alleviates the somatoform disorder or its symptoms. A subsequent relaxation can then often make the disorder stand out all the more.
Somatoform disorder: causes and risk factors
The causes of a somatoform disorder are complex, experts suspect that several factors interact. There are different explanations for the development of a somatoform disorder:
The psychoanalytic model assumes that internal psychological conflicts are carried out on the “stage of the body” and thus express themselves externally in the form of physical complaints and organic suffering. The somatoform disorder often manifests itself in the form of a generalized fear that the patient cannot assign to any specific cause. The internal tension is redistributed through the treatment of the external complaints and is experienced as relief.
The learning theory approach assumes a learned, recurring and thus intensifying behavior pattern for the somatoform disorder. This creates a vicious circle that the patient can hardly break through on his own. For example, if the patient is afraid that their heart will beat irregularly, they will begin to feel their pulse and focus their attention on the physical symptoms. The breathing and the pulse rate can then really change, which in turn makes the patient feel confirmed in his fear - the somatoform disorder solidifies.
Various neurobiological models are also currently being discussed. Since some somatoform disorders often also affect first-degree relatives, a certain inheritance cannot be ruled out. There is also the possibility that the immune system and nervous system as well as their hormones react more strongly in stressful situations in patients with a somatoform disorder than in healthy people. So far, however, this has not been clearly proven.
Risk factors for somatoform disorders
Emotional stressful situations, unconscious conflicts and emotionally stressful processes are considered risk factors for a somatoform disorder.
Certain personality types are also more prone to somatoform disorder than others: The fearful, insecure personality structure often suffers from a feeling of helplessness and worthlessness. Because of his obvious suffering, the person concerned experiences a secondary gain in illness. In this way he gets the attention of his fellow human beings, and a framework is created in which the patient can admit weakness.
Personalities who have difficulty expressing their emotions are more prone to somatoform disorder. Another risk factor is permanent increased stress in daily life or the feeling of being overwhelmed.
Somatoform disorder: examinations and diagnosis
It is not always easy to distinguish a somatoform disorder from physical illness. Therefore, careful examinations are necessary to rule out the physical causes of the symptoms (e.g. blood tests, EKG, X-rays) before the doctor can assume a somatoform disorder as a working diagnosis.
However, a somatoform disorder is not a diagnosis of exclusion. The occurrence of many different physical symptoms, which are usually not limited to one organ system and for which there is no medical explanation, is also decisive for the diagnosis. The somatoform disorder can also be identified by the presence of symptoms over a long period of time.
Somatoform disorder: treatment
There is no single therapy for the different forms of somatoform disorder. Rather, the therapy is individually adapted to each patient. If psychiatric or physical illnesses are also associated with the somatoform disorder, these must also be treated. The alleviation of such comorbidities can also improve the somatoform disorder.
A good, trusting relationship between doctor and patient is also important for treatment - people with somatoform disorders have often lost confidence in doctors.
Somatoform disorder: therapy requirements
Psychoeducation is the foundation for the successful treatment of somatoform disorders: the therapist / doctor explains to the patient the psychological processes that can cause the somatoform disorder. Only with this understanding on the part of the patient can therapeutic work bear fruit.
It is also important to prevent the patient from perceiving himself as chronically ill and preventing the somatoform disorder from dominating his or her life. The psychosocial stress should be reduced permanently. Relaxation methods such as progressive muscle relaxation according to Jacobson often show a positive, supportive effect, since the somatoform disorder is often associated with stress and excessive demands.
Hypochondriac Disorder - Therapy
So far there is no standard drug therapy for this somatoform disorder. Therapy plans vary individually depending on the severity of the symptoms. If concomitant psychological illnesses occur, anti-anxiety drugs and antidepressants are used.
In addition, early psychotherapy is advisable in order to counteract the chronicity of the clinical picture. The therapist tries to give the patient the feeling of security that he does not suffer from a serious illness, but is nevertheless taken seriously in relation to the somatoform disorder.
It is also important to change the patient's attitude towards his or her body perception. The aim is to identify the patient's problems and stressors in order to be able to work on them and manage the somatoform disorder.
Somatization Disorder Therapy
There is also no known drug therapy for somatization disorder, but antidepressants are often used with success. The guidelines for this somatoform disorder state that concomitant physical illnesses must always be treated, as their alleviation can lead to an improvement in the somatization disorder.
Psychotherapeutic treatment is also recommended so that the patient manages to distance himself from the supposed symptoms and to get a certain distance from the suffering. This should help him to cope better with everyday life and make it easier for him to deal with his own problems.
Relaxation procedures are also helpful in overcoming the somatoform disorder permanently.
Somatoform Pain Disorder - Therapy
The somatoform pain disorder is treated with drugs such as pain relievers or antidepressants.
So-called multimodal therapy programs are available as part of psychotherapy. They are carried out on an outpatient basis. The patient becomes an expert in his or her own pain: the therapist provides him with basic knowledge about the development of pain, the processing of pain stimuli and the triggering conditions.The patient is asked to carefully monitor himself and his somatoform disorder and to keep a pain diary and create a pain scale. It helps to better assess the course and the triggering factors.
The goals of multimodal therapy are to change the patient's perception of pain, promote healthy patient behavior and cure the somatoform disorder.
Somatoform disorder: disease course and prognosis
If the somatoform disorder is left untreated, repeated visits and changes of doctor can lead to excessive diagnostic measures. This is more harmful to the patient than good.
However, if psychotherapy is started in good time, the prognosis for a somatoform disorder is good.
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