Somatoform disorders: 10 essential questions

Somatoform disorders are diseases in which physical symptoms appear that suggest a physical illness, but no sufficient organic causes or other mental illnesses can be found as an explanation for the symptoms. Irritable bowel syndrome (IBS) is often referred to as a somatoform disorder, although the trend is to speak more of a psychosomatic illness. There are also more and more indications that IBS is also based on physical causes.

1. What are somatoform disorders?

With somatoform disorders, there is a strong interaction between psyche and body, and real physical symptoms are experienced. Somatoform disorders have both psychological and physical components. Most of the time they have triggering physical causes. Mental processes and psychosocial stress factors are responsible for maintaining the disorders.

People who suffer from a somatoform disorder tend to visit the doctor frequently to clarify the repeated symptoms, even if a wide variety of doctors cannot find an explanation for the symptoms. About 30 percent of all family doctor visits are due to somatoform disorders. Women are affected about twice as often as men. The start is typically between the ages of 16 and 30.

Somatoform disorders often occur in combination with depression or anxiety disorders.

2. Is IBS a somatoform disorder?

IBS can be a somatoform autonomic dysfunction if symptoms occur that only relate to the gastrointestinal tract and for which there is no sufficient organic cause.

The latest research shows, however, that IBS sufferers also often have physical abnormalities, including:

• Imbalance of the intestinal flora,
• Bacterial colonization,
• Micro-inflammation,
• Intestinal barrier disorder (Leaky Gut), or a
• Disorder of the bowel muscle activity (motility)

These physical abnormalities indicate an organic component of IBS, which, according to the latest findings, is therefore regarded as a psychosomatic disease. Psychosomatic medicine deals with disorders in which physical and psychological factors are intertwined. In most cases, there is therefore a double need for treatment: both from the medical and from the psychological side.

3. Are those affected by somatoform disorders just pretending?

No. Pretending means that bodily symptoms are presented but not experienced. With somatoform disorders, there is a real experience of symptoms, so those affected by somatoform disorders are not pretending.

4. What types of somatoform disorders are there?

There are roughly four different somatoform disorders:

• Somatization disorder
• Somatoform autonomic dysfunction
• Persistent somatoform pain disorders
• Hypochondriacal disorder

5. What are somatization disorders?

Somatization disorder is a chronic disease, which is accompanied by diffuse symptoms. There is a recurrence of many frequently changing physical symptoms, over a period of two years or longer.

People affected by a somatization disorder usually have a long medical history with frequent doctor contacts and a few attempts at self-healing. The symptoms can relate to any part of the body or system of the body.

For example, the following symptoms may appear:

• Gastrointestinal symptoms: e.g. abdominal pain, diarrhea, nausea, vomiting, choking, bad taste in the mouth
• Cardiovascular symptoms: e.g. chest pain, shortness of breath without previous effort
• Skin or pain symptoms: e.g. numbness, tingling sensation, body aches, color changes in the skin
• Urogenital symptoms: e.g. pain when urinating, changed discharge, unpleasant sensations in the genital area
• Pseudo-neurological symptoms: e.g. coordination and balance disorders, paralysis and muscle weakness, lump in the throat, visual disturbances, seizures, changes in sensations of sensitivity

In the case of a shorter course with fewer and less pronounced symptoms, one speaks of an undifferentiated somatization disorder.

6. What are somatoform autonomic dysfunctions?

With somatoform autonomic dysfunctions similar to somatization disorder, diffuse body symptoms can occur. Compared to the somatization disorder, those affected by the somatoform autonomic dysfunction experience the symptoms as a disease of a specific organ or body system., These disorders can lead to symptoms of the cardiovascular system, for example in the case of a cardiac neurosis, or symptoms in the upper or lower gastrointestinal tract, such as in irritable bowel syndrome, or symptoms of the genitourinary or respiratory system.

With somatization disorder and somatoform autonomic dysfunctions, they can lead to specific bodily symptoms such as bloating or diarrhea. In persistent pain disorders those affected report about persistent, excruciating pain that occur regardless of specific physical symptoms. This pain cannot be fully explained by physiological processes. Emotional and psychosocial stress factors are causally involved in the development of a pain disorder. Head or back pain is particularly common. The pain can vary and does not always have to refer to the same part of the body.

7. How do patients deal with somatoform disorders?

While the focus of somatization disorder, functional disorders or pain disorders is on experiencing physical symptoms and there is not necessarily a need for pronounced fear of the disease, sufferers of hypochondriacal disorder suffer from the conviction and fear of being affected by a serious, perhaps even life-threatening, physical illness such as colon cancer. As a result, there are many visits to the doctor and a strong preoccupation with physical phenomena. The strong focus on one’s own body and an increased alertness can lead to a rapid overestimation of general body perceptions.

8. What are the causes of somatoform disorders?

The causes of somatoform disorders are largely unclear and (so far) only sparsely researched. The following factors are discussed as causes and risk factors:

• Genetic factors
• Somatoform symptoms with family members and positive associations with the role of the patient (e.g. illness goes hand in hand with care and permission to maintain care subsequently)
• Childhood stress factors such as poverty, neglect, abuse, loss of a parent
• Early disturbances in the relationship with one's own body
• Trauma
• Violence experiences
• Neurophysiological causes, such as an increased cortisol level
• Minimal organic dysfunction, such as disturbed intestinal mortality or micro-inflammation
• Consequences or side effects of medication
• Inactivity, gentle behavior, or poor sleep
• Low arousal threshold for external stimuli
• Not recognizing physical or psychological complaints and mistreatment
• Stress caused by stigmatization and the trivialization of symptoms by the social environment
• Personality variables, such as deficits in emotion perception and cold, emotional features

Often, not a single factor can be identified as the trigger, but rather a sum of unfavorable factors that can contribute to the development of a somatoform disorder.

9. How does a chronic course develop?

The symptoms, such as pain, are often initially a symptom of an existing physical illness. They serve as warning signals and require healing behavior. With a chronic illness, the symptoms are often decoupled from physical harm.

This means that the intensity and location of the symptoms no longer correspond to the actual physical damage. The symptoms have lost their warning function, and the symptom of an original illness has become an independent illness. The treatment therefore aims primarily to alleviate the symptoms and not to heal physical damage.

10. How can somatoform disorders be treated?

When treating somatoform disorders, it is important that the body and physical symptoms are included. The exchange between doctors and psychologists and psychotherapists is not only central during diagnostics, but also during treatment.

The following procedures have proven to be effective:

• Psychodynamic therapies
• Cognitive-behavioral therapy
• Psychoeducation
• Relaxation techniques
• Hypnotherapy
• Sports therapy, physiotherapy, creative therapy