Somatoform personality disorder – This is a set of psychogenic diseases, united by a common phenomenon, namely, in their symptomatology, mental process disorders are hidden behind somatovegetative manifestations resembling a somatic ailment. At the same time, no signs of an organic nature related to a particular disease are detected. In other words, somatoform mental disorders are found in various complaints of patients in the absence of objective evidence or laboratory and instrumental confirmation of the presence of a serious illness. The main manifestation of the described disorder is considered to be the recurring occurrence of somatic symptoms, the diagnosis of which does not confirm the presence of the disease. Patients with this violation constantly require medical examination.
Somatoform pain disorder
Somatisable mental pain disorder or chronic somatoform pain disorder is a mental pathology that is included in the group of somatoform disorders. This ailment is characterized by the complaints of subjects for painful sensations not supported by laboratory tests and highly specialized diagnostics.
Somatoform pain disorder, what is it? This is a mental illness characterized by the appearance of physical symptoms, namely pain. At the same time, somatic manifestations are not associated with any pathology of internal organs, any other disorder of mental activity or excessive use of alcohol-containing beverages or narcotic drugs.
The main pathological manifestation in somatoform pain disorder is a painful reaction, severe and prolonged, which cannot be explained by known somatic ailments. Persistent pain does not change the location and intensity, and does not reflect the physiological pathologies of organs and systems. Such pain is also called idiopathic algias.
Somatoform disorder with pain is characterized by debilitating pain, reflecting a deep saturation of sensations. The occurrence of idiopathic algy is often spontaneous, and their course is very long. They can last from six months to a couple of years.
Another inherent feature of chronic somatoform pain disorder is the “attachment” of pain to certain systems or organs of the patient’s body. Based on this, the term “organ neurosis” has appeared in psychiatric science. This term has nothing in common with the neuropathological process of a specific organ. The essence of the problem lies in the psychopathological focus of the patient’s internal experiences.
Somatoform pain disorders are not one group related to internal factors. They include heterogeneous subgroups consisting of pain. Algias can concentrate in the lower half of the dorsal region, the head or on the face (atypical painful sensations of the face), pelvic organs.
Also, pain reactions can be neuropathic, iatrogenic, neurological. May occur after injury or localized striated muscles. Pain may be accompanied by other disorders.
It is assumed that somatoform disorder with pain syndrome is due to psychological factors, however, to confirm this hypothesis, there are currently few facts.
Somatoform pain disorder is twice more often diagnosed in the female part of the population than in the male. The peak of the onset of this disease falls on the age between forty and sixty years, due to the fact that the tolerance of pain decreases with age. This type of disorder is more common in the working class.
A number of researchers believe that chronic pain is almost always a variation of the depressive state. In other words, they are convinced that chronic somatoform pain disorder is a latent depression, accompanied by a disorder in the form of somatization. The most pronounced symptoms observed in these patients are reduced libido, irritability, anergy, anhedonia and insomnia. Not so often this disease is accompanied by psychomotor retardation and weight loss.
Psychodynamic factors are more often distinguished from the reasons provoking the onset of the described pathology. In other words, pain is a kind of way to avoid punishment, to achieve love, to make amends. That is, pain is a mechanism for manipulating loved ones.
The described disease is characterized by a sudden onset with a gradual increase in intensity. A specific feature of pain is constancy, intensity, inability to arrest the usual analgesic means.
Common manifestations of somatoform disorder with pain are:
– constant painful and painful pain of different localization lasting at least six months;
– the absence of somatic pathology, confirmed as a result of laboratory diagnosis, which could provoke the occurrence of algy;
– the severity of complaints of pain in the body and a decrease in adaptation associated with them, are significantly superior in cases of accompanying pathology of a somatic nature, the expected effects of bodily symptoms.
You can also select additional signs of the described disorder:
– the absence of symptoms of endogenous disorders (schizophrenia) and organic pathology of the nervous system;
– Compatibility with pain reactions observed in bodily pathology.
Algia is often accompanied by psychosocial problems or emotional conflict, which are regarded as the root cause.
Differential diagnosis of somatoform disorder
Pain of psychogenic origin is difficult to differentiate from organic due to the fact that psychogenic processes can reinforce organic pain. However, they are poorly susceptible to analgesics, but are sensitive to antidepressants, they are also more variable, in contrast to pain of organic origin.
The most difficult somatoform disorders to differentiate from a number of somatic pathologies, such as systemic lupus erythematosus or multiple sclerosis, which begin with nonspecific, transient reactions. For example, multiple sclerosis often begins with transient motor visual impairment and paresthesia. The clinical picture of hyperparathyroidism is manifested by loosening and tooth loss, systemic lupus erythematosus often begins with polyarthritis.
Most often it is possible to distinguish the pathology described with the hysterical alteration of organic pain. Individuals who suffer from the pain of organic genesis, in which a definite somatic diagnosis has not yet been identified, easily become offended or fearful, which leads to the formation of a behavioral response that is focused on getting attention.
Somatoform disorder, what is it from the standpoint of various scientific approaches?
The modern scientific community considers various pathologies of the psyche, in particular, and somatoform dysfunction, as diseases, the genesis of which is contributed by various social factors, biological and psychological causes. Therefore, somatoform disorders require complex treatment, including medication and psychotherapy.
Biological factors in the development of the disease described. As a rule, this dysfunction is formed as a reaction to actual physical changes in the form of transformations in the state of the endocrine, nervous and immune systems. Such transformations can be generated by various stressful influences, for example, due to the loss of work, conflicts in the family.
The biopsychosocial model of the origin of somatoform disorder suggests that the impact of psychosocial stressors can cause biological modifications that are based on genetic predisposition (low pain sensitivity threshold due to a decrease in the level of endorphins, which are a natural means of reducing pain).
The hypothalamic-pituitary system is responsible for the release of adrenaline and cortisol (stress hormones), as well as endorphins, which are necessary for raising the pain threshold. Under the influence of stress factors of the hypothalamic-pituitary-adrenal system is activated, which leads to an increase in cortisol levels. Normally, on the basis of the inverse mechanism, its level decreases when the stress effect ceases. If the feedback mechanism malfunctions, the organism continues to function in emergency mode, as a result of which the cortisol content does not decrease. If such a mode of functioning continues for a long time, the reserves of cortisol are exhausted and its content decreases sharply. Therefore, patients suffering from somatoform dysfunction show either dramatically increased or reduced cortisol levels.
Patients with a history of neurotic somatoform disorders with multiple clinical manifestations demonstrate a high content of cortisol in the morning. Chronic pain syndromes, in contrast, are often associated with a decrease in cortisol levels.
Psychological factors of somatoform dysfunction
The psychological model of this disorder is based on the central role of anxiety in focusing on bodily sensations. At the same time, most patients are aware of somatovegetative manifestations and interpret such physical sensations as symptoms of a serious somatic malady. And the emotion of anxiety, in most cases, is not generally recognized by them.
This occurs due to overwork, overload, prolonged lack of sleep, abuse of harmful substances, intense negative experiences. These stressors provoke transformations in the vegetative nervous system, which leads to a change in the normal functioning of the body. It includes the so-called vicious circle – physiological changes (dizziness, nausea, rapid heartbeat) occur against the background of stressors, then the thought of distress occurs, which causes anxiety, in turn, provoking an increase in physiological symptoms, which leads to anxious listening to sensations in the body , causing enhancement and concentration of bodily sensations.
That is, regular listening to one’s own state can provoke an even greater increase in unpleasant and painful sensations. This mechanism is called somatosensory amplification. It is closely associated with an increased level of anxiety, which, in turn, depends on stressors.
Another significant factor of fixation on sensations in the body is the difficulty in controlling and regulating emotions. The lack of emotional regulation skills is found in the difficulties of recognizing and internal processing of emotions, which leads to a steady accumulation of negative emotions and a high degree of stress.
Inadequate understanding of excellent health is another factor in somatization. Many people are convinced that good health is when there are no physical problems at all. This setting to focus on the inevitable deviations (situational nature) in the body.
Somatisation factor may be a deficiency in the children’s age period of parental care and a variety of mental trauma.
Social factors of somatoform dysfunction. The spread of the described violation today can be associated with the specificity of the culture. In the first turn, this is a high degree of stress in everyday life, namely: a high pace of life, intense workload, financial problems. Also a high level of anxiety is promoted by a number of values attitudes of modern culture, such as: the worship of success and the cult of financial security, along with a high level of rivalry between individuals, which force subjects to live to the limit, hiding their own difficulties.
Somatoform disorder of the autonomic nervous system
Somatoform disorder of the nervous system is a condition characterized by dysfunction of the neurohumoral regulation of the functioning of individual internal organs.
The function of the autonomic nervous system lies in the regulation of the work of blood vessels, internal organs, lymphatic system, glands. She is also responsible for maintaining homeostasis. Therefore, various defects in the functioning of the autonomic nervous system lead to disruptions in the systems that it controls, namely: the cardiovascular, respiratory, digestive.
Doctors identify the following causes of somatoform disorder:
– hereditary features of the functioning of the ganglion nervous system;
– brain injuries and other damage to the nervous system;
– physical overload or mental strain;
– violation of hormonal levels;
– chronic infectious processes;
– sedentary lifestyle.
The most common causes of somatoform disorder are found in the complex.
For somatoform dysfunction of the ganglion nervous system is characterized by a variety of symptoms.
The most frequent manifestation of the described are heart pains (cardialgia syndrome), arising at rest, after stress or nervous tension, due to changes in the weather. Pain can last from several hours to two days. Against the background of unpleasant sensations, the pulse increases and there are interruptions in heart rate.
Somatoform vegetative disorder can manifest itself by various disturbances in the functioning of the respiratory system. The patient is constantly haunted by a feeling of lack of air.
Also described violation affects the functioning of the gastrointestinal tract. It is manifested by the following symptoms: belching, pain in the stomach, increased or decreased salivation. This violation causes irritation of the large intestine, which leads to the alternation of psychogenic diarrhea with constipation.
Somatoform disorder of the nervous system is also reflected in the work of the urinary system, which is manifested by frequent urge to urinate, in the presence of outsiders, for example, in a public toilet, on the contrary, urinary retention, urinary incontinence.
In the described form of dysfunction, in addition to the above symptoms, the neurological clinical picture is also characteristic: permanent subfebrile condition, increased fatigue, meteorological dependence, decreased performance, impaired adaptation ability, depression, dry skin, and an uneven distribution of excess fat deposits.
Somatoform vegetative disorder is diagnosed through a series of studies, namely electrocardiography, ultrasound examination of the abdominal cavity, X-ray, laboratory tests.
Symptoms of Somatoform Disorder
The somatoform disorder described is one of the most common among the population. Approximately 13% of people in different life periods were subject to somatoform dysfunction.
Somatoform mental disorders are characterized by a variety of manifestations, but it is customary to single out the two most frequently encountered options. Patients with the first variant of this disease complain of repeated and changing bodily manifestations that are not limited to any particular organ (somatized violation). The second option is characterized by complaints about the dysfunction of a separate system or organ (vegetative somatoform pathology).
Both types of dysfunction torment patients and their relatives. At the same time, doctors of general therapeutic practice are often not recognized.
In the absence of timely and adequate treatment, neurotic somatoform disorders can become chronic. This can lead to severe maladjustment, manifested by problems in family interaction, conflicts in the professional sphere, and depressive states.
Among the typical signs of somatoform disorders can be identified:
– complaints of unpleasant or painful sensations;
– violations of the work of individual organs;
– rapid heartbeat, heart pain, algii, feeling of heaviness or burning in the retrosternal space, as well as other manifestations of impaired functioning of the cardiovascular system;
– feeling of lack of air, shortness of breath or difficulty breathing;
– belching, nausea, difficulty swallowing, heartburn, algia, epigastric discomfort, intestinal disorders;
– painful or difficult urination, pain in the suprapubic and in the pelvic region;
– joint and muscle pain;
– chronic headaches;
– feeling of instability and inner tremor;
– hot flushes or chills.
The diagnosis of somatoform dysfunction is made on the basis of the presence of six signs in the representatives of the weak part of the population, and at least four in the male part.
It should also be noted that patients suffering from the pathology described do not present any complaints of mood changes. In addition, they have difficulty describing their own emotional state. Only with a detailed, targeted survey, such patients may experience irritability, fatigue, sleep disturbances, anxiety, and low mood. At the same time, they do not associate their depressed emotional state with somatic manifestations. Often they are disturbed by the thought that they suffer from a serious unrecognized pathology, which pushes such patients to retake tests and conduct a survey.
Treatment of Somatoform Disorder
Due to the lack of knowledge about the manifestations and methods of treatment of the described ailment, patients seek professional help late, when the disease has already become protracted. Often, patients suffering from somatoform dysfunction, there are psychological and social difficulties: problems in communicative interaction, in family relationships, professional activities, reduced work capacity, there are financial difficulties.
Typical complications of somatoform disorder are:
– the narrowing of the social sphere of life (failure of communication, career growth);
– the formation of secondary depression due to the protracted severe clinical picture and the loss of faith in recovery;
– a painful concern about the state of health, fixing on tracking one’s own physical condition, irrational passing of the examination and visiting doctors;
– family conflicts, because relatives do not understand the causes of the condition, as a result, they tend to consider the sick relative as an suspicious, egocentric, overly fixed, shirking subject.
The modern approach to curing the described pathology involves a complex of various measures – medication, non-drug methods and psychotherapy.
Drug treatment includes the use of psychopharmacological drugs of different groups, namely, antidepressants and benzodiazepines. Antidepressants can alleviate somatic manifestations and pain, but can always stop them completely. Preparations of this group are considered a safe type of psychotropic drugs with their adequate use according to the recommendations of the doctor. The dosage is determined for each patient individually. The therapeutic effect of antidepressants occurs gradually and appears slowly. Their advantage is the absence of the effect of addiction and the development of withdrawal syndrome.
Benzodiazepine intake is based on prescribing minimally adequate doses in order to avoid addiction. A therapeutic course is usually limited to a maximum of two months, after which, if necessary, you can replace the drug.
For the treatment of somatoform disorders most commonly used today are Diazepam, Fenazepam, Lorazepam, Clonazepam.
The main stages of therapy include the definition of therapeutic tactics, the main and supporting therapeutic courses.
The first stage – the determination of the tactics of treatment of somatoform disorder consists in the selection of medicines taking into account the main manifestations of the described disorder in a patient, the individual treatment regimen and an adequate dose of the drug.
Conducting the main therapeutic course is aimed at reducing anxiety and somatic manifestations up to their full relief, restoring the previous level of social activity characteristic of the patient.
A supportive course of therapy is designed for approximately six weeks or more after the general stabilization of the condition. This stage includes prevention of the resumption or worsening of symptoms, as well as exacerbation of the disease.
Misconception about the origin of somatoform dysfunction, misunderstanding of the importance of psychopharmacological treatment prevents full recovery. Also, due to the existing misconception about the dangers of all psychotropic drugs, in particular, the appearance of dependence on them, a negative impact on the internal organs, many patients refuse to take these funds or stop taking them due to the lack of immediate effect.
Psychotherapy in the treatment of somatoform dysfunction
Cognitive-behavioral psychotherapy is in the first place among psychotherapeutic measures aimed at curing somatoform disorders. During its application, it has practically proven its own high efficiency through practical means.
The most important special task of psychotherapy is informing the patient of the subject about the nature, origin and mechanisms of its violation, as well as about the main laws of the emotional sphere of life (about its continuity and direct connection with the physiology of the organism, about the phenomenon of “accumulation” of negative emotions that are not transformed at the psychological level, resulting in they manifest as somatic symptoms). The inability to recognize one’s own emotions and the inability to regulate them is the main cause of violations of the inverse relationship, designed to “turn off” the body’s emergency functioning mode at rest when it has ceased to be in danger.
Therefore, the following specific task of psychotherapy is the development and development of the ability of emotional self-regulation:
– the ability to notice the daily minor provocateurs (triggers) of negative emotions and note the response of the weak emotional response;
– the ability to give a clear name to such reactions, based on mastering the vocabulary, which includes the main emotional categories of speech;
– skills to reveal the essence of negative emotions, grasping and formulating associated thoughts with them;
– the ability to effectively internally transform negative emotions through the formation of the ability to work with negative attitudes, thoughts and the use of constructive behavioral skills.
The formation and development of the above abilities is necessary for lowering the level of daily stress and the tendency of individuals to experience it at the level of somatics.