1.What is somatoform disorder?
Somatoform disorder is a neurological disorder characterized by a persistent fear or belief in the predominance of various somatic symptoms. Patients repeatedly seek medical attention for these symptoms, and various negative medical tests and doctors’ explanations fail to dispel their doubts. Even though sometimes the patient does have some kind of somatic disorder, it does not explain the nature of the symptoms, their degree or the patient’s distress and predominant perception.
These somatic symptoms are thought to be the result of psychological conflicts and personality tendencies, but for patients, they refuse to explore the possibility of a psychological etiology even if the symptoms are closely related to stressful life events or psychological conflicts. Patients are often accompanied by anxiety or depression.
Most of these patients are initially seen in internal and external medicine, and psychiatrists often encounter cases with many years of experience, extensive clinical examination data, and poor results after multiple medications and even surgical procedures.
Because of the low recognition rate of these patients by general practitioners, the diagnosis and treatment of these diseases are often delayed, and this results in a huge waste of medical resources. Therefore, it is of great practical importance to improve the recognition of somatoform disorders among contemporary physicians.
Somatoform disorders include somatization disorders, undifferentiated somatoform disorders, hypochondriacal disorders, somatoform autonomic disorders, and somatoform pain disorders. The disorder is more common in women, and the age of onset is mostly before 30 years. Comparable epidemiological data are lacking due to differences in diagnostic criteria between countries.
Few systematic observations have been reported regarding the prognosis of somatoform disorders. It is generally accepted that the prognosis is good for those with an acute onset with obvious psychogenic triggers. If the onset of the disease is slow and the duration of the disease lasts for more than 2 years, the prognosis is poor.
2.What are the manifestations of somatization disorder?
Somatization disorder is a neurological disorder with multiple, recurring and frequently changing somatic symptoms. The symptoms may involve any part or organ of the body, and various medical examinations cannot confirm any organic lesion sufficient to explain the somatic symptoms, often leading to repeated visits to the doctor and obvious social dysfunction, often accompanied by significant anxiety and depression. The disease mostly starts before the age of 30, is more common in women, and has a duration of at least 2 years.
Common symptoms can be summarized into the following categories.
1. Pain is a common symptom. The location involves a wide range of head, neck, chest, abdomen, extremities, etc. The location is not fixed, and the nature of the pain is generally not very strong, and is related to the emotional condition, and may not be painful or reduced when the mood is good. It can occur during menstruation, sexual intercourse or urination.
2. Gastrointestinal symptoms are common. Belching, acid reflux, nausea, vomiting, abdominal distension, abdominal pain, constipation, diarrhea and other symptoms can be manifested. Some patients may feel particularly uncomfortable with certain foods.
3.The common genitourinary system includes frequent urination, difficulty in urination; discomfort in or around the genitals; sexual frigidity, erection or ejaculation disorders; menstrual disorders, excessive menstrual blood; abnormal vaginal secretions, etc.
4.Respiratory and circulatory system such as shortness of breath, chest tightness, palpitations, etc.
5. Pseudoneurological symptoms commonly include ataxia, limb paralysis or weakness, dysphagia or a sense of pharyngeal obstruction, blindness, deafness, skin sensory loss, and convulsions.
In addition, some patients have undifferentiated somatoform disorders, often complaining of one or more somatic symptoms, with variable symptoms, and their manifestations are similar to somatization disorders, but the typicality of what constitutes a somatization disorder is not enough, and their symptoms involve less extensive and less abundant sites than those of somatization disorders. The duration of the disease is more than half a year, but less than 2 years.
3.What is hypochondriasis?
Also known as hypochondriac disorder, the main manifestation is the fear or belief that one is suffering from some serious physical disease, and the degree of concern is very disproportionate to the actual health condition. Patients repeatedly go to the doctor because of this symptom, and the conclusion of various negative medical tests and the doctor’s explanation cannot eliminate the patient’s concern.
Some patients do have certain somatic disorders that do not explain the nature and extent of the patient’s stated symptoms or the patient’s perception of distress and dominance. Most patients are accompanied by anxiety and depression. Concerns about body dysmorphic disorders (also known as body dysmorphic disorders) are also part of the disorder, although they are not well founded or even unfounded.
Symptoms vary from patient to patient, with some manifesting mainly as suspicious discomfort, often accompanied by significant anxiety and depression; some with prominent suspicion and no significant somatic discomfort or mood changes; some with more vague or widespread suspicion of illness, and some with more single or specific suspicion. Whatever the case, the patient’s suspicion never reaches the level of absurdity or delusion. Patients mostly know that they have insufficient evidence of their illness and thus want repeated tests to clarify the diagnosis and demand treatment.
4.What is somatoform pain disorder?
Somatoform pain disorder is a persistent and severe pain that cannot be rationally explained by physiological processes or somatic disorders, and patients often feel distressed and have impaired social functioning. Emotional conflicts or psychosocial problems directly contribute to the onset of pain, and medical examination does not reveal corresponding organic changes at the site of pain.
The course of the disease is often prolonged and lasts for more than 6 months. The common sites of pain are headache, atypical facial pain, low back pain and chronic pelvic pain. The pain can be located on the body surface, deep tissues or internal organs and can be dull, distending, aching or sharp in nature. The peak age of onset is 30 to 50 years old, and it is more common in women. Patients often repeatedly go to the doctor with pain complaints and take multiple medications, some even lead to sedative and pain medication dependence, accompanied by anxiety, depression and insomnia.
5.What should be noted in the treatment of somatoform disorders?
1, pay attention to the doctor-patient relationship at the beginning of treatment, to pay attention to the establishment of the doctor-patient relationship. To be patient, sympathetic, accepting attitude to the patient’s pain and complaints, understanding that they are indeed sick, not all “imaginary problems” or “pretend to be sick”. Because most patients have had a long history of seeking medical care, their symptoms and suffering may have been denied by other doctors. In fact, many patients do come back to the clinic with a sense of anger after being dismissed by other doctors.
For the management of such patients, a thorough medical evaluation and appropriate examination should be done at an early stage, and the doctor should give a clear report of the findings and give additional verbal explanations. A reckless request to see a psychiatrist is only likely to cause resentment in the patient. Treatment can begin with medication, but emphasis should be placed on psychological and social aspects of the assessment.
3. Introduce the topic of psychosocial factors contributing to the illness as early as possible Once the diagnosis of somatoform disorder is confirmed, the physician should choose an appropriate time to raise the issue of the relationship between psychosocial factors and somatic illness to the patient as early as possible. Patients should be encouraged to view their illnesses as involving somatic, emotional, and social aspects.
4. Give appropriate explanations and assurances that giving explanations and assurances based on medical findings is in itself therapeutic. However, reassurance should be given at the appropriate time, not easily before the examination and before the patient fails to properly describe their distress.
5. Appropriate control of patient requests and treatment measures Physicians should avoid committing to scheduling too many tests that would reinforce the patient’s disease behavior. Doctors can make regular appointments to provide necessary tests but not too frequently, which can avoid misdiagnosis on the one hand and reduce patient anxiety on the other. It is important to educate the patient’s family members about the disease, because family members may also reinforce the patient’s disease behavior.
6.How to treat somatoform disorder?
Psychotherapy Psychotherapy is the main form of treatment, which aims to let patients gradually understand the nature of the disease, change their misconceptions, remove or reduce the influence of mental factors, so that patients have a relatively correct assessment of their physical condition and health status. Currently, psychotherapy includes psychoanalysis, behavioral therapy and cognitive therapy, etc. Morita therapy may have a good impact on eliminating the concept of suspicion and is worth trying. Specific treatment methods can be found in the chapter on psychotherapy and related monographs.
Pharmacological treatment can include benzodiazepines, tricyclic antidepressants, SSRIS, and symptomatic analgesics and sedatives. The patient should be informed of the possible side effects and the time of onset of action to increase the patient’s compliance with the treatment. Other acupuncture, physiotherapy and qigong are effective for some patients and can be tried.