This time, let’s talk about Mr. A, a handsome man in his 30s, who has been repeatedly seeking medical treatment for dizziness, blankness in the brain, and uncontrollability of both lower limbs for several years. The doctor at the mental health center said that they could only diagnose and treat the problem if the general hospital excluded organic diseases.
In this way, for several years, Mr. A repeatedly went to major hospitals, and he often felt that his brain was being controlled, and in order to seek medical treatment, he quit his job and sold a house in a first-tier city, but the situation did not improve at all.
He was admitted to our ward with the diagnosis of “cervical spondylosis”. The first time I checked on him, I felt a depressing aura coming from afar, only to see him with his eyebrows locked, telling in great “detail” the whole process of his illness and consultation. After understanding, Mr. A had a lot of discomfort including headache, abdominal pain and chest tightness, in addition to dizziness and weakness of both lower limbs.
Although the MRI of the cervical spine suggested cervical hyperplasia, the degree was very mild; although he had complaints of weakness in both lower extremities, he had never fallen during walking, and there were no signs of “ataxia” on physical examination.
After repeated communication with Mr. A and his family, he was treated with psychotherapy and medication, and after one month, Mr. A started to return to work. Now, when he comes to the follow-up appointment, although he still says he has occasional dizziness, he can clearly feel his vitality, not only at work, but also after work, doing housework and tutoring his children’s homework in elementary school (if you also have the experience of tutoring elementary school students, you can imagine how capable you are to do this job).
So, what’s wrong with Mr. A. Mr. A is in general discomfort and has a lot of complaints, but the doctor is not only unproductive during the physical examination, but the machine examination is also unproductive.
There is a disease, which is not quite the same as traditional diseases, it is psychologically related, called somatization disorder. So, what is somatization disorder?
Somatization disorder is the psychological process of expressing psychological distress through somatic symptoms that manifest as varied, recurrent, and frequently changing somatic discomfort or pain. The disorder is characterized by a persistent fear or belief in the predominance of various somatic symptoms, a variety of medical tests that do not confirm any organic pathology, a duration of ≥2 years, and may be accompanied by varying degrees of impairment in social functioning.
Most of these patients are initially seen in internal, external and gynecological departments, but some, like Mr. A, go to a mental health center and then are “returned” to a general hospital.
I. Etiology and pathogenesis
The etiology and pathogenesis of somatization disorder are still inconclusive, and may be related to the following factors.
1, genetic factors including genetic and environmental inheritance, if the elders in the family have a similar situation, the younger generation in this environment, the influence, the possibility of suffering from related diseases will increase.
2.Patients with personality characteristics are sensitive, suspicious, stubborn, overly concerned about health and other neurotic personalities, mostly focus on their own physical discomfort and related events, lower sensory threshold, increased sensitivity to somatic sensations, prone to headaches and various physical discomfort. The patient’s sensory threshold and nociceptive threshold are low, showing the characteristics of neurosis.
3. Psychosocial factors various pressures come to the surface and are somewhat overwhelming. Patients often develop the disease due to life events that become its important trigger.
Some studies have shown that patients have more life events and mainly long-term life events, which may be the cause of their chronic migratory course. Memories of traumatic experiences may be stored outside the range of consciousness and manifest as somatic symptoms.
Patients are not good at expressing their internal conflicts and are not good at distinguishing between internal emotions and somatic sensations, so they tend to express their emotions in “organ language”. Especially due to the influence of traditional culture, patients often understand illness as physical discomfort and see symptoms as something real, thinking that this is the problem to be solved by the doctor, while emotions are imaginary and should not be solved by the doctor.
Even if there is depression at the same time, when seeking treatment, they still only complain of somatic symptoms and put depression aside, for example, when seeking treatment, they only complain of somatic symptoms such as “chest tightness, breath-holding, sleeplessness” when the emotional problems are obviously caused by psychological factors.
Clinical manifestations
The clinical manifestation is mainly a variety of recurrent and frequently changing somatic discomfort symptoms based on neurosis. The symptoms can involve any part or organ of the body, and various medical examinations cannot confirm any organic lesion to support its somatic discomfort, which often leads to repeated visits to the doctor and obvious social dysfunction, often accompanied by obvious anxiety and depression.
Common manifestations are as follows.
1. Pain is a common symptom. The location involves a wide range, which can be head, neck, chest, abdomen, extremities, etc. The location is not fixed, and the nature of pain is general, not strong, and related to the emotional condition, and there may be no pain or reduced when the mood is good.
2. Gastrointestinal symptoms are common. They can be manifested as belching, acid reflux, nausea, vomiting, abdominal distension, abdominal pain, constipation, diarrhea and other symptoms. Some patients may feel particularly uncomfortable with certain foods.
3.The genitourinary system commonly includes frequent urination and difficulty in urination.
4.The respiratory and circulatory system commonly includes shortness of breath, chest tightness, palpitations, etc.
5.Pseudoneurological symptoms commonly include ataxia, limb paralysis or weakness, difficulty swallowing or feeling of pharyngeal obstruction, blindness, deafness, loss of skin sensation, convulsions and other conversion symptoms, and sometimes dissociative symptoms such as amnesia or altered state of consciousness.