The Department of Psychosomatic Medicine occasionally encounters the “monster” of the three volt days, we must be curious, what does the “monster” of the three volt days look like? The “monster” looks no different from us, two eyes, a nose, a mouth …… then we will certainly ask: you said the “monster” strange in what? The three volt days, most people would like to run naked, they have to wear a cotton jacket to go out! Why? In fact, the three volt days cold is an abnormal skin sensation. The relevant examination are no problem ah, emotionally okay, is to feel so go out want to drill holes in the ground, the pain is unspeakable, what to do? Many doctors will only send you a sentence: you are not sick, go home! Only a psychosomatic doctor can understand you. What is the illness of the above-mentioned visitor in the psychosomatic medicine department? Actually, it is what psychiatry/psychiatry call somatoform disorder. Next, I will talk to you about somatoform disorders so that you can see if you have a somatoform disorder or not. Clinical manifestations Somatic symptoms can involve the whole body and all systems, mostly manifested as various discomfort or pain, however, no evidence of organic damage can be found. Often accompanied by anxiety or depression. (A) Somatization disorder manifests as multiple, recurrent, and frequently changing somatic discomfort and pain; often starts before the age of 30 and lasts for at least 2 years; various medical examinations cannot confirm any organic lesion sufficient to explain the somatic symptoms, often leading to long-term recurrent medical visits and significant social dysfunction; common symptoms are summarized in the following four categories: 1. Pain sites are often widespread and can be pain of various nature, not fixed in one place. 2. gastrointestinal symptoms such as nausea, vomiting, acid reflux, bloating, diarrhea, etc. Gastrointestinal examination only reveals superficial gastritis or irritable bowel syndrome, which is difficult to explain the severe symptoms often present in patients; 3. sexual dysfunction sexual apathy, erectile and ejaculatory disorders, menstrual disorders, excessive menstrual bleeding, etc.; 4. pseudo-neurological symptoms these symptoms suggest neurological disorders, but examination cannot find organic damage to the nervous system evidence. The common ones are: ataxia, limb paralysis, dysphagia, pharyngeal obstruction, loss of voice, urinary retention, diplopia, blindness, deafness, convulsions and other conversion symptoms; (b) Undifferentiated somatoform disorder The patient complains of one or more somatic symptoms and is distressed by them; however, various medical examinations cannot confirm any organic lesion sufficient to explain his or her somatic symptoms and social functioning is significantly affected. (iii) Hypochondriasis Patients are overly worried about their own health or disease, fearing that they are suffering from a serious disease; they feel very troubled. The severity of the patient’s worries is very disproportionate to the patient’s actual health status. These patients are particularly alert to changes in their bodies, and any slight changes in body functions, such as heartbeat, will attract the patient’s attention. Even minor sensations can cause significant discomfort or severe uneasiness that is unbearable; thus, the patient is convinced that he or she has a serious illness. Although the results of various tests do not support the patient’s speculation, and the doctor patiently explains and repeatedly assures that the patient does not have a serious disease, the patient is often skeptical about the reliability of the test results, disappointed by the doctor’s explanation, and still insists on his or her suspicion of the disease, and continues to go to major hospitals to repeatedly request tests and treatment. Patients mostly know that they have insufficient evidence of their disease and demand treatment. The above symptoms are not consistent from patient to patient. Some patients have a very pronounced suspicion of discomfort, which may be accompanied by anxiety or depression; some have a more prominent suspicion of illness, without significant somatic discomfort or mood changes; some have a more ambiguous or widespread suspicion of illness; some have a single suspicion of illness, with a specific and clear expression, but not to the extent of absurdity or delusion. Body deformation disorder Patients are convinced that their physical appearance, e.g., nose, lips, etc., is seriously defective or has become so unsightly that they request corrective surgery; however, this is not the case, and even if they have mild variations in their appearance, it is far less difficult than the patient believes. This type of perception is not swayed by explanations and brings obvious emotional overtones; it is understandable and not absurd with respect to the patient’s cultural background, and thus has the character of a hypervalent perception. (iv) Somatic forms of autonomic dysfunction Patients have clear symptoms of autonomic arousal, such as palpitations, sweating, trembling, and flushing, which are bothersome; often the complaints are of pain, burning, heaviness, tightness, and swelling in indeterminate locations; patients insist that these symptoms are attributed to a specific organ or system suffering from a serious disease and are distressed by it; however, the There is no evidence of disorder in the structure or function of these organs, and repeated explanations and reassurances by the physician are of no avail. Diagnoses such as gastric neurosis, psychogenic eruption, irritable bowel syndrome, psychogenic hyperventilation, psychogenic dysuria, and psychogenic dyspareunia also belong to this category of disorders. (v) Somatoform pain disorders Persistent pain at various sites that cause distress or affect the patient’s social functioning, but medical examination cannot reveal any organic lesion at the site of pain that is sufficient to cause such persistent pain symptoms. Typical sites of pain are headache, atypical facial pain, low back pain, and chronic pelvic pain; however, pain can occur in other parts of the body. Patients often seek medical attention repeatedly with chronic pain as their prominent symptom, and often have used multiple medications, physical therapy, and even surgical treatment without definite results, often leading to sedation and pain medication dependence; with anxiety, depression, and insomnia. (vi) Other somatic form disorders Patients’ complaints of discomfort focus on specific parts of the body, such as localized swelling sensation, skin ant crawling, tingling or numbness, hysterical ball, psychogenic squint, psychogenic pruritus, psychogenic dysmenorrhea, teeth grinding, etc. also belong to this type of disorder. The above are only the common clinical manifestations of the disease, whether it is the disease or not, it needs to be analyzed by the specialist according to the specific situation of each patient. I would like to tell the patients and their families about this disease: (1) I understand the patients’ feelings, and the somatic discomfort is indeed a real feeling for the patients. (2) Medication is important to interrupt the vicious circle between patients’ emotions and somatic symptoms, reduce somatic symptoms, improve patients’ emotions, form a new virtuous circle, and improve patients’ quality of life; (3) Although the tests are normal or there are organic problems but cannot explain the severity of patients’ symptoms and their duration, patients’ somatic discomfort is real, and the support and understanding of patients’ families are important to avoid patients’ pessimism and pain due to the lack of family support and understanding. (4) Patients can choose to participate in group activities, develop hobbies and other diversions to change their focus on the body to the outside world and improve their quality of life. Through the above elaboration you have a more comprehensive understanding of the “monster” of the three volt days!