Manifestations of somatoform disorders
I. Somatization disorder
The clinical manifestations are multiple, recurrent, and frequently changing somatic discomfort and pain. It often starts before the age of 30 and lasts for at least 2 years. The common symptoms are
1. Pain
This is a group of frequently present symptoms, often in a wide range of locations, such as head, neck, abdomen, back, joints, extremities, chest, rectum and other pain of various natures, not fixed in one place. Ni Aihua, Department of Psychology, Hebei Provincial People’s Hospital
2. Gastrointestinal symptoms
This group of symptoms is also very common. Such as warmth, acid reflux, nausea, vomiting, bloating, diarrhea or certain foods cause particular discomfort. Gastrointestinal examination only shows 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. are common.
4.Pseudoneurological symptoms
These symptoms suggest neurological disorders, but examination cannot reveal evidence of organic damage to the nervous system. Common ataxia, limb paralysis or weakness, dysphagia or a sense of pharyngeal obstruction, loss of voice, urinary retention, absence of tactile or pain sensation, diplopia, blindness, deafness, convulsions, and other conversion symptoms.
Second, the manifestation of undifferentiated somatoform disorder
Patients often complain of one or more somatic symptoms, for which they feel distressed, but medical examination cannot find evidence of somatic diseases and any organic lesions. The duration of the disease is more than six months, and there is significant social dysfunction. Common symptoms include fatigue and weakness, lack of appetite, and gastrointestinal or urinary discomfort. The areas involved are less extensive and less abundant than in somatization disorders, and the duration of the disease is not always longer than 2 years.
3. Manifestations of somatoform disorder
Mainly seen in adolescence or early adulthood, patients are convinced that their physical appearance, such as nose, lips, etc., has serious defects or has become so unsightly that they require orthopedic surgery, but this is not actually the case, and even if their appearance has mild variations, it is far from being as unsightly as the patient believes, and such notions are not swayed by explanation.
Fourth, the manifestation of somatoform pain disorder
Somatoform pain disorder, also known as psychogenic pain, is sometimes clinically referred to as chronic pain syndrome for some unexplained chronic pain. The main manifestation is persistent pain at various sites, which makes the patient feel painful or affects social function, but medical examination cannot find any organic lesion at the pain site, which is sufficient to bowl up such persistent pain symptoms. Typical sites of pain are headache, atypical facial pain, low back pain, and chronic pelvic pain, but pain can occur in any other part of the body. The pain can be located on the body surface, in deep tissues, or in internal organs; it can be vague dull, swollen, aching, or sharp in nature. There is clinical evidence that psychological factors or emotional conflicts play an important role in the onset, exacerbation, persistence and severity of this type of pain. Peak incidence is between the ages of 30 and 50. Female patients are 2 times more likely than males, with a predominance of manual workers and a tendency for familial aggregation. Patients often have chronic pain as their prominent symptom and repeatedly seek medical attention, often using a variety of medications, physical therapy, and even surgical treatment, but failing to achieve definitive results, often leading to sedation, pain medication dependence, and complications of anxiety, depression and insomnia.
V. Somatic form of autonomic dysfunction
The main manifestation is a neurosis-like syndrome caused by the occurrence of somatic disorders in the organ systems innervated by autonomic nerves (such as cardiovascular, gastrointestinal, and respiratory systems). The patient develops non-specific, but more individual and subjective symptoms such as pain, burning, heaviness, tightness, swelling in indeterminate locations on top of autonomic excitation symptoms (e.g. palpitations, sweating, flushing, tremor), none of which on examination proves the occurrence of a somatic disorder in the organ or system in question. Thus this disorder is characterized by obvious autonomic involvement, nonspecific symptoms attached to subjective complaints, and insistence on attribution of symptoms to a specific organ or system.
VI. The main manifestations of somatic forms of autonomic dysfunction
1. Symptoms are the result of dysfunction of organ systems that are primarily or completely under autonomic innervation and control.
2. The most common and prominent ones involve the cardiovascular and other systems (“cardiac neurosis”), the respiratory system (cardiac hyperventilation and cough) and the gastrointestinal system (“gastric neurosis” and “neurogenic diarrhea “).
3, Symptoms are usually of two types, the first type is characterized by objective signs based on autonomic excitation, such as palpitations, sweating, flushing, tremor; the second type is characterized by more individual specificity and subjectivity, while the symptoms themselves are non-specific, such as pain at indeterminate sites, burning, heaviness, tightness, swelling, etc.
4. Patients attribute symptoms to specific organs or systems (the same systems as autonomic symptoms), but no evidence of organic lesions in the organs and systems in question can be found for any of the types of symptoms.
5. The characteristic clinical phase of the disease lies in a combination of the following three aspects: clear autonomic involvement, nonspecific subjective complaints, and the patient’s insistence on attributing it to a specific organ or system.
6. Many patients have psychological stress or difficulties and problems, and a subset of patients do not.
7. Sometimes there can be mild disturbances of physiological function, such as erratic reflux, gastrointestinal distention, and hyperventilation, but these do not in themselves affect the physiological function of the corresponding organ or system.