Body And Psyche Paradoxes. Somatoform Disorders

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

PARADOXES OF PSYCHE AND BODY. SOMATOFORM DISORDERS

Stresses, conflict situations, unpleasant life events in reality require a person to have a special ability to properly respond to stimuli.

But not everyone succeeds in this, and the army of somatic patients is constantly replenished with mysterious patients presenting various complaints of pronounced symptoms that dramatically worsen the quality of life, but cannot be explained by the presence of any significant somatic pathology identified.

Bodily ailment as a manifestation of a neurosis repressed into the “subconscious”

Up to 50% of patients who turn to therapists, cardiologists, neurologists and other specialists do not have a real somatically explainable pathology based on the results of an objective examination, as well as laboratory and instrumental studies.

The diagnostic challenge is the absence of somatic pathology and the presence of signs of a mental disorder - anxiety, depression, hypochondria. For such cases, ICD-10 provides a heading F45 - somatoform disorders.

F45.0 Somatization disorder

The main features are numerous, recurring, frequently changing physical symptoms occurring over at least two years. Most patients have a long and complex history of contacts with primary and specialty care services, during which many ineffective tests and sterile diagnostic manipulations may have been performed.

Symptoms can affect any part of the body or organ system. The course of the disorder is chronic and unstable and is often associated with impaired social, interpersonal and family behavior. Short-lived (less than two years) and less pronounced examples of symptoms should be classified as undifferentiated somatoform disorder (F45.1).

Subheadings of the group "Somatoform disorders"

The rubric also includes hypochondriacal disorder, somatoform autonomic disorder, somatoform pain disorder, neurasthenia.

F45.2 Hypochondriacal disorder Refers to somatoform, although in fact it comes close to a social disorder

It is manifested by the patient's persistent concern about the suspicion of a severe progressive disease or several diseases. The patient presents with persistent somatic complaints or persistent anxiety about the symptoms.

The main distinguishing feature is that the patient does not seek relief from suffering, but seeks confirmation of his innocence through diagnosis.

F45.3 Somatoform autonomic dysfunction

This subheading is especially relevant for neurological practice. The presented symptomatology is similar to that that occurs when an organ or system of organs is damaged, mainly or completely innervated and controlled by the autonomic nervous system: the cardiovascular, digestive, respiratory and genitourinary systems.

Symptoms are usually of two types, neither of which indicates a violation of a particular organ or system.

First type - these are complaints based on objective signs of vegetative tension, such as palpitations, sweating, redness, tremors and expressions of fear and concern about a possible health disorder.

Second type - these are subjective complaints of a non-specific or variable nature, such as fleeting pains throughout the body, a feeling of heat, heaviness, fatigue or bloating, which the patient associates with any organ or organ system.

The manifestations of this disorder were described as cardiac neurosis, Da Costa's syndrome (acute transient heart failure in soldiers), gastroneurosis.

F45.4 Persistent somatoform pain disorder

The main complaint is persistent, severe, excruciating pain that cannot be fully explained by a physiological disorder or physical illness and which arises in connection with emotional conflict or psychosocial problems, which allows us to consider them as the main etiological cause. Complaints usually result in a noticeable increase in support (compassion) and attention of a personal or medical nature. Pain of a psychogenic nature arising in the process of a depressive disorder or schizophrenia cannot be attributed to this rubric.

Treating somatically unexplained pain as a somatoform disorder often causes disagreement among neurologists, who nevertheless tend to look for the cause in innervation dysfunction. But from the point of view of psychiatrists, it is pain that helps a person to endure anxiety. Typical examples are tension headache (neurological diagnosis G44.2) and fibromyalgia, which are primary anxiety disorders with secondary pain sensations.

F48.0 Neurasthenia

It can be characterized as personal (constitutional) anxiety, manifested by somatic symptoms. There are two main types of disorder, which largely overlap. The main characteristic of the first type is complaints of increased fatigue after mental exertion, which is often associated with a slight decrease in performance or productivity in daily activities. Mental fatigue is described by the patient as an unpleasant occurrence of absent-mindedness, weakening of memory, inability to concentrate and ineffectiveness of mental activity.

In another type of disorder, the emphasis is on feeling physically weak and exhausted even after minimal exertion, accompanied by a feeling of muscle pain and inability to relax ("depletion of vitality").

Both types of disorder are characterized by a number of common physical unpleasant sensations such as dizziness, tension headache, and a feeling of general instability.

Common features are also anxiety about declining mental and physical abilities, irritability, loss of the ability to enjoy, and mild depression and anxiety. Sleep is often disrupted in its early and middle phases, but daytime sleepiness can also be pronounced.

Is it possible to suspect the presence of a somatoform disorder already at the first stages of patient management in real practice, or are they doomed to a long and exhausting diagnostic search?

In clinical practice, the term "functional disorders" is widely used - it is familiar to many specialists and implies the presence of disorders that are not explained by specific morphological changes in organs and systems.

The most famous functional disorders include irritable bowel syndrome (IBS), chronic pain in the pelvis and lower back, fibromyalgia - intense musculoskeletal pain without objective causes.

Sending such patients to a psychiatrist would be logical, but not always, however, this is the case.

Meanwhile, the list of conditions in which the psychological component can play a leading role and which can be eliminated by correcting the symptoms of the depressive or anxiety spectrum is much larger:

- in gastroenterology - in addition to IBS, non-ulcer (functional) dyspepsia;

- in gynecology - pelvic arthropathy, premenstrual syndrome, chronic pelvic pain;

- in rheumatology - fibromyalgia, pain in the lower back;

- in cardiology - atypical angina pectoris (cardiac syndrome X);

- in pulmonology - hyperventilation syndrome;

- in the practice of therapists - chronic fatigue syndrome;

- in neurology - tension headache, pseudoepileptic seizures;

- in dentistry and facial surgery - dysfunction of the temporomandibular joint, atypical facial pain;

- in ENT practice - Globus pharyngeus (feeling of a lump in the throat);

- in allergology - multiple chemical sensitivity, etc.

Also described are psychogenic forms of aerophagia, cough, diarrhea, dysuria, hiccups, deep and rapid breathing, frequent urination, pylorospasm.

PSYCHOLOGICAL PORTRAIT OF A PATIENT

Such a patient usually shows disregard or denial of the psychological (personal and interpersonal) and microsocial causes of "physical" suffering.

He is absolutely convinced of the organic nature of the symptoms and shows irritability or distrust when trying to dissuade or present evidence of the absence of somatic causes of the disorder (examination results, analyzes). This often leads to the loss of contact with the doctor and the continuation of the search for a better specialist or more reliable methods of examination.

The main feature is the repeated presentation of complaints of somatic symptoms simultaneously with insistent demands for medical examinations, despite their repeated negative results and assurances from doctors that the symptoms are not of a somatic nature.

If such a patient does have any real physical illness, they do not explain the nature and severity of the symptoms or the suffering associated with it.

The general psychological characteristics of patients with various somatoform diseases are:

biased presentation of medical history;

maximum exaggeration and dramatization of the phenomena being tested;

neglect or denial of psychological (personal and interpersonal) and microsocial causes of "physical" suffering;

absolute conviction of the organic nature of suffering;

difficulties in emotional response both in everyday life and in relationships with others about the disease;

excessive irritability towards others.

Unfortunately, when making a diagnosis, physicians of the somatic profile often do not know about the existence of the headings F40-F48 (neurotic, stress-related and somatoform disorders) and use definitions that do not exist in the ICD, for example, the "chronic fatigue syndrome" popular among doctors

Meanwhile, there are quite definite terms to denote such a patient's condition: dysthymia (subthreshold neurasthenia F48) (personal anxiety).

The paradox is that the patient is referred to a psychiatrist last and in every similar case we are dealing with interrelated - biopsychosocial causes of the disorder.

The transformation of an indefinite foreboding anxiety into somatoform sensations, as a rule, is associated with a constitutionally weak functional system (locus minoris resistentiae).

Common to these states (no matter in which organs and systems the patient is experiencing discomfort) is psychological distress - a person's upset, which acts as both a cause and a consequence, as a rule, not expressed or not detected in primary practice.

And the specific symptomatology is determined by the premorbid personality traits and the proportion of emotional / cognitive processing and very much depends on the level of intelligence and education of the patient. The higher the level of both, the more diverse and complex the complaints, the more difficult the differential diagnosis.

Recognition and therapy of somatoforms is successful only when the work of psychologists and psychiatrists is integrated into the somatic service system.

In this case, the necessary therapy can be prescribed taking into account the preferences of the patient. Cooperation with a psychotherapist, psychiatrist suggests the possibility of clarifying the therapy regimen, carrying out specialized psychotherapeutic and rehabilitation measures.

Thus, the patient will avoid walking in a vicious circle for a long time with visits to numerous specialists - cardiologists, neurologists, gastroenterologists, rheumatologists and other doctors, trying to find the cause of pain, malaise, decrease and even loss of working capacity.

This will significantly reduce the cost of useless diagnostic and therapeutic procedures.

Best regards, wishes for health and faith in your potential, Victoria Tanaylova

Systems psychologist, psychogeneticist, expert on effective strategies for overcoming crisis and illness through activation of the resource state of consciousness

Tel. +79892451621, +380986325205, +380666670037 (viber, WatsApp, telegram) skype tanaylova3