Psychosomatic disorders

Overview and management

What is psychosomatic illness?

Psychosomatic means mind (psyche) and body (soma).

What is somatisation? When physical symptoms are caused by mental or emotional factors it is called somatisation. For example, many people have occasional headaches caused by mental stress. But, stress can cause many other physical symptoms. For example: chest pains, tiredness, dizziness, back pain, feeling sick, etc.

What are the somatoform disorders?

The somatoform disorders are the extreme end of the scale of somatisation, the physical symptoms persist long-term, or are severe, but no physical disease can fully explain the symptoms.

Somatoform disorders include: somatisation disorder; hypochondriasis; conversion disorder; body dysmorphic disorder; pain disorder.
These are classified as separate mental health disorders as the cause of the symptoms is thought to be mental factors, but they cannot be fully explained by depression, substance abuse, or other recognised mental health disorders. People with somatoform disorders usually disagree that their symptoms are due to mental factors, and are convinced that the cause of their symptoms is a physical problem

Body Dysmorphic Disorder

An obsession or preoccupation with a minor or imaginary flaw, such as wrinkles, small breasts, or the shape or size of other body parts. causes severe anxiety and may impact a persons ability to function normally in daily life

Conversion Disorder
It is a disorder in which a person experiences neurological symptoms that affect his or her movement and senses and that do not appear to have a physical cause. Symptoms can include seizures, blindness or paralysis

Pain Disorder
Pain disorder is a condition where a person has a persistent pain that cannot be attributed to a physical disorder.

Hypochondriasis
It is an obsession or fixation with the fear of having a serious disease. People with hypochondriasis misconstrue normal body functions or minor symptoms as being serious or life threatening.

For example, a person with hypochondriasis may become convinced that he or she has colon cancer when having temporary flatulence after eating cabbage.

Somatization disorder

A person with somatization disorder is chronically preoccupied with numerous "somatic" (physical) symptoms over many years. These symptoms, however, cannot be explained fully by a nonpsychiatric diagnosis. Nonetheless, the symptoms cause significant distress or impair the person's ability to function. The disorder usually begins before age 30 and occurs more often in women than in

Stress often worsens the symptoms.

The cause
The cause of the symptoms may be that people with this disorder perceive bodily sensations in an unusual way. Trauma or stress may cause a person's physical sensations to change.

Symptoms of Somatization disorder

Symptoms of somatization disorder vary by culture. Cultural factors also affect the proportions of men and women with the disorder.

Pain Including headache, back ache, stomach ache, joint pain and chest pain Gastrointestinal symptoms Nausea, vomiting, diarrhea Sexual symptoms Erectile dysfunction Menstrual problems Irregular periods Neurological symptoms Problems with coordination or balance, paralysis, numbness, weakness, vision problems or seizures

DSM-IV Criteria for Somatoform Disorders

History of many physical complaints beginning before age 30 years that occu over a period of several years and result in treatment being sought or significant impairment of functioning. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance. 4 pain symptoms: a history of pain related to at least 4 different sites or functions 2 gastrointestinal symptoms: a history of at least 2 gastrointestinal symptoms ther than pain 1 sexual symptom: a history of at least 1 sexual or reproductive symptom other than pain 1 pseudoneurological symptom: a history of at least 1 symptom or deficit suggesting a neurological condition not limited to pain

Multisomatoform disorder (MSD)

Multisomatoform disorder (MSD) is characterised by > or = 3 medically inexplicable, troublesome physical symptoms, together with a > or = 2-year history of somatisation. Co-morbid depressive disorders are associated with increased symptom severity and functional impairment

Goal of treatment

The goal of treatment is to control your symptoms. Having a supportive relationship with the doctor is the most important part of treatment. Cognitive behavioral therapy (CBT)

During therapy, patient will learn:

To recognize what seems to make the pain worse To develop methods of coping with the symptoms To keep himself more active, even if he still has pain Therapy with antidepressants reduces symptom severity in somatoform pain disorders and multisomatoform disorder.

Treatment of underlying neurosis in somatoform disorders

If anxiety or depression is the cause of somatization, SSRIs like escitalopram can help 12-week, randomized, placebo-controlled study, escitalopram (10-20 mg/day) was both effective and well tolerated in the treatment of patients with somatoform disorders. Compared with placebo, escitalopram was associated with lower symptom scores, increased response and remission rates, and improved functioning.

Muller JE Escitalopram in the treatment of multisomatoform disorder: a double-blind, placebo-controlled trial Int Clin Psychopharmacol. 2008 Jan;23(43-8 1):..

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