Somatoform Disorder

Somatoform Disorder: Overview

Alternative Names: Somatization Disorder, Psychosomatic Disorder, Psychogenic Illness, Somatic Symptom Disorder

Somatisation is the production of recurrent and multiple medical symptoms with no discernible organic cause.  The symptoms – including pain, headache, seizures, etc.  – are very real symptoms but cannot be traced back to any physical cause and are not the result of substance abuse or a mental disorder.  In short, they are a complete mystery.

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Do you have various worrying symptoms that multiple doctors/hospitals and laboratory tests have been unable to find a cause for? Are you occasionally rushed to the emergency room with apparently life-threatening symptoms... only to come out a few hours later with no abnormal lab test results, feeling fine? You may have a somatoform disorder, and you are not alone.

People with somatoform disorder are not faking their symptoms, and these symptoms can significantly affect their daily functioning.

Although somatoform disorder is classified as a psychiatric disorder, it does not mean that the patient is 'crazy'.  It is simply a disorder of the brain.

When somatoform disorder is suggested, the patient might think that the doctor is either inexperienced, lazy, or indirectly accusing the patient of lying or being crazy – "it's all in your head, go away".  This is almost certainly not the case.

As the 'control center' of the body, the brain is responsible for virtually all functions and symptoms occurring in the body.  Usually there is a valid reason behind a symptom (cut finger → pain; infection → fever), but on occasion there is not.

Receiving a diagnosis of a somatoform disorder is often very stressful for the patient, who may feel frustrated by the lack of a definitive diagnosis and question the doctor's diagnostic abilities.  This can make the patient even more worried about their health, which creates a vicious cycle.

Incidence; Causes and Development

Up to 50% of new patients present with physical symptoms that cannot be easily explained by a general medical condition.  Some of these patients meet criteria for somatoform disorders.

Symptoms usually start appearing during adolescence and most patients are diagnosed before they are 30 years old.

Little is known about the causes of the somatoform disorders.  However, they do show connections to preexisting mental health disorders such as mood disorders, anxiety disorders, personality disorders, eating disorders, and psychotic disorders.

Signs and Symptoms

Patients typically present with several very real, clinically significant, yet unexplained (idiopathic) physical symptoms.  Some of these include:

  • Abdominal pain
  • Back pain
  • Chest pain
  • Limb or joint pain
  • Pain in the extremities
  • Headaches
  • Tingling, pins and needles
  • Paralysis
  • Dizziness
  • Fainting
  • Pounding or racing heart
  • Shortness of breath
  • Bloating
  • Food intolerance
  • Constipation
  • Diarrhea
  • Rectal pain
  • Difficulty swallowing
  • Nausea
  • Vomiting
  • Gas or indigestion
  • Psychogenic Non-Epileptic Seizures (PNES) or 'Pseudoseizures' – seizures that occur despite no brain abnormalities being found.  They resemble and are often misdiagnosed as epileptic seizures.
  • Amnesia
  • Blindness
  • Double vision
  • Inability to vocalize/speak
  • Hearing loss
  • Tinnitus
  • Lack of coordination
  • Losing consciousness
  • Inability to empty the bladder (ischuria)
  • Painful or difficult urination
  • Pain or problems during sexual intercourse
  • Ejaculatory dysfunction
  • Erectile dysfunction
  • Lack of interest in sex
  • Irregular periods
  • Heavy menstrual bleeding (menorrhagia)
  • Menstrual pain (dysmenorrhea)

Diagnosis and Tests

The prerequisites for diagnosing somatoform disorder are:

  1. The physical symptoms cannot be fully explained by any general medical condition, mental disorder, or the effects of a substance;
  2. The patient is not deliberately faking, exaggerating or producing symptoms in order to avoid duty or work;
  3. The symptoms cause significant impairment in social, occupational, or other functioning of the patient;
  4. The patient has had recurring somatic complaints for at least 6 months.

Diagnosis is to a large extent a process of eliminating medical causes of the presented symptoms using conventional methods: physical examination, laboratory testing, imaging, monitoring.  The diagnosis of a somatoform disorder should be considered as a possibility in a patient with unexplained physical symptoms; over-evaluation and unnecessary testing is not generally useful and should be avoided.

Clinical diagnostic tools, though imprecise, can be used to assist in the diagnosis.  Taking somatization disorder as an example, the somatoform screening section of a 'patient health questionnaire' asks about various physical symptoms; if a patient is bothered "a lot" by 3 or more symptoms that do not have a good medical explanation, somatoform disorder becomes a possibility.

Treatment and Prevention

Those with somatoform disorder often believe strongly that their symptoms have a physical cause despite evidence to the contrary.  A strong doctor-patient relationship is a vital prerequisite to providing help.

The delivery of the diagnosis may be the most important treatment step: a tactless (and wrong) doctor might pull aside a relative and tell them in a hushed voice, "It's all in their head" or "They are faking the symptoms".  Discussing this diagnosis and building a therapeutic alliance with the patient requires forethought, acknowledging the symptoms, empathy – and practice.  The cause, diagnostic criteria, and goal of treatment should be discussed openly.

Collaboration with a mental health professional can help confirm the diagnosis, identify any co-existing disorders, and provide treatment.  Psychiatric disorders rarely exist in isolation, so any co-existing psychiatric disorders should be treated if possible.

It goes without saying that drugs are not useful for treating non-existent medical conditions.

Complications

A patient suffering from a genuine but poorly-understood and/or rare medical condition can be misdiagnosed as having somatoform disorder – "it's all in their head".  This is especially the case now that doctors have available less and less time for each patient; it may be the easy diagnosis but not the correct one.

Somatoform disorder also carries with it the risk of desensitizing the patient's friends and loved ones after several 'false alarms'.  The repeated stress, use of time, and expense of dealing with symptom flare-ups, doctor/hospital visits and testing – without any definitive result in the end – lower the likelihood that the patient will be taken seriously in future.  And yet, symptoms must always be taken seriously because one day they just might be due to a very real and serious medical condition.

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Somatoform Disorder:

Signs, symptoms & indicators of Somatoform Disorder:

Personal Background

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