Somatoform (so-MA T-a-form) disorders are a group of conditions in which physical symptoms suggest a disease or medical condition, but no physical cause can be found. The term "somatoform" is derived from the Greek "soma, "meaning "body. "A "somatoform disorder" is one in which emotional problems are transformed into body symptoms. These disorders include hypochondria (hy-po-KON-dree-a), conversion disorder, and somatization (so-ma-ti-ZA-shun) disorder. Somatoform disorders do not include malingering or Munchausen syndrome, both of which involve pretending to be physically ill or intentionally producing the symptoms of an illness.
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How Can Somatoform Disorders Be Told Apart?
Somatoform disorders are alike in that they each involve physical symptoms without evidence of physical disease. The symptoms stem from an emotional cause. To understand how the disorders differ from each other, consider three young people in a doctor's waiting room who are all having trouble with their voices. Tommy, a teenager, was only hoarse, but he feared this meant that he was getting throat cancer. Nine-year-old Mary had suddenly lost her voice completely and could not speak. Lilian, who was 25, was also hoarse and coughing, but she had many other symptoms, including dizziness and a stomachache.
As it turned out, Tommy was suffering not from cancer but from hypochondria. He had been much too worried about his hoarseness, which had come from cheering for his high school football team. The doctor could find nothing wrong with Mary's larynx, or voice box. Her mother said that Mary had been punished severely for "talking back," and the doctor suspected that she had lost her voice because of conversion disorder. None of Lilian's many symptoms, which had come and gone for years, could be traced to any physical disorder. The doctor thought that she must have somatization disorder. Tommy, Mary, and Lilian were referred to mental health professionals for treatment.
More Symptoms of Somatoform Disorders
People with hypochondria have the fear or belief that they have a serious illness, such as heart disease or cancer, even though medical tests show no sign of disease. People with this condition may be excessively concerned with a wide range of common, usually minor, symptoms, such as coughing, nausea, dizzy spells, and various aches and pains. When their physicians reassure them that these symptoms do not mean that they are seriously ill, they are not always convinced and may remain anxious, worried, and preoccupied with their symptoms. They may then go to one doctor after another for a "true" diagnosis of the same symptoms.
Conversion disorder, a much rarer somatoform disorder, might cause people to lose their voice, sight, or hearing or to become paralyzed in one or more of their limbs. They also may have trembling or lose feeling in various parts of their bodies. The condition is psychological, because medical examination can find no physical explanation for the symptoms. It typically begins suddenly after an extremely stressful event in a person's life. The symptom or affected body part is usually related in some way to the trauma or stress that triggered the conversion reaction. For example, a soldier who is extremely distressed after killing people during battle might develop "paralysis" in his weapon arm. Conversion disorder resulting from war experience has also been called shell shock or battle fatigue. Someone who has witnessed the murder of a loved one may develop "blindness" as a conversion symptom.
In somatization disorder, there are many different recurring symptoms in various parts of the body. They may include headache, backache, and pains in the abdomen, chest, and joints. There also may be digestive symptoms, such as nausea and abdominal bloating, or symptoms that involve the reproductive and nervous systems. As in other somatoform disorders, medical examinations and testing generally find no clear physical cause for the symptoms.
Pain disorder and body dysmorphic disorder
Two other kinds of somatoform disorders are pain disorder and body dysmorphic (dis-MOR-fik) disorder. Pain disorder is similar to somatization disorder, except that pain is the main symptom. The pain may be in one or several areas of the body, but it doesn't fit a pattern of any particular medical illness or injury, and diagnostic tests fail to show the presence of any disease. In body dysmorphic disorder, a person becomes extremely concerned about some imagined or very slight body defect. Sometimes called "imagined ugliness," body dysmorphic disorder can cause great distress and cause a person to avoid being seen in public. In some cases, a person may seek unnecessary plastic surgery.
Causes of Somatoform Disorders
The causes of somatoform disorders are not clearly understood. In hypochondria, a person may be overly sensitive to body sensations or overinterpret the meaning of normal body sensations. A distressing memory of childhood illness may also play a part. It is believed that conversion disorder, somatization disorder, and pain disorder are all caused by the conversion, or shifting, of stressful emotional events or feelings of conflict into body symptoms to relieve anxiety * . Body dysmorphic disorder involves a distorted body image, and may be influenced by cultures that emphasize the importance of physical appearance, and early experiences which may have interfered with developing self-esteem.
Diagnosis and Treatment of Somatoform Disorders
Somatoform disorders are diagnosed by performing a medical evaluation and testing to determine whether there is a physical reason for a patient's symptoms and complaints. If there is not, a somatoform disorder may be diagnosed by looking closely at the particular signs and symptoms. A correct diagnosis is important, in order to avoid unnecessary surgery and other medical procedures and to begin proper treatment for the particular disorder.
Psychotherapy is the appropriate treatment for somatoform disorders. With the help of a mental health professional, a person tries to understand and resolve anxiety, trauma, or conflicts that are behind these conditions. Treatment may take varying lengths of time, depending on the severity of a disorder in a particular person.
* anxiety (ang-ZY-eh-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person's physical or mental well-being.
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