Somatic Signs and Related Disorders
Soma means “body” in ancient Greek. Somatoform diseases include a group of psychiatric diseases where physical complaints and symptoms are at the forefront. The common feature of these diseases is that there is no physical disease that will explain the patient’s complaints by examinations and tests, or even if a physical disease is detected, it does not explain the existing complaints in the patient.
The absence of an organic cause used to lay the groundwork for diagnosing somatization, but it no longer matters whether there is a physical disease. Previously, only those with medically unexplained symptoms were diagnosed, while now those with any chronic disease are also highly diagnosed.
When we look at the researches, the lifetime prevalence of somatic symptoms and associated disorders is 1%. However, considering the cultural dynamics in Turkey, this rate is estimated to be higher.
Somatic symptoms and associated disorders are most commonly accompanied by mood-state and anxiety disorders. It is generally seen that the first pattern begins during adolescence. The frequency of being diagnosed with somatization disorder in first-degree relatives is 20%. It is known to be more common in women. However, it is important to carefully evaluate the diagnostic criteria.
Reasons
There is no single cause of somatoform disorders. Somatic symptoms may occur as a result of the interaction of genetic, biological, learning and sociocultural factors, personality traits and many psychological factors.
Stressful life events, family history are an important risk factor in the emergence of somatic symptoms. In this view, some individuals may develop physical symptoms in order not to experience depression or anxiety in the face of stressful life events.
Physical Symptom Disorders (Somatization Disorder)
It is seen with one or more bodily symptoms that cause distress to the person or significantly disrupt daily life. It is enough that there is even one symptom. In addition, there must be an excessive intellectual, behavioural and emotional engagement related to the resulting physical symptom. Changing symptoms may occur here, but the patterns of infrastructure and behaviour thinking continue in a similar manner.
Emotional blindness is a common personality trait, especially in cases with physical complaints. Emotional blindness is a difficulty in expressing emotions. The reason seems to be difficulty in recognizing emotions. Basically, we can say that these people don’t really recognize positive negative emotions. Regarding expressing emotions, it is seen that they cannot express negative emotions more. The person speaks of the traumatic events that happen to him/her in an attitude that you can perceive as if he/she is not the one who is experiencing them.
After severe stressful events, often the death of a beloved relative, or serious discomfort, temporary bodily symptoms may occur. Temporary bodily symptoms can become chronic if reinforced by the society in which the person is involved.
There are two types.
Type with predominant pain (Pain Disorder): This determinant is for those whose bodily symptoms are predominant in pain.
Persistent Type: Severe symptoms are marked by a marked decrease in functionality and prolongation.
Hypocondriazis-Disease Anxiety Disorder
Although there is no medical evidence here, the person interprets a slightest bodily sensation as a sign of a serious illness. There is a very clear belief in people that even the smallest and insignificant symptom is a harbinger of a very severe disease, and this belief does not disappear with simple persuasion efforts.
There are two types: Maintenance seeker and avoidant type: The care-seeking type walks around doctor to doctor, and the avoidant type does not look in the mirrors, does not check his body or go to hospitals for fear of a poor diagnosis. I mean, there could be an extraordinary case of avoiding a doctor. Typically, the type seeking care is more common.
These people may exhibit avoidant behaviours in certain periods. Sometimes their fear is so great that they do not avoid hearing something bad and go to the doctor, but then they cannot resist and go again.
Artificial Disorder
Artificial disorder is defined as purposeful revealing or pretending to have physical or psychological signs and symptoms. Repeated frequent health institution applications such as faking disease, lying pathologically, (such as pseudologia fantastica; exaggerating symptoms, believing in them) are important characteristics of artificial disorder.
There is a constant disease role here, constant illness, but the bodily symptoms here are either not correct or one can harm oneself just to attract attention and stay in the patient role. These people deliberately reveal the symptoms. They can either make it up or really hurt their bodies so they can’t tell what they’re making it up. There is an interest in these people, but this interest is not a material interest. It may function as a psychological or social center of attention.
There are 2 types: Self-directed artificial disorder and self-directed artificial disorder.
A person may knowingly exhibit a pattern of artificial disorder directed at himself or herself in a way that injures any limb or an artificial disorder directed at someone else in a way that harms someone else’s health. Especially in cultures where psychiatric disorders are not approved or are feared to be stigmatized, people prefer to be physical patients rather than being psychiatric patients. In addition, physical symptoms cause the patient to be taken more seriously by his/her family, the people he/she conflicts with and the physicians.
Conversion (Functional Neurological Disorder)
Conversion Disorder is a common mental illness in our country. The word meaning of the conversion is transformation. Conversion disorder means the transformation of various mental problems (sadness, fear, shame, and anger) into physical problems (inability to speak, fainting, paralysis, weakness, loss of sensation, etc.). Despite all the examinations made in these individuals, there is no physical disease that can cause symptoms. It is 2-3 times more common in women than in men. It can be seen at any age, but often occurs during adolescence and youth.
Conversion disorder is the way in which some individuals react to various mental difficulties, that is, when there are problems that a person cannot cope with, environmental events (domestic disputes, family problems, exposure to violence, blaming himself or herself for an event that he or she does not deem appropriate, excessive fear, anxiety, and regret). It is a protection mechanism that allows the person to temporarily move away from negative intense emotions.
It is thought that people with conversion disorders who cannot communicate verbally with their environment and share their problems express these problems with their bodies in a sense. Symptoms can depend on any kind of psychological distress. (grief, death, debate, economic difficulty, family problems)
The person has a serious dysfunction. In physical symptom disorders, his hands may be numb, he may have very common pain, but he does not lose his organic function. In functional neurological symptom disorder, it loses organ function.
There are 3 minor types of conversion disorder:
- Type Showing Motor Symptoms
- Type Showing Symptoms Related to Sensations
- ype Showing Symptoms Related to Neurological Table.
Dealing with these people only when there are signs of conversion (i.e. only when they faint, are speechless, etc.) causes the problem to persist. For this reason, it would be beneficial for the family to show a suitable and supportive approach to this person in general and not to show a special attitude change while there are signs of conversion. The family’s cooperation with the doctor in the treatment has a great influence on the success of the treatment. Some people may have additional mental illnesses. In such cases, this disorder should also be treated. In chronic and difficult cases, two points are emphasized in the treatment. The first is to solve the problems that create difficulty in the patient and, secondly, to develop more mature responses instead of conversion response to the problems.
Somatoform Disorder Treatment
Somatic symptoms and associated disorders are treatable health problems. Early initiation of treatment and regular follow-up will increase the efficiency of the treatment. Psychotherapy and antidepressant drugs are used together or separately depending on the severity, frequency and duration of depression symptoms.
- Your doctor and psychologist may request some additional tests to better understand you and create an appropriate treatment plan during the evaluation period.
- In medications, you can easily ask your doctor questions such as the duration and frequency of use of the drug, possible side effects, and how to stop the drug.
- Psychotherapy is an important part of treatment. Different therapeutic approaches can be applied in accordance with the individual. Feel free to consult your therapist about which therapeutic approach he/she uses, how you can benefit at the end of the therapy, and any questions that come to your mind like this.
It should be noted that treatment is a process and in this process;
Taking care of everything at once can be intimidating. You may feel better later in treatment, not in a few days or in a single meeting with a mental health worker. Feel free to share what you feel with a trusted relative or friend; let them support you.
The information on this page has been prepared by the Moodist Psychiatry and Neurology Hospital Medical Team.
