Last Monday we discussed "psychosomatic symptoms or disorders" where psychological states such as stress, worry, and other negative emotions cause or aggravate real, demonstrable physical problems such as hypertension, asthma,  or ulcers. Today we are discussing something different - somatoform disorders - where an individual under the age of 30 complains of somatic (bodily) symptoms, but there are no physical signs of illness. All medical tests suggest that nothing is wrong with the person, and yet he/she complains, seeks medical help, and often suffer substantial impairment of their everyday functioning. Yet they are not feigning or faking illness; the physical problem is very real in the mind of someone with a somatoform disorder.
 
 

Here is an introduction to this topic, adapted from Dr. David B. Adams:                                 A patient believes that he/she has carpal tunnel syndrome or perhaps suffers from seizures.                                 Another patient reports that he/she has numbness or paralysis in a limb. Another patient for                                  months is certain he/she is experiencing the symptoms of a serious disease like cancer, while                                 another is preoccupied with pain complaints.                                 In all of these examples, the physical symptoms suggest a medical                                 condition, but in the absence of objective clinical findings, the disorder                                 is judged to be not physical but Somatoform. The disorder resembles a                                 physical problem. The patient, however, either does not have the                                 disorder or his/her symptoms are markedly more extreme than would                                 be indicated by the physical findings.                                 While the symptoms in all of the Somatoform disorders cause                                 impairment in social or occupational functioning or create significant                                 emotional distress, the complaints are not fully explained by the                                 objective physical findings. It is as though the patient is perceiving that                                 there is an illness or injury despite data which would ordinarily be                                 reassuring that the problem does not exist or is certainly less than the                                 patient fears.

The Diagnositic and Statitistical Manual of Mental Disorders - IV (DSM-IV) distinguishes 5 categories of somatoform disorders. Our text only talks about 2 of these, but I will add a little background  on the other categories as well.

Somatization disorder: A history of many physical complaints beginning before age 30 years that occur over a period of several years and  result in treatment being sought or significant impairment in social, occupational, or other important areas of  functioning. The symptoms cannot be explained adequately based on physical and laboratory examinations. Specific characteristics of somatization disorder:            Multiple pain symptoms involving multiple sites, such as the head, neck, back, stomach, and limbs             At least 2 or more unexplained gastrointestinal symptoms, such as nausea and indigestion             At least 1 sexual complaint and/or menstrual complaint             At least 1 pseudoneurological symptom, such as blindness or inability to walk, speak, or move            Repeatedly consult multiple physicians; may have an endless series of tests and even unnecessary surgeries            Although this full-blown syndrome is relatively rare, somatic complaints in the absence of organic impairment may            occur in over 11% of the population. DSM-IV Criteria

Conversion disorder: a somatoform disorder characterized by a sudden loss of sensory or motor neurological function, usually in the context of a severe stressor. Usually the deficit fails to conform to known anatomical or physiological characteristics. Specific characteristics of conversion disorder include the following:            One or more symptoms of loss of voluntary motor or sensory function (e.g. inability to walk, sudden blindness)            Psychological factors felt important in initiation or exacerbation of loss of function            No evidence that the symptom is feigned or intentionally produced            Loss of function that is not due to medical illness             Common conversion symptoms (eg, pseudoseizure, weakness, paralysis, numbness or sensory disturbance,             becoming mute, involuntary tremors or movements)            The symptom or deficit causes clinically significant distress or impairment in social,             occupational, or other important areas of functioning or warrants medical evaluation.  DSM-IV Criteria

Hypochondriasis: a patient remains preoccupied with the fear that they have a serious medical illness despite the fact that medical evaluation has ruled out such an illness.            Bodily symptoms reported consistent with patient's conception of            specific illness             Fear persists for at least 6 months DSM-IV Criteria

Pain Disorder: a somatoform disorder characterized by a focussed pain complaint that cannot be entirely attributed to a specific medical disorder. Specific symptoms of pain disorder include the following:            Pain in 1 or more anatomical site producing a predominant clinical focus            Psychological factors (felt to play an important role in the onset, severity, or course of pain)            Pain symptom that is not feigned or intentionally produced DSM-IV Criteria

Body Dysmorphic Disorder: a somatoform disorder characterized by preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern  is markedly excessive.              The preoccupation causes clinically significant distress or impairment in social, occupational, or other important              areas of functioning.               The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape               and size in Anorexia Nervosa).

Females outnumber males in all categories except Hypochondriasis. It is very important that physician's consider the possibility that a patient's complaints may reflect a somatoform disorder. At the same time, every so often s condition thought to be psychologically based will turn out to be a reall physical illness.

Some possible contributing factors: 1) Heightened awareness of bodily symptoms 2) Cognitive bias towards negative interpretation  3) "Suffering" may be reinforced (e.g. by attention, sympathy, or avoidance of responsibility)