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Somatized disorder: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Somatized disorder is characterized by multiple somatic complaints (which include pain and gastrointestinal, sexual and neurological symptoms) over a number of years that can not be fully explained by a physical illness.
Symptoms usually manifest up to 30 years of age, are not caused intentionally and are not imitated. The diagnosis is based on anamnestic information after the elimination of somatic diseases. Treatment focuses on establishing a stable supportive relationship between the doctor and the patient, which will free the patient from performing unnecessary and potentially dangerous diagnostic studies and therapies.
Somatic disorder is usually a family illness, although the etiology is unknown. This disorder is more common in women. Men, relatives of a sick woman, are at risk of antisocial personality disorder and substance use disorders.
Symptoms of somatized disorder
Repeated and multiple somatic complaints usually begin at the age of up to 30 years. The severity changes, but the symptoms persist. Complete disappearance of symptoms for any long period is rare. Some patients become clearly depressed, and the possibility of suicide becomes threatening.
Involved can be any part of the body, specific symptoms and their frequency vary in different cultures. In the US, typical symptoms include headache, nausea and vomiting, bloating, abdominal pain, diarrhea or constipation, dysuria, dysmenorrhea, dyspareunia, loss of sexual desire. Men often complain of erectile or ejaculatory dysfunction. Neurological symptoms are common. It is also possible to develop anxiety and depression. Usually the patient brightly and emotionally tells about his symptoms, often talking about them "unbearable", "impossible to describe" or "worse can not be."
The patient can become extremely dependent. He is increasingly demanding help and emotional support and can be furious if he feels that his needs are not being met. Such patients are sometimes evaluated as demonstrative and attracting attention. They can also threaten with suicide or attempt suicide attempts. Often dissatisfied with the medical care provided to them, they go from one doctor to another in search of treatment or are observed by several doctors at the same time. The intensity and consistency of the symptoms reflect the patient's strong desire to be cared for. The presence of symptoms helps the patient avoid responsibility, but they can also prevent pleasure and act as punishment, indicating the underlying feelings of insolvency and guilt.
Diagnosis and treatment of somatized disorder
The patient is not aware of the underlying mental problems and believes that he has a physical illness, so requires the doctor to conduct examinations and treatment. Doctors usually perform a variety of examinations and tests to exclude the physical illness as a cause. Since such patients may develop concomitant somatic disease, it is necessary to conduct appropriate examinations and tests if the symptoms change significantly or develop objective symptoms. Patients are usually referred to a psychiatrist, even those who have a trusting relationship with their family doctor.
Specific diagnostic criteria include the occurrence of multiple somatic symptoms up to 30 years, the search for treatment or impaired function, the presence of a history of pain in at least 4 parts of the body, 2 or more gastrointestinal symptoms, at least 1 sexual or reproductive symptom and at least 1 neurological symptom pain). The diagnosis is confirmed by dramatization when presenting complaints and sometimes demonstrative, dependent and suicidal behavior of the patient.
Somatized disorder differs from generalized anxiety disorder, conversion disorder and major depression by domination, multiplicity and persistence of somatic symptoms. Patients presenting complaints for at least 6 months for at least 1 somatic symptom, not explainable by a somatic disease, the condition of which does not completely correspond to the specific diagnostic criteria of somatization disorder, should be considered as patients with undifferentiated, somatoform disorder.
Treatment is difficult. Patients tend to be irritated and frustrated from the assumption that their symptoms are psychic. Drug therapy can help in the treatment of concomitant mental disorders (eg, depression). Psychotherapy, especially cognitive-behavioral therapy, focuses on self-care for this disorder. It is important for the patient to have a supportive relationship with the therapist who offers symptomatic treatment, observing the patient regularly and preventing unnecessary tests and procedures.
