Body complaints without cause: Is there a somatoform disorder?

27. May 2021

Somatoform disorders are manifested by physical complaints for which no physical cause can be found. Affected persons have usually already undergone all conceivable medical diagnostic procedures without clear indications of an underlying physical illness. Only the holistic view of the clinical picture shows: A complex interplay between physical and psychological processes underlies the symptoms. This realization paves the way for interdisciplinary treatment, which holds great prospects for success. Clarification of terms: the term “somatoform” means symptoms that take shape (soma) at the body level. However, the cause of the symptoms is not found in the body.

Main features of somatoform disorders

In principle, any physical complaint can be an expression of a somatoform disorder. Nevertheless, three overarching areas to which most symptoms can be assigned:

  • Pain: Many affected persons suffer from nonspecific pain that cannot be assigned to any physical cause. Examples are back pain, headaches, joint pain, muscle pain or pain in the limbs.
  • Functional disorders:Functional means that certain body functions are impaired. For example, the vestibular system (dizziness), the digestive system (nausea, vomiting, diarrhea, constipation or irritable bowel), the perceptual system (insensations such as tingling, itching, burning), the cardiovascular system (palpitations, heart palpitations, shortness of breath) or the sexual functional level (erectile dysfunction, orgasmic disturbances) may be affected.
  • Disturbances of the activity level: fatigue, chronic fatigue (also called fatigue syndrome), or perceived low resilience.

Other main features of somatoform disorders are the severe limitations in daily life, the long-term and the suffering pressure. Sufferers have often been searching for years for a physical explanation of their symptoms. Often they have already consulted countless specialists and made quite a few attempts at treatment. Sufferers suffer greatly from their limitations, and psychological disorders such as depression, anxiety– or compulsive disorders often develop as a result.

Challenges in diagnosing somatoform disorders

Somatoform disorders require special sensitivity among patients, physicians, therapists, and health care professionals. Not infrequently, affected persons are confronted with prejudices such as “That’s just a simulation,” or “You just have to pull yourself together now,” or “Nothing more can be done.” Feelings of shame, strong frustration and the constant change between doctors (also called “doctor hopping”) are the result. It is important for everyone involved to keep reminding themselves that the symptoms are real. Those affected feel them and suffer massively from them.

Psychological component is often rejected

When doctors bring up psychological causes in the course of diagnosis, it is common for sufferers to feel resentment at first. Medical diagnoses are still perceived as less stigmatizing than psychiatric diagnoses. Virtually all patients want a clear, simple, and physical explanation for their symptoms, which then leads to an equally clear and effective treatment. However, as complex as our bodies and minds are, so can illnesses be. Psyche and body influence each other and only when this connection is taken into account does the path for treatment pave itself. This process requires a gentle approach and a trusting doctor-patient relationship.

Somatoform Disorders – The Origins

The genesis of somatoform disorders is as complex as the clinical picture itself. The process of emergence may begin with an actual physical illness. At this point, the symptoms are still traceable to a physical disease state. If the symptoms remain after the actual cause has healed, a somatoform disorder may develop. However, other causative factors are also conceivable: Medication side effects, everyday stresses or psychological stress factors can play a role. But how do physical symptoms become entrenched?

High sensitivity to bodily sensations

It is often seen that people suffering from somatoform disorder are sensitive to bodily processes. Any slightest deviation from normal is registered and perceived as unpleasant or threatening. The body complaints are then reinforced by these thought patterns and interpreted as a physical illness. Often a vicious circle of avoidance, protection and withdrawal begins, which in turn massively limits the quality of life.

The vicious circle of somatoform disorders

Due to the strong complaints, doctors are visited more and more often. However, most often the diagnosis or treatment does not lead to the desired success. This leads to frustration, disappointment about one’s own body and to strong emotional stress. In addition, those affected are often dissatisfied with the health care system, discontinue treatments and try to find new ways. A strong focus on the subject of illness and the symptoms themselves set in.

The emergence of somatoform disorders

Fortunately, nowadays patients with somatoform are no longer labeled as “incurable” but can seek psychosomatic treatment. This treatment combines medical, psychiatric and psychotherapeutic knowledge.

  • On a medical level, the previous diagnostic process is carefully considered and the exact symptoms are recorded. If necessary, a setting with medications, such as painkillers or circulatory drugs, is made if these serve the short-term symptom reduction.
  • At the psychiatric level, secondary disorders are detected, such as depression, and psychotropic drugs are prescribed if necessary. The treating physicians are always particularly trained in the area of conversation and take a lot of time for the admission of the patients and recognize the body complaints from the beginning. This understanding, approachable attitude alone can contribute to a positive development of the course of the disease!
  • At the psychotherapeutic level, patients learn about the development model of their disease. What factors have led them to suffer from these symptoms and what circumstances maintain the symptoms? In addition, a new way of dealing with the situation is established on the level of thoughts and behavior. An important component of psychotherapeutic care is also the area of stress management and relaxation.

Fortunately, more and more practitioners, including family physicians, are being trained in the psychosomatic view of body complaints. In this way, somatoform disorders are detected earlier and affected persons receive adequate treatment more quickly. The LIMES Schlosskliniken are a particularly suitable point of contact here. As specialist clinics for psychosomatics and psychotherapy, the combination of medical and psychological expertise is a top priority at our clinics.

References

(1) Hiller, W., & Rief, W. (1997). What are somatoform disorders? Diagnoses, models, and instruments. Psychotherapy in Psychiatry, Psychotherapeutic Medicine, and Clinical Psychology, 2, 61-70

(2) Lahmann, C., Henningsen, P., Noll-Hussong, M., & Dinkel, A. (2010). Somatoform disorders. PPmP-Psychotherapy- Psychosomatics- Medical Psychology, 60(06), 227-236. (3) https://juf.podigee.io/33-somatoform

Categories: Somatoform disorders

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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