Somatization & Somatoform Disorders

Somatization

What is somatization?

When physical symptoms are caused by mental or emotional factors it is called somatization. For example, many people have occasional headaches caused by mental stress. But, stress and other mental health problems can cause many other physical symptoms. For example: chest pains, tiredness, dizziness, back pain, feeling sick, etc.

(The term 'psychosomatic disorder' means something similar to somatization, but includes other things. See separate leaflet called 'Psychosomatic Disorders'.)

How can the mind cause physical symptoms?

The relationship between the mind and body is complex and not fully understood. When we 'somatize', somehow the mental or emotional problem is expressed partly, or mainly, as one or more physical symptoms. However, the symptoms are real and are not imagined. You feel the pain, have the diarrhoea, etc.

How common is somatization?

It is common. Sometimes we can relate the physical symptoms to a recent stress or mental health problem. For example, you may realise that a bout of neck pain or headache is due to stress. Anxiety and depression are also common reasons to develop physical symptoms such as palpitations, aches and pains, etc. Often the physical symptoms go when emotional and mental factors ease. However, often we do not realise the physical symptom is due to a mental factor. We may think we have a physical disease and see a doctor about it.

Somatization and functional symptoms

Some doctors prefer to use the term 'functional' when no known physical cause can be found for a physical symptom. A 'functional' symptom means: a function of the body is faulty (for example, there may be pain or diarrhoea), but we dont know the cause. The cause may be due to mental factors (somatization), physical factors not yet discovered, or a combination of both. Another term which is sometimes used for such symptoms is 'medically unexplained symptoms.'

What are the somatoform disorders?

The somatoform disorders are the 'extreme' end of the scale of somatization. So, the physical symptoms persist long-term, or are severe, but no physical disease can fully explain the symptoms. Somatoform disorders include:

• somatization disorder
• conversion disorder
• pain disorder
• hypochondriasis
• body dysmorphic disorder

These are classed as separate mental health disorders as the cause of the symptoms is thought to be mental factors, but they cannot be fully explained by depression, substance abuse, or other recognised mental health disorders.

People with somatoform disorders usually disagree that their symptoms are due to mental factors, and are convinced that the cause of their symptoms is a physical problem.

Somatization disorder

People with this disorder have many physical symptoms from different parts of the body. For example, headaches, feeling sick, abdominal pain, bowel problems, period problems, tiredness, sexual problems. The main symptoms may vary at different times. Affected people tend to be emotional about their symptoms. So they may describe their symptoms as 'terrible', 'unbearable' etc, and symptoms can greatly affect day-to-day life. The disorder persists long-term although the symptoms may 'wax and wane' in severity.

The cause is not known. It may have something to do with an unconscious desire for 'help, attention and care'. It runs in some families. The disorder usually first develops between the ages of 18 and 30. More women than men are affected.

It is difficult for a doctor to diagnose somatization disorder. This is because it is difficult to be sure that there is no physical cause for the symptoms. So, people with this disorder tend to be referred to various specialists, have many tests and investigations, but no physical disease is found to account for the symptoms.

Hypochondriasis

This is a disorder where people fear that minor symptoms may be due to a serious disease. For example, that a minor headache may be caused by a brain tumour, or a mild rash is the start of skin cancer. Even normal bodily sensations such as 'tummy rumbling' may be thought of as a symptom of serious illness. People with this disorder have many such fears, and spend a lot of time thinking about their symptoms.

This disorder is similar to somatization disorder. The difference is that people with hypochondriasis may accept the symptoms are minor, but believe or fear they are caused by some serious disease. Reassurance by a doctor does not usually help as people with hypochondriasis fear that the doctor has just not found the serious disease.

Conversion disorder

Conversion disorder is a disorder where a person gets symptoms which suggest a serious disease of the brain or nerves (a neurological disease). For example, blindness, deafness, weakness, paralysis, or numbness of arms or legs. The symptoms usually develop quickly in 'response' to a stressful situation. You unconsciously 'convert' your mental stress into a physical symptom.

Conversion disorder tends to occur between the ages of 18 and 30. Symptoms often last no longer than a few weeks but persist long-term in some cases. In many cases there is only ever one episode and no treatment is needed once symptoms have gone. Some people have repeated episodes of conversion disorder from time to time.

Body dysmorphic disorder

Body dysmorphic disorder is a condition where a person spends a lot of time worried and concerned about their appearance. A person with this disorder may:

• focus on an apparent physical defect that other people cannot see, OR
• have a mild physical defect but the concern about it is out of proportion to the defect

For example, a person may think that he or she has a skin blemish or an odd shaped nose. However, no-one else can see the defect, or the blemish would be considered trivial by most people. The person becomes preoccupied with the imagined defect, or slight defect. For example, he or she may spend a lot of time looking in the mirror at the apparent defect, or wear camouflaging make-up to hide the defect. The thought of the defect is very distressing for people with this condition. Some people with this condition consult a cosmetic sugeon to have the imagined or trivial defect corrected.

Pain disorder

Pain disorder is a condition where a person has a persistent pain that cannot be attributed to a physical disorder.

Who gets somatoform disorders and what causes them?

Somatoform disorders can affect anyone of any age. The exact number of people affected is difficult to determine as many cases are probably not diagnosed. Somatization disorder is thought to be quite rare, perhaps affecting about 1 in 1000 people. Hypochondriasis and body dysmorphic disorder are perhaps more common. Some studies suggest that body dysmorphic disorder may affect about 1 in 200 people.

It is not clear why some people develop somatoform disorders. Genetic and environmental factors both probably play a part. That is, your genetic make-up combined with factors such as how you were brought up, your parental and peer influences, etc, may all contribute.

Somatoform disorders are more common in people who abuse alcohol and drugs. However, drugs and alcohol may be factors in both cause and effect. For example, some people may turn to alcohol or other drugs to ease the burden of their somatic symptoms. On the other hand, excess alcohol or illicit drugs may make the symptoms worse.

What is the treatment for somatoform disorders?

Treatment is often difficult as people with somatization disorders commonly do not accept that their symptoms are due to mental factors. They may become angry or irritated with their doctors who cannot 'find the cause' for their symptoms. Another difficulty that doctors may face is that people with somatization disorder, like everyone else, will develop physical diseases at some point. So, every new symptom is a challenge to a doctor to know 'how far to investigate'.

Many people who are thought to have a somatoform disorder also have other mental health problems such as depression, anxiety or substance abuse. Treatment of these other mental health problems may improve the situation.

If the person can be convinced that mental ('psychological') factors may contribute to, or cause, the physical symptoms then they may accept a 'talking treatment' such as cognitive behaviour therapy. Talking treatments may help people to understand the reasons behind symptoms, aim to change any 'false' beliefs that they may have, and how to identify and deal with emotional issues.

Medication generally does not have much of a role except in body dysmorphic disorder. Studies have shown that medicines called selective serotonin reuptake inhibitors (SSRIs) can ease symptoms in many people with body dysmorphic disorder. See separate leaflet called 'Body Dysmorphic Disorder' for details. SSRIs are sometimes useful in pain disorder too.