Somatoform disorders

Every doctor has at least one: a patient who comes in often with a variety of physical complaints that don't have an obvious medical explanation.

Sometimes these frequent visitors are seen as a nuisance. Often, they won't accept an explanation when it's given and they may believe they are afflicted with a serious disease no one has been able to diagnose yet.

These patients are often stigmatized by society as whiners, attention-seekers or malingerers, but they suffer from a disorder of thought and/or behavior and are seeking reassurance that they are well. Unfortunately, they are often unable to accept reassurance when it is given.

Several conditions, labeled somatoform disorders, present with physical complaints. Some of these disorders include hypochondriasis, somatization disorder and delusional disorder. Many psychiatric disorders such as depression, anxiety and schizophrenia, are also commonly associated with unexplainable physical symptoms.

Sometimes, physical complaints are the primary symptoms presented to physicians in these disorders. For example, people with an undiagnosed anxiety disorder often visit their physician many times with various physical complaints before the primary anxiety is discovered.

Often, these disorders involve a preoccupation with normal sensations or insignificant physical symptoms. The more the person focuses on a particular part of his or her body, the more they begin to believe there is something seriously wrong with it.

Many of us have probably experienced this to some extent. We learn about an illness and we start trying to diagnose ourselves. Medical students are famous for this as they learn about so many diseases. Sometimes a small amount of knowledge can be a dangerous thing. This could be on the rise today as a vast amount of medical information is easily accessible on the internet. The average person, just like the medical student, doesn't have the necessary education to put this information in context and may therefore jump to the wrong conclusions.

Although many of us experience this from time to time in a fleeting way, people with somatoform disorders tend to be preoccupied with these thoughts most of the time. For these individuals, the worry and reassurance seeking can become disabling.

Physical symptoms can also be the result of psychosis as in the case of delusional somatoform disorders or schizophrenia. People with these disorders truly believe they have an illness no one has diagnosed and their belief is very resistant to rational argument or evidence.

While preoccupation and delusion can both lead to reports of physical symptoms, the symptoms can also be the result of a physiological response to an emotional state. Just as tears are a physical manifestation of sadness and rapid heart beat and butterflies are the same for anxiety, many emotional states have physiological companions. With this in mind, it is understandable that a person experiencing chronic depression or anxiety could feel a variety of physical ailments.

Physical symptoms can also be reinforced by consequences. This can be seen when children have frequent headaches or abdominal pain when they wish to avoid school. Whenever the child wishes to stay at home, he or she gets a headache or a stomach-ache. Similarly, people who are lonely may find that illness leads to caring and special attention from family and health care professionals. They do not fake their symptoms, but really experience them when needed.

With today's tendency toward the walk-in clinic and dealing with only one symptom at each doctor's visit, these kinds of disorders can be overlooked. Physicians tend to tell us what we haven't got, when they can't explain what we are experiencing. When an explanation is given, stress is often cited as the cause of symptoms. While stress can lead to many physical symptoms, it is not always the culprit.

Treatment of somatoform disorders depends on an analysis of the problem, which usually involves a physical examination as well as a detailed history, education about the condition, reassurance and management. Many people with these disorders benefit from cognitive behaviour therapy and some have shown positive results from the most commonly used antidepressant medications. The appropriate treatment will depend on the analysis of the problem.


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