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All emotions have a physical part. We may have tears when we are sad and breathe faster when afraid. “Somatization” is the word we use for the physical (or body) expression of stress and some emotions. It is the medical term for the mind body connection. We all somatise. Somatic symptoms are very real. Everyone experiences somatization, but, for some people, it gets in the way of everyday life and requires treatment.
Somatic symptom and related disorders are mental health disorders characterized by an intense focus on physical (somatic) symptoms that cause significant distress and interferes with daily functioning.
Most mental health disorders are characterized by mental symptoms. That is, people have unusual or disturbing thoughts, moods, and behaviors. However, in somatic(Physical) symptom disorders, mental factors are expressed as physical symptoms a process called somatization and the person’s main concern is with physical (somatic) symptoms, such as pain, weakness, fatigue, nausea, or other bodily sensations. The person may or may not have a medical disorder that causes or contributes to the symptoms. However, when a medical disorder is present, a person with a somatic symptom or a related disorder responds to it excessively.
Everyone reacts on an emotional level when they have physical symptoms. However, people with a somatic symptom disorder have extremely seriousthoughts, feelings, and behaviors in response to their symptoms. In order to differentiate a disorder from a normal reaction to feeling ill, the responses must be intense enough to cause significant distress to the person (and sometimes to others) and make it difficult for the person to function in daily life.
The different responses people have defined the specific disorder they have, as in the following:
In conversion disorder, physical symptoms that look like those of a nervous system (neurologic) disorder develop. The symptoms are commonly triggered by mental factors such as conflicts or other stresses. For instance, an arm or leg may be paralyzed, or people may lose their sense of touch, sight, or hearing.
Many physical examinations and tests are usually done to make sure symptoms do not result from a physical disorder. Reassurance from a supportive, trusted doctor can help, as can hypnosis and cognitive-behavioral therapy.
Conversion disorder is a form of somatization, in which mental factors are expressed as physical symptoms. It is thought to be caused by mental factors, such as stress and conflict, which people with this disorder experience as (convert into) physical symptoms.
Although conversion disorder tends to develop during late childhood to early adulthood, it may appear at any age. The disorder appears to be more common among women.
SYMPTOMS
The symptoms of conversion disorder such as paralysis of an arm or leg or loss of sensation in a part of the body suggest nervous system dysfunction. Other symptoms may resemble a seizure or involve problems with thinking, difficulty swallowing, or loss of one of the special senses, such as vision or hearing.
Often, symptoms begin after some distressing social or psychologic event. Symptoms are not consciously produced. That is, people are not faking their symptoms. Symptoms are severe enough to cause substantial distress and to interfere with functioning. People may have only one episode in their lifetime or episodes that occuroccasionally. Usually, the episodes are brief.
In factitious disorder, people pretend to have symptoms for no apparent external reason in order to get time off from work. Factitious disorder is pretending to have or producing physical or psychologic symptoms for no apparent external reason.The cause is unknown, but stress and a severe personality disorder may contribute.
Symptoms may be dramatic and convincing, and the people may wander from one doctor or hospital to another in search of treatment. The doctors will diagnose the disorder after ruling out any other disorders and after discovering evidence that symptoms have been faked. There are no effective treatments, but psychotherapy may help.
People with factitious disorder imposed on self repeatedly fake having a disorder. If they have a disorder, they exaggerate or lie about the symptoms, pretending to be sicker or more weakened than they are. However, this disorder is more complicated than pure dishonesty. It is a mental health problem that is associated with severe emotional difficulties.
What causes factitious disorder imposed on self is unknown, but stress and a severe personality disorder, most often borderline personality disorder, may be involved. People may have an early history of emotional and physical abuse, or they may have experienced a severe illness during childhood or had a seriously ill relative. They appear to have problems with their identity and self-esteem, as well as unstable relationships. Faking an illness may be a way to increase or protect self-esteem by blaming social or work problems on their illness, by being associated with prestigious doctors and medical centers, or by appearing unique, heroic, or medically knowledgeable and sophisticated.
SYMPTOMS
People with factitious disorder imposed on self may report physical symptoms that suggest a particular disorder, such as chest pain that resembles a heart attack. Also, they may report symptoms that could result from many different disorders, such as blood in their urine, diarrhea, or fever. They often know a lot about the disorder they are pretending to have. For example, that pain from a heart attack may spread from the chest to the left arm or jaw. They may change medical records to provide evidence that they have a disorder. Sometimes they do something to themselves to produce the symptom. For instance, they may prick a finger and put the blood in a urine specimen. Moreover, they may inject bacteria under their skin to produce fever and sores.
People with the disorder are usually quite intelligent and resourceful. They not only know how to fake a disorder convincingly, but they also have sophisticated knowledge of medical practices. They can manipulate their care so that they are hospitalized and subjected to intense testing and treatment, including significant operations. Their deceits are conscious, but their motivation and quest for attention are mostly unconscious. They often wander from one doctor or hospital to another for treatment. Factitious disorder imposed on self may continue throughout life.
Factitious disorder imposed on another is falsifying or producing symptoms of a physical or psychologic disorder in another person. It is usually done by caregivers (typically parents) to someone in their care.
Factitious disorder imposed on another is similar to factitious disorder imposed on self, except that people (usually caregivers, typically a parent) intentionally falsify or produce physical or psychologic symptoms in a person in their care (usually a child who is unable contradict the caregiver’s falsehoods or tell how the caregiver caused injury).
The caregiver/parent falsifies history for example, by stating that children have been having fevers or vomiting at home when they have been well. Some caregivers/parent may even injure the child with drugs or other agents or add blood or bacterial contaminants to urine specimens to simulate disease. The caregiver seeks medical care for the child and appears to be deeply concerned and protective. The child typically has a history of frequent hospitalizations, usually for a variety of nonspecific symptoms, but no firm diagnosis was made. Such children may be seriously ill and sometimes die because of the caregiver’s/parent attempts to fakean illness.
Another somatic disorder is Illness anxiety disorder. Illness anxiety disorder is a preoccupation with having or acquiring a severe disorder. People are so worried that they are or might become ill that they become very distressed and have difficulty functioning. Doctors diagnose the disorder if people continue to worry about having or getting a severe disorder after a thorough evaluation has ruled out severe disorders.
A relationship with a supportive, trusted doctor could help, as can cognitive-behavioral therapy. Illness anxiety disorder used to be called hypochondria, but that term was abandoned because of its negativeundertones. This disorder most commonly begins during early adulthood and appears to affect men and women equally. People may become overly anxious because they misinterpret irrelevantphysical symptoms or normal bodily functions such as awareness of the heart’s beating.
SYMPTOM
People are so preoccupied with the idea that they are or might become ill that they become very distressed and unable to function. As a result, personal relationships and work performancedecline.
People with an illness anxiety disorder may or may not have physical symptoms. If they have physical symptoms, the symptoms are mild, and people are more concerned about what their symptoms might mean (that is, that they have a severe disorder) than with the symptoms themselves. Fear of illness is their main worry. (If people also have significant physical symptoms, they may have somatic symptom disorder.) If people with illness anxiety disorder have a physical disorder, their anxiety is out of proportion to the seriousness of the disorder.
Some people examine themselves repeatedly. For example, they may check their pulse repeatedly to see if their heartbeat is regular. They are easily frightened by new bodily sensations. Some people with illness anxiety disorder seek medical care frequently. Others are too anxious to seek it. Illness has a central place in their life and controls their conversation with others. They considerablyresearch the disorder they think they may have. They are easily alarmed about illness, even in someone else.
People with illness anxiety disorder repeatedly seek reassurance from family members, friends, and doctors. When their doctor tries to reassure them (for example, by telling them that examination and tests results are normal), they often think that the doctor is not taking their symptoms seriously. Then they become more anxious. Often, their endless worrying is frustrating to others, resulting in strained relationships.
Affected people may then avoid situations that could result in more stress such as visiting sick family members. They may also avoid activities that they fear may endanger their health such as exercise. Illness anxiety disorder tends to be chronic. Symptoms may lessen, then recur and some people can recover.
TREATMENT
Even when people have a good relationship with their doctor, they are often referred to a psychiatrist. Psychotherapy, particularly cognitive-behavioral therapy, is the most effective treatment.
People with somatic symptom disorder benefit from having a supportive, trustful relationship with a doctor. The doctor can coordinate their health care, offer treatments to relieve symptoms, see them regularly, and protect them from unnecessary tests and treatments. However, the doctor must remain alert to the possibility that these people may develop a physical disorder that requires evaluation and treatment.
