Psychosomatic illness

Psychosomatic means mind (psyche) and body (soma) and can have both mental and physical aspects.

 Psychosomatic related conditions can be separated into three classes.

Class1: those with both a mental and medical illness. Both illnesses complicate the symptoms and management of each other.

Class 2: those with a mental issue as a direct result of a medical illness or its treatment, i.e. depression brought on by having cancer and subsequent treatment.
Class 3, the most prevalent type of psychosomatic related condition is somatoform disorders. These are a group of mental or psychiatric disorders manifested as physical problems or feelings of illness with no apparent, identifiable medical issue. To put another way, the physical symptoms experienced are related to psychological factors as opposed to anything identifiably medical.

 Somatoform disorder are more common in females. Onset is usually before age 30. Common somatoform symptoms include digestive problems, headaches, pain, fatigue, menstrual problems, and sexual difficulties.

The exact cause isn’t known. Family history / genetic predisposition may be a contributing factor. Somatoform disorders may be triggered by strong emotions, situations or events, such as anxiety, grief, trauma, abuse, stress, depression, anger or guilt. Despite what anyone thinks, they are not intentionally producing physical symptoms or making up physical problems. These are real, but caused by psychological factors.

In the main, there are four main types: -

Body dysmorphic disorder is an individual’s obsession or fixation with a minor or imaginary physical flaw, or with the shape or size of their body parts, leading to severe anxiety impacting negatively on ability to function normally.

Conversion disorder: a condition where a person experiences neurological symptoms that affect their movement and senses not attributable to any physical cause. They may feel they’ve lost the use of a body part, however, no medical or physical reason can explain it. Conversion disorder can produce symptoms as debilitating as seizures, blindness or paralysis.

Hypochondriasis: a preoccupation with the fear of having a serious disease. Sufferers misinterpret normal body functions or minor symptoms as being those of a more serious illness or even, life threatening. For example, a person with hypochondriasis may become convinced that they have colon cancer whilst experiencing a bout of temporary flatulence after eating cabbage.

Somatisation disorder:a disorder where a person experiences physical complaints, with no apparent physical cause (e.g.)  headaches, diarrhoea, or premature ejaculation. A person may have a history of medical complaints with no organic foundation.

In the main, somatoform disorders are not considered life-threatening. With the right support and treatment pathway, sufferers can lead normal lives even whilst living with ongoing symptoms. That said, there is currently no cure and treatment can be difficult. The key to a successful outcome is based on the establishment of a consistent and relationship between the patient and their healthcare professional, in most cases in Ireland, their GP. In many cases, the GP will refer the patient to a mental health specialist such as a psychiatrist to help better manage their symptoms.

Symptoms

 

Somatoform disorders are the major forms of psychosomatic illness. Physical symptoms of these disorders are real and may appear to be those of medical conditions. However, they are psychological in nature rather than physical. Medical testing and evaluation may sometimes be required to establish that the symptoms are in fact, by elimination, psychosomatic.

Common symptoms of body dysmorphic disorder

Those with body dysmorphic disorder become fixated with physical appearance. The person sees minor flaws as a major issue or indeed, may see flaws where none exist. Common areas of focus include loss of hair; the physical size and shape of body features, such as the facial (eyes, nose, lips etc.); breast size / shape; weight gain; wrinkles.

Associated behaviours may include:

·         Anxiety, fear of what other people “see”.

·         Depression, perhaps related to low self esteem

·         Withdrawal from situations where there are other people, i.e. public, social

·         Mirrors: - either avoiding or the need to constantly check appearance

·         Seeking reassurance /validation from others about their appearance

Common symptoms of conversion disorder

Symptoms of conversion disorder usually look like neurological problems and can include:

·         Vision impairment (Sudden loss of vision, double vision)

·         Swallowing (can lead to tube feeding in severe cases)

·         Impaired balance or coordination, difficulty walking

·         Inability to speak (aphonia)

·         Loss of sensation

·         Paralysis or weakness, in a limb, or entire body

·         Seizures

·         Urinary retention or conversely incontinence

Common symptoms of hypochondriasis

Hypochondriasis is thinking that everyday normal body functions or minor symptoms represent a serious medical condition. In the mind of a sufferer, for example, a common headache may be a brain tumour or muscle soreness in the limbs may be a sign of impending paralysis. Typical behaviours include:

·         Anxiety and depression

·         Feeling that their GP has made an error in not diagnosing the cause of symptoms, or in some cases, not taking them seriously.

·         Repeated GP visits until (in their mind) a correct diagnosis is made

·         Seeking constant reassurance / validation from friends and family about their symptoms and that they’re “ok”.

Common symptoms of somatisation disorder
Somatisation disorder is characterised by physical symptoms manifesting without an attributable physical cause. May include:

·         Digestive related symptoms, such as nausea, vomiting, abdominal pain, constipation, and diarrhoea

·         Neurological symptoms, headaches and constant fatigue

·         Pain, anywhere

·         Sexual symptoms, such as pain during intercourse, loss of libido, erectile dysfunction, and extreme menstrual problems in women

 

Potential complications of psychosomatic illness?

A person with psychosomatic illness, specifically a somatoform disorder are at increased risk of:

·         Difficulty functioning effectively

·         Physical Disability

·         Diminished quality of life

·         Major depression

·         Suicidal thoughts or actions (especially prevalent in younger people)

It can be hard to spot and especially in people we see every day. Indicative symptoms to look for may present as follows, if identified, prompt medical help should be sought

·         Noticeable changes in eating habits. such as overeating, bingeing or conversely, loss of appetite, desire to eat “alone”.

·         Inability to concentrate

·         Recall or memory issues

·         Constant lethargy

·         Feelings of despair, low self-esteem.

·         Irritability and restlessness

·         Activities and hobbies once enjoyed no longer interesting or important.

·         Persistent melancholy, desolate feelings

·         Problems sleeping (either too much or too little), the change from normal is key

Causes

The exact cause is not known, there may be a genetic link. Somatoform disorders represent the major form of psychosomatic illness. Somatoform disorders may be a coping strategy related to a previous life experience or trauma such as abuse or loss. It may be a learned behaviour, or the result of a personality characteristic. Research also indicates possible comorbidities with other mental health disorders, such as mood disorders, anxiety disorders, personality disorders, eating disorders, and psychotic disorders. Irrespective of causes, the symptoms are real to the person experiencing them, not imagined or made up.

A reaction to a particular emotional or psychological experience, past or present, may act as a trigger to the disorder.

Risk factors

It can be difficult to identify specific risk factors. If a family member has had a somatoform disorder in the past, a person may also be at risk. Other risk factors include:

·         Past sexual, emotional or physical abuse

·         A major childhood illness

·         Poor or reduced ability to show or express emotions

How is psychosomatic illness treated?

Diagnosis and subsequent treatment of somatoform disorders, can not only be challenging and can create stress and frustration for patients. Believing or feeling that there's no known explanation for their symptoms and getting nowhere can then lead to further increased stress and a vicious cycle ensues as they then become even more worried about their health. Once actual physical causes of symptoms have been eliminated, the focus of further treatment is based on a continuing, trusting, supportive relationship between patient and GP or lead health professional, in the mutual knowledge that there is in fact something to treat.  Once a treatment pathway has been agreed, close monitoring of progress through regularly scheduled follow up appointments is important for treatment success.

Psychiatric treatment of somatoform disorders

The GP may refer a patient to a psychiatrist or qualified mental health professional for help in managing their disorder. Psychotherapy and particularly “talking therapies” such as CBT (cognitive-behavioural therapy), may prove effective in dealing with those underlying psychological factors that are causing the physical symptoms and having a positive effect on both. Stress management techniques may also be part of the therapy. Learning to identify, anticipate and manage stress in a healthy way can help those patients where stress brought on by certain triggers is a particular issue.

If a mental disorder, such as depression, anxiety etc. is identified, then treatment with suitable medications may also be recommended and initiated as part of the overall programme.

Symptomatic treatment of somatoform disorders

Talking therapies such as CBT, whilst proven effective in a wide range of mental health management strategies, are not necessarily beneficial for everyone, so for some, symptoms may continue. In such cases, treatment will then be centred on providing symptomatic relief and helping people live normal lives.

Medication

As stated above, comorbid psychiatric disorders should be treated with the appropriate intervention. Medications can help to provide relief from symptoms, such as headache, fatigue, pain, and digestive problems etc. However, any medication should be used sparingly and always for an identified cause and in many cases may not be needed.

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.