Somatoform disorders are characterized by persistent physical complaints for which no sufficient organic explanation can be found despite appropriate medical examination. Pain complaints of various localization are the most common worldwide. They also include complaints and functional disorders of bodily organs, such as dizziness or digestive problems, as well as states of exhaustion.
Here you will find further information as well as selected specialists and centers for somatoform disorders.
Somatoform disorders include, among others
In these disorders, those affected suffer from persistent, frequently changing physical complaints for which no physical cause can be found despite extensive examination. This means that the body is medically healthy. However, those affected are not imagining the symptoms: Rather, the complaints are caused psychologically.
However, those affected are usually convinced that they are suffering from a physical illness. The classification of their symptoms as "psychologically caused" often offends them greatly.
Those affected avoid many activities and focus heavily on their symptoms. As a result, the symptoms often lead to psychological and social restrictions.
Somatoform disorders are classified in the ICD-10 according to the frequency, type and organ-relatedness of the physical complaints:
Around 13 percent of all people are affected by a somatoform disorder in their lifetime, women twice as often as men. The most common of these is somatoform pain disorder, mainly with back pain and headaches. Around two thirds of those affected also have another mental disorder, very often depression.
Somatoform disorders can occur at any age. This contrasts with many other mental disorders, which typically begin in young adulthood.
25 percent of all patients in primary care have somatoform disorders, 5 percent in dermatology, 30 percent in neurology and 50 percent in gastroenterology.
The disorders often arise in connection with stressful events or phases of life. A clear connection is visible to outsiders, but often not to those affected.
The disorder is maintained by
A complex process - accompanied by many factors - plays a role in the development of somatoform disorders. These factors include
aspects that influence each other. The following aspects are significant in somatoform disorders:
The most important form of treatment is psychotherapy.
Patients are often sent for psychiatric or psychotherapeutic treatment by other doctors without seeing any point in it. Accordingly, they are skeptical and often very offended by the supposed labeling as "crazy" or "malingering".
It is therefore particularly important to establish a good and respectful therapeutic relationship.
Therapy should also focus on
Patients should also look for ways to make their lives more satisfying and enjoyable.
Outpatient or inpatient specialist psychotherapy may be considered if
The most important somatoform disorders and forms of somatoform disorders are described below.
In somatization disorder, physical symptoms occur over a longer period of time for which no organic cause can be found. The quality of the symptoms changes frequently and different organ systems are often affected. For example, the patient suffers from the following in succession over several months
Patients brood a lot about their symptoms and the underlying illnesses. They frequently visit doctors and often withdraw socially.
Somatization disorders are classified in the ICD-10 under
classified.
In hypochondriacal disorder ("hypochondria"), the person affected fears that they are suffering from a serious physical illness, e.g. cancer. They can name the suspected illness precisely and describe symptoms to match. He observes all kinds of symptoms and discomfort and classifies them as confirmation of the suspected illness.
Accordingly, he demands many medical examinations, the inconspicuous results of which, however, do not reassure him in the long term. The patient continues to check his supposed signs of illness and does not believe the doctors.
The patient suffers greatly from the symptoms or the cognitive and anxiety effects associated with them.
Cognitive-behavioral psychotherapy or an interpersonally oriented form of psychotherapy, e.g. psychodynamic therapy, is effective.
Hypochondriacal disorders are classified in the ICD-10 under F 45.2. They can be associated with obsessive-compulsive disorders or specific phobias (illness phobias).
Somatoform pain disorders are pain conditions that persist for a long time and cannot be explained, or cannot be adequately explained, by a physiological process or a physical illness.
According to this definition, pain syndromes caused by muscle tension are not classified as somatoform disorders. In practice, however, pure centralized pain syndromes are rather rare. Much more common are mixed patterns in which peripheral processes (e.g. muscular tension) and pain centralization occur in a complementary series.
Somatoform pain disorder is characterized by persistent pain. The location and quality of the pain changes frequently.
According to ICD-10, somatoform pain disorder is classified under the diagnosis number F 45.4. It is to be distinguished from somatization disorders (F 45.0 and F 45.1), in which pain can also occur.
The lifetime prevalence of somatoform pain disorders in Germany is around 12.3 percent. The proportion is correspondingly higher in the population using medical facilities. It is between 20 and 40 percent in general practices and hospital specialist departments.
The diagnosis of a somatoform pain disorder first requires
Childhood stress factors appear to lead to increased vulnerability.
Comorbidities (concomitant diseases) are
Specialist psychotherapy is required if
Furthermore
an indication for outpatient or inpatient psychotherapy.
Case study: Somatoform pain disorder
Mr. F., a 54-year-old technical employee, is referred to a psychotherapist by his GP because of his chronic pain. He reported that he had been experiencing increasing pain in his joints and back for around 15 years. The pain had been repeatedly investigated , especially orthopaedically, without any findings.
Initially, measures such as mud and massages had helped, but this had not brought any relief for about 10 years. Since then, he has been dependent on painkillers, initially mainly paracetamol and aspirin. About two years ago, it had become so extreme that he had switched to morphine preparations prescribed by his GP. He was now regularly taking three times the recommended maximum daily dose.
After lengthy exploration, it emerged that the pain was significantly less when the patient pursued his much-loved hobby of gardening.
Regarding his social situation, he reported that he had been married for a long time. His wife moved out two and a half years ago and they lived apart. Since then, he has been in a casual relationship with an acquaintance. The family doctor reports that his wife's separation came as a great surprise to the patient. It had hit him hard.
He works in the technical department of a medium-sized publishing house. There had been increasing pressure there in recent years as the company had been sold. Many long-standing colleagues had subsequently been made redundant. The patient has so far been able to avoid dismissal thanks to his severely disabled status, which he acquired as a result of the pain. He hopes to be retired due to the pain before he is made redundant.
Functional disorders of the digestive tract are defined as persistent indigestion and pain in the stomach and intestines for which no sufficient organic, e.g. inflammatory, explanation can be found despite appropriate examination.
They can be differentiated according to whether they affect more the upper or the lower gastrointestinal tract. These include
There are also vegetative symptoms such as
In addition to somatoform body complaints, anxiety or depressive disorders can also occur.
Two somatoform disorders of the digestive tract are particularly significant:
Psychosomatic treatment is indicated if symptom-oriented treatment does not bring about an improvement. In addition, there must be clear psychosocial stress in the present or past.
Psychoeducational treatment is useful initially. Its aim is to promote the patient's self-help potential and thus allow them to play an active role in their recovery.
The focus of psychoeducation is the joint discussion and exchange of experiences between
The existing experiential knowledge of the participants is always taken into account.
Building on this, the therapist conveys the most important scientific findings. This gives patients and relatives a clear overview of
are given. This treatment can be followed by short-term psychotherapy or behavioral therapy. Body-oriented psychotherapies and relaxation techniques are also effective.
Functional disorders of the cardiovascular system are defined as persistent pain and other complaints that the affected person experiences as an expression of heart disease, without a corresponding disease of the heart or other thoracic organs (e.g. the esophagus) being confirmed by an appropriate medical examination.
In the ICD-10, they are summarized under somatoform autonomic dysfunction of the cardiovascular system (F 45.3). This includes terms such as cardiac neurosis and neurocirculatory asthenia (DaCosta syndrome).
Pain and other complaints affecting the heart are closely linked to anxiety in two ways: the experience of anxiety itself contains the element of chest tightness and discomfort experienced as an expression of heart disease. This goes hand in hand with fears of heart attack and the general threat of death, which further promotes the symptoms experienced.
Functional disorders of the cardiovascular system are treated in the same way as general somatoform disorders. Behavioral therapies and psychodynamic psychotherapies are effective. Patients also respond well to relaxation techniques and body awareness exercises.
Drug therapies with beta blockers can alleviate the symptoms.
Functional disorders of the urogenital tract are characterized by three partially overlapping symptom complexes:
The micturition disorders show the following manifestations:
According to ICD-10, they are classified as F 45.3 and F 45.4.
Psychogenic bladder voiding disorders are usually caused by neurotic conflicts. The focus here is on fear and shame.
Furthermore, from a psychodynamic point of view, the integration of aggressive impulses has not been successful. Secondarily, avoidance behavior and social reinforcement conditions can also lead to a fixation of the symptoms.
Treatment usually takes place on an outpatient basis, either
Pain syndromes in the urogenital area are a special group:
The most common causes are
Treatment is primarily conservative and symptomatic. In some cases, it is necessary to treat the underlying psychological conflicts or structural disorders.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
