The defining feature of the disorder is physical symptoms. Patients do not feign these symptoms, and they are beyond the patient’s voluntary control. The German Pain Society (Deutsche Schmerzgesellschaft e. V.) notes that this pain can persist for months. Physical examinations reveal no abnormalities; in other words, doctors cannot find a cause for the pain.
This fact unsettles many of those affected. Therefore, it must be made clear: The symptoms are real, and the patient is not “crazy.”
Somatoform pain disorders can manifest in all organ systems and cause a variety of symptoms. The following areas are most commonly affected:
- Cardiovascular system: a feeling of pressure or chest pain
- Gastrointestinal tract: Digestive problems including diarrhea, constipation, and abdominal pain
- Urogenital system: Lower abdominal pain and discomfort when urinating
- Lungs: Breathing difficulties associated with pain
- Joints and muscles: Pain in the legs, arms, or back
In addition to the pain, patients report accompanying psychovegetative symptoms, such as
The severity of symptoms can vary greatly from person to person and may include either individual physical symptoms or multiple symptoms occurring simultaneously. Each patient experiences the pain subjectively with varying intensity.
Somatoform pain disorders can also manifest as headaches and dizziness © Klaus Eppele | AdobeStock
In somatoform pain disorders, there is no physical cause for the symptoms. The patient is physically completely healthy. For those affected, however, this brings no relief, as the pain persists.
For a long time, medical professionals attributed this phenomenon to “hypochondria,” in the sense of an “imaginary illness.” Those affected reported going through a veritable “medical odyssey.” This view is, in any case, too narrow: People who actually suffer from a hypochondriacal disorder interpret all pain as a sign that they are afflicted with a serious or incurable illness. Fear is the primary focus. In contrast to hypochondriacal disorder, somatoform pain disorder is not primarily characterized by fear of serious illnesses, but rather by the actual distress caused by the pain itself. Modern psychosomatic medicine views these symptoms as a serious interaction between the body and the mind.
The condition “Somatoform Disorders” has the ICD-10 code F45.ff. ICD-10 is the diagnostic classification system of the World Health Organization (WHO).
Today, researchers and physicians know a great deal about psychosomatic symptoms. It is well established that there are complex interactions between the body and the mind. Pain patients need not fear being labeled as “hypochondriacs” or even hysterical.
To obtain a reliable diagnosis, the primary care physician refers the patient to a pain specialist or a specialist in psychosomatic medicine.
The specialist conducts various tests to better classify the pain:
- a comprehensive analysis of the patient’s medical history (anamnesis)
- Analysis of the pain diary kept by the patient
- Measurement of pain intensity using questionnaires
- Scales for measuring pain sensitivity (quantitative sensory measurement)
The lifetime prevalence of somatoform pain disorder is less than one percent. This means that less than one percent of the population suffers from a somatoform pain disorder at some point in their lives.
In contrast, 11 percent of the population will experience an undifferentiated pain disorder (F45.1) at some point in their lives. This diagnosis refers to symptoms that do not meet the full criteria for a somatization disorder.
The high rate of comorbidity with somatoform pain disorders is striking. Patients with a pain disorder often also suffer from other conditions such as
The cause of these symptoms is a disruption in the processing of stress and pain. As a result, patients are more sensitive to pain and stress than other people.
In most cases, psychological stress triggers the condition. This makes sense when you consider that the human perception of pain originates in the brain, just like emotions. For this reason, psychological and physical pain are very closely linked. Possible psychological causes include, in particular, persistent stress and personal challenges in one’s life situation. Repeated or prolonged stressful life situations can further negatively impact pain processing.
In somatoform pain disorders, pain and negative emotions are intertwined. These negative feelings may stem from experiences of deprivation, loss, or bullying. Those affected also report traumatic experiences such as
- early experiences of pain,
- chronic illnesses,
- alcoholism,
- emotional neglect, or
- past physical abuse.
From “Imagination” to Illness: Neuroscience and the Mind
Brain research has brought countless insights to light, thereby influencing our understanding of the relationship between body and soul.
Early cultures, as well as religions, assume a separation between body and soul. This means that the soul exists independently of the body. In antiquity, for example, the Greek poet Homer described how the soul (psyché) breathes life into the body. Modern scientific findings are fueling the debate over the mind-body problem.
For example, scientists have been able to use
- sonography (ultrasound),
- EEG (measurement of brain waves), or
- SPECT (brain metabolism)
to determine how pain signals travel from the body to the brain. This allows us to draw conclusions about pain perception. Studies show that certain pain-related areas in the brain are more actively engaged in affected individuals. At the same time, the body’s own alarm system reacts more sensitively to stimuli, which can cause pain to be perceived more intensely.
These findings led to a breakthrough: the notion that the body and mind are separate can no longer be sustained. Currently, scientists from many fields, such as
- psychosomatics,
- psychoneuroimmunology, and
- neuropsychology
are investigating the fundamental question of how the body and mind interact. It is a complex field of research with many unanswered questions.
One thing is certain, however: pain without a physical cause is real, explainable, and treatable. You can find the latest scientific findings and a 3D representation of the brain, for example, on the website www.gehirn.info
Treatment for somatoform pain disorders typically takes place within the framework of psychosomatic medicine and psychotherapy. Various therapeutic approaches are used, which are individually tailored to the symptoms and resources of the affected individuals. Psychotherapy is the first-line treatment for somatoform pain disorder. Therapy for somatoform pain disorder aims to
- get to the root of the causes of the pain and
- resolve the pain or at least alleviate it.
Talk therapy can be combined with the following methods:
- mindfulness training,
- music and art therapy,
- social skills training,
- exercise therapy,
- relaxation techniques, and
- if necessary, the use of antidepressants
Pain relievers play a secondary role in pain management. They are primarily used as short-term acute treatment.
The goal of treatment is to change the patient’s individual perception of pain. The patient learns to distinguish between emotions and pain. In addition, the patient is encouraged to practice allowing emotions associated with the pain to surface. As treatment progresses, the therapist and patient work together to find alternative ways to express negative feelings.
The patient’s social environment and the quality of their relationships also play an important role in treatment. The patient is encouraged to thoroughly reflect on their expectations of themselves and their environment, as well as their behavior. They learn to recognize their needs and take good care of themselves. The goal is for the patient to recognize overwhelming situations more quickly and protect themselves from them.
During the course of therapy,
- stressful events,
- experiences of loss,
- disappointments, or
- insults
be addressed. This provides relief and reduces pain.
Until a few years ago, the standard medical advice for pain was essentially: “Tough it out and don’t reach for medication right away.”
Today, medical science knows that the longer the pain persists, the higher the risk that it will become chronic. So if you suffer from physical symptoms repeatedly or have been experiencing them for a long time, you should talk to your primary care physician about it.
Rule out possible physical causes and also consider psychological triggers such as stress, anxiety, or depression. Ask yourself, for example, whether there are any current sources of stress in your life that could be the cause of your symptoms. Improving your ability to cope with stress can help reduce the risk of your symptoms becoming chronic.
In general,
- a balanced lifestyle,
- a varied diet, and
- nurturing positive relationships
are among the central pillars of a healthy life.
Some patients suffering from somatoform pain disorders become increasingly lethargic. They avoid social contact and are reluctant to leave their homes. This behavior is not helpful, because the goal is to stay as active as possible. Doing so can reduce functional impairments in the affected area of the body over the long term.
- Incorporate regular exercise into your daily routine—for example, go to a gym or learn a relaxation technique.
- Make sure to get enough relaxation and rest breaks. This will help you avoid both under- and over-exertion
- Participate in social activities despite your pain. When you’re with other people, your physical discomfort takes a back seat.
- Find or pursue a hobby that does you good.
- Seek out places where you feel comfortable and spend time with people you enjoy being with.
1. What distinguishes somatoform pain disorder from an organic disease?
In somatoform pain disorder, despite comprehensive examinations, no pathological findings are found to explain the pain, even though there is no organic damage.
2. What role do psychological factors play in the condition?
Psychological factors such as stress, unresolved emotions, or traumatic experiences play a central role in the development and persistence of the pain.
3. Is this condition comparable to other pain conditions such as fibromyalgia?
It is important to distinguish it from other forms of pain, such as fibromyalgia, as the causes, course, and treatment approaches may differ.
4. How is somatoform pain disorder treated?
Treatment is tailored to the individual and aims for long-term pain reduction and better management of symptoms.
