Somatoform Disorders: Types, Manifestations, Diagnosis, and Treatment

A somatoform disorder is a type of psychosomatic disorder where a person experiences real symptoms of a disease, but medical examination reveals no organic lesions in the organs. In other words, symptoms arise solely against the background of stress. Unlike other psychosomatic problems, somatoform disorders do not require medical treatment.

Clinical Picture

It’s important to note that somatoform disorder cannot be considered a simulation of illness. The person genuinely experiences discomfort or various symptoms. For them, all sensations are real.

Often, people start to self-diagnose on the internet, adding new symptoms to their existing ones, leading to increased discomfort. Such patients often come to the doctor with a self-diagnosed condition.

Interesting! Detailed information about what somatoform disorder is, its manifestations, and treatment can be found in A.Yu. Berezantsev’s book “Psychosomatics and Somatoform Disorders.”

Signs of the Disease

Discomfort and symptoms vary widely: some feel pain, others suffocation or a lump in their throat, others suffer from toothaches, etc. However, common signs of somatoform disorders include:

• Pain of any location and character;
• Heart rhythm disturbances;
• Weakness;
• Decreased performance;
• Changes in sensitivity (enhanced or weakened).

Another characteristic feature: medical examination reveals no abnormalities, but this does not reassure the patient. They continue to visit doctors, worry, feel symptoms, and seek confirmation of the disease.

Interesting! People with somatoform disorder tend to exaggerate symptoms, deny the influence of psychological factors, and are often more irritable towards others.

Causes

Somatoform disorders arise due to:

• Stresses (job loss, strong fear, loss of a loved one, change in social status, etc.);
• Chronic stress leading to exhaustion (mental and physical fatigue, joyless life, unmet needs, excessive demands and expectations);
• Conflicts;
• Misunderstanding in relationships with loved ones;
• Loneliness, lack of attention and love (illness as a way to attract attention);
• Boredom;
• Habit of suppressing emotions and desires;
• Suggestibility as a personality trait;
• Negative personal experience, fantasizing (recalling or imagining a situation, such as a loved one’s illness).

Women and people with asthenoneurotic and histrionic character types are more prone to somatoform disorders. These are sensitive, vulnerable, and timid individuals but simultaneously prone to demonstrative behavior. They see the world in negative tones, tire quickly, and get exhausted.

Important! In somatoform disorders, medical examination will be futile. One can spend years visiting doctors and undergoing tests, but this will not yield results. Only a psychotherapist can solve the problem and eliminate symptoms.

Types and Forms of Somatoform Disorder

Somatoform disorders are of several types: somatization (somatic) disorder, hypochondriacal disorder, somatoform autonomic dysfunction, persistent somatoform pain disorder, and undifferentiated somatoform disorder. Each has its characteristics.

Somatic Disorder

Characterized by multiple symptoms that change over time. Discomfort persists for two or more years. Such people constantly experience “this and that” health issue. They frequently visit hospitals but each time see a doctor of a different specialty. Their medical records are filled with results of various examinations, all indicating good health.

Hypochondriacal Disorder

The individual is convinced of being ill, but medical examinations do not confirm this. Typically, the concern is about a specific, often severe or even fatal disease. The person complains about a particular organ or system, interpreting normal organ functions as pathological. The self-diagnosed disease may change, e.g., initially believing in stomach cancer, then in severe tuberculosis.

Signs of hypochondriacal disorder:

• Cenesthopathy (excruciating tactile sensations bordering on fantasy): skin burning, sensation of organ displacement, organ twisting, vein pulsation, etc.
• Emotional disturbances: anxiety, sadness, hopelessness.
• Heightened sense of loneliness, self-focus in the “everyone has abandoned me” format.
• All patient’s actions are directed towards confirming the disease, not relieving symptoms.

Somatoform Autonomic Dysfunction

A special form of disorder where individuals feel vegetative disturbances that are actually not present. For example, they might feel a temperature rise, but the thermometer shows 36.6°C. Patients with a diagnosis of somatoform autonomic dysfunction emotionally narrate their symptoms. They talk not only about discomfort but also about how disease signs disrupt life.

For example, chest pain intensifying during work report submission. The individual gets distracted because the pain shifts all attention to itself. In reality, this is a clue: subconsciously, the person distracts themselves with pain from what causes psychological discomfort. Work might be the stress factor.

Somatoform Autonomic Nervous System Disorder

Observed are vegetative disturbances: tremor, heart rhythm disturbances, sweating, skin flushing, blood pressure elevation, gastrointestinal disorders.

Also observed in somatoform autonomic nervous system disorder:

• Cough;
• Feeling of suffocation;
• Laryngospasm;
• Heart pain;
• Swallowing difficulties;
• Sleep disturbances;
• Decreased performance;
• Headaches;
• Urination problems. The complaints are usually abundant but vague.

Undifferentiated Somatoform Disorder

Symptoms, signs, and complaints constantly change. The disease picture is too blurry to diagnose somatoform disorder.

Somatoform Pain Disorder

The individual experiences constant acute pain, which neither they nor medical professionals can explain. There is a real decrease in the sensitivity of analyzers: vision, hearing, smell, touch. Movement coordination disturbances are observed. Like a hypochondriac, the patient describes pain vividly: abdominal pain as if tightened by a tight belt. However, in expressing their state, the patient is more aggressive than a hypochondriac.

Somatoform Autonomic Dysfunction in Children

Somatoform autonomic dysfunction (SAD) can first be observed in childhood. Symptoms typical for this age include:

• Tachycardia;
• Heart pain;
• Muscle and joint aches;
• Shortness of breath;
• Feeling of suffocation;
• Sharp abdominal pain;
• Urination disorders;
• Headache;
• Temperature fluctuations, especially under stress;
• Fainting;
• Sleepiness;
• Apathy;
• Decreased cognitive abilities;
• Nervousness.

SAD is more commonly observed in adolescence, due to natural hormonal changes and rapid body and organism growth. Other factors causing the disorder in children and adolescents include:

• Heredity;
• Stress;
• Mental and physical fatigue;
• Unhealthy habits;
• Infections;
• Surgery;
• Hypodynamia;
• Excess weight;
• Overuse of computers and social networks (lack of real communication).

In adolescents, the manifestations of SAD are also externally noticeable: oily skin, acne, redness, and pallor of the skin. Sometimes a different set of symptoms is observed: increased appetite without characteristic weight gain, pale and dry skin.

Symptoms of Somatoform Disorders

Somatoform neurosis manifests symptoms of disturbances in all body systems:

• Cardiovascular system: changes in heart rhythm and pressure, pain, discomfort, aching in the chest area.
• Respiratory system: shortness of breath, dizziness, suffocation, headache.
• Digestive system: diarrhea, constipation, flatulence, pain, spasms, nausea, vomiting, appetite change, feeling of a lump in the throat, swallowing problems.
• Urinary system: pain during bowel movements, frequent urination.
• Reproductive system: decreased libido, erectile and ejaculatory dysfunction, vaginismus, inability to achieve orgasm.
• Other symptoms: chills, changes in body temperature, sweating.

Symptoms can appear individually or together; within one system or across different systems.

Diagnosis of Somatoform Disorders

Medical examination will show that all body indicators are normal. Therefore, the responsibility for diagnosis falls on the shoulders of the psychotherapist. The mere obsessive thoughts about certain symptoms and the sensation of these symptoms without medical confirmation already suggest the likelihood of a somatoform disorder. It is also important to pay attention to the symptoms and signs discussed earlier.

Important! Diagnosis can take years, especially with somatized and undifferentiated disorders.

Treatment of Somatoform Disorders

It’s crucial to understand that taking painkillers, antispasmodics, antibiotics will not only be ineffective but also worsen health. In somatoform disorders, the person is physically healthy! All problems and symptoms exist in the mind. Therefore, psychotherapy is needed for treatment.

Psychotherapeutic Treatment of Somatoform Disorder

It is necessary to change attitudes towards life, learn to cope with stress and anxiety. More importantly, identify the psychological trauma. This involves understanding the benefit of the illness. Typically, it’s used to satisfy the need for attention and to fill one’s life with something. It’s important to find a more rational life purpose, means of self-expression, and obtaining recognition and care from others.

Biofeedback (BFB) technology is particularly popular. The person learns relaxation, control of autonomic reactions (breathing, pulse, pressure, muscle tone). These skills are applied in difficult life situations.

In severe cases, psychoactive drugs may be prescribed:

• Tranquilizers,
• Antidepressants,
• Nootropics,
• Neuroleptics.

Important! Only a psychotherapist can prescribe treatment! Drug selection requires an individual approach, considering the personality traits of the patient.

Traditional Methods of Treating Disorders

For mild symptoms, traditional methods can help. It is beneficial to take calming herbal infusions:

• Pour a cup of boiling water over two large spoons of linden flowers. Drink three times a day in equal portions (a cup per day).
• Pour fresh or dried raspberries (2 large spoons) with half a liter of boiling water. Drink three sips up to five times a day.
• Steep dried or fresh mint leaves (a large spoon) in boiling water and let it infuse. Drink two spoons with tea up to four times a day. The typical course of taking calming infusions is one and a half months.

Important! Before using traditional methods, it is better to consult with a doctor.

Prevention of Somatoform Nervous System Disorder

For prevention, it is recommended to:

• Monitor the balance of work and rest;
• Avoid psychophysiological exhaustion;
• Walk, meet friends, relax;
• Regularly engage in sports;
• Watch the correctness and balance of the diet;
• Use physiotherapy to relax muscles and relieve psychological tension: baths, massage;
• Take vitamin courses;
• Drink calming teas and herbal remedies during stress.

If you have serious psychological problems that you cannot cope with yourself, visit a psychologist. You can find online consultations, seek anonymous help, or at least confide in a close friend. Make it a rule to talk about your problems.