What are psychosomatic disorders? |

Causes and Symptoms

In the 1950s, the diagnosis of “psychosomatic disorders” was coined to refer to medical conditions for which there were no clear medical causes, but there was a subtle distinction between psychological processes and physical illness in its definition. The current understanding of medical illness has progressed, however, and health professionals now understand that psychological or sociological factors contribute to most medical illnesses. Thus, the diagnosis of psychosomatic disorders has undergone refinement and more specific diagnostic classification. The two related psychiatric diagnostic classifications are “psychological factors affecting medical condition” and “somatoform disorders.”

Psychophysical disorders. The diagnosis of psychological factors affecting a medical condition (also occasionally referred to as psychophysiological disorders) describes any physical condition or disorder that is influenced by psychological factors. These psychological factors can range from true psychiatric disorders such as depression to emotional stressors in the person’s environment such as the death of a loved one, anger toward a coworker, or the inability to cope with normal life changes. The more common environmental stressors can lead to the initiation or the exacerbation of physical conditions, including headache, ulcer, asthma, arthritis, acne, irritable bowel syndrome, diabetes mellitus, muscular disorders, and essential hypertension. In certain cases, such as headache, the stressor causes the onset of symptoms. In others, such as diabetes, the stressors might cause a worsening of already existing symptoms because of their influence on the person’s attitude about the illness and the resultant quality of life, the willingness or the ability of the person to comply with treatment, or the person’s capacity to understand the illness and its treatment. For example, in a situation in which a person is faced with the death of a loved one, it would not be unusual to see a corresponding increase in headache frequency or uncontrolled blood sugar levels in the diabetic.

Somatoform disorders. Somatoform disorders are the second diagnostic classification subsumed under the old psychosomatic disorders category. In somatoform disorder, a person displays symptoms that suggest a physical disorder, but no medical evidence exists for such a disorder. In these cases, it is believed that the person possesses psychological stresses, conflicts, or needs that manifest themselves in physical symptoms. The distinction between somatoform and psychophysiological disorders is that in psychophysiological disorders the person has an identified physical illness or disorder that is influenced by psychological stress. In somatoform disorders, there are only physical symptoms and no physical findings or known mechanisms to diagnose any physical illness or disorder.

People with somatoform disorders are presumably unable to tolerate certain forms or intensity of emotional stresses, leading to an expression of their emotional distress through physical symptoms. These disorders typically afflict people in their adolescence or young adult years and cause considerable disruption in life. The symptoms or focus on physical attributes are not intentionally produced or controlled. They are, at the time, outside the person’s capacity to control them. There is no known cause for these disorders, and because they occasionally run in families, some have speculated that environment or genetics may play a role.

An example of a somatoform disorder is conversion disorder. People with conversion disorder display an alteration or loss of physical functioning characterized most often as paralyses, seizures, coordination problems, or visual problems. No physical causes are found for these symptoms. Instead, psychiatric evaluation suggests that the symptoms serve a role in helping the person cope with some type of stress, conflict, or need. A person might become temporarily blind or paralyzed in the right arm as an unconscious way of dealing with an upcoming stressful situation, such as a marriage.

Another somatoform disorder is somatization disorder. People with this disorder complain of unexplained symptoms for which no physical evidence exists. Such people believe that they have acquired a serious physical disorder and often seek out many health care providers to locate a cause for their symptoms. The disorders are often very disruptive to the person’s life and quite costly in terms of medical expenses.

Treatment and Therapy

Treatment for psychophysiological disorders can include using psychiatric medications to manage intense depression or anxiety; educating the patient about the relationship between stressors and physical illness; challenging maladaptive health care beliefs or any unrealistic assumptions or expectations that the person might possess; teaching physical and emotional relaxation skills; developing and utilizing social support from others in the person’s life; and instructing the patient in personal skills to manage better the event or situation causing the stress. These treatments can be very effective with psychophysiological disorders.

Treatment for somatoform disorders involves the use of individual, group, or family therapy to address the stresses, conflicts, or needs that are believed to be at the root of the problem. When patients identify the underlying problems, change their thoughts about these problems, and learn skills to deal more adaptively with them, their physical symptoms typically subside.

Perspective and Prospects

The relationship between the mind and the body has intrigued humankind for centuries. Beliefs about the contribution of the mind in the functioning of the human body have had a mixed history. Scientists and clinicians currently appreciate the influence of psychological and social factors in physical illness and dysfunction, but this has not always been the case. Theories of personality and its influence on health and illness can be found in ancient writings as early as 400 BCE. In the late sixteenth and early seventeenth centuries, the view that psychological factors could influence physical illness lost favor as the medical profession began an era of strict scientific study of the body and bodily processes. During this era, an illness or treatment would be considered legitimate only if a scientific explanation could be found for the process. Because of the limits of scientific methodology at the time, many of the traditional beliefs of this mind-body link were abandoned. The mind and body were theoretically separated until the early twentieth century, which saw the introduction of the field of psychobiology and the scientific study of the influence of the mind on the body.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, Va.: Author, 2013.

Asaad, Ghazi. Psychosomatic Disorders: Theoretical and Clinical Aspects. New York: Brunner/Mazel, 1996.

Asmundson, Gordon J. G., et al., eds. Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. New York: Wiley, 2001.

Gatchel, Robert J., and Edward B. Blanchard, eds. Psychophysiological Disorders: Research and Clinical Applications. Washington, DC: American Psychological Association, 1998.

Mate, Gabor, and T. Miller. When the Body Says No: Understanding the Stress-Disease Connection. New York: Wiley, 2003.

Phillips, Katherine A., ed. Somatoform and Factitious Disorders. Washington, DC: American Psychiatric Association, 2001.

Safer, Diane A., and Lukas Rimas. "Somatization Disorder." Health Library, Mar. 27, 2013.

Smith, G. Richard, Jr. Somatization Disorder in the Medical Setting. Rockville, Md.: Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, 1990.

"Somatoform Disorders." FamilyDoctor.org, Feb. 2010.

"Stress." MedlinePlus, May 22, 2013.