Somatoform Disorders

These are group of disorders that have one thing in common; that is the sufferer has physical symptoms. Unlike other psychiatric disorders where people complain of anxiety or depression, in these disorders patients experience aches and pains, for e.g. in chest, abdomen, head, arms, legs etc. They may also complain of weakness, paralysis, indigestion or difficulty in breathing.

These are psychiatric disorders because there is no identifiable medical cause for these symptoms and they do not fit into the pattern of known medical illnesses. Cause for these symptoms is psychological and for many it becomes an ongoing part of their life and personality makeup, where symptoms get worse in times of stress.

It is also important to remember that these symptoms are not intentionally produced, even though the sufferer gets benefits from it in many ways. When a person intentionally produces symptoms, for some identified gain it is then called malingering, which is not a psychiatric disorder.

Following are the different types of somatoform disorders:

Conversion disorder: Commonly known as hysteria, in the industrialized countries, these days, it occurs relatively rarely. However, in Pakistan it is extremely common, especially among women and children. Its symptoms are very dramatic and it appears as if the person has a serious medical problem, yet there is no physical illness. Most of the time, the symptoms occur suddenly, for e.g. paralysis of arm or legs, blindness, inability to speak or falling down as if person has lost consciousness. At times symptoms are similar to epilepsy. Keep in mind that epilepsy is a neurological disorder (not psychiatric) in which due to electrical discharge in the brain, a person has a fit. It lasts for a minute or so in which person loses consciousness and shakes violently. Treatment for hysteria and epilepsy are completely different; former benefits from psychological management whereas latter requires medications

Somatization disorder: In this disorder presentation is less dramatic but there are multiple symptoms, like aches, pain in different parts of the body, nausea, vomiting, indigestion and various other symptoms occurring at the same time. Yet there is no identifiable cause for these symptoms. Understandably, patients go to physicians and surgeons instead of seeing a psychiatrist. They tend to see many different doctors with poor outcome, hence the term doctor shopping. Some of them get multiple surgeries or are on various medicines. In short term, psychiatric treatment is not very effective, other than making correct diagnosis, which can decrease risk of unnecessary medical or surgical treatments and their associated costs and complications. Patients benefit from long-term psychotherapy, if they commit to this type of treatment.

Somatoform pain disorder: It is similar to above two. The key feature is experiencing and preoccupation with pain for a long period of time, in absence of any good physical explanation for it.

Hypochondriasis: The difference between this and other somatoform disorders is that the person does not have any significant symptoms or pain, but has a fear or the belief that one has a serious physical disease. This fear or belief persists despite medical reassurance, and it interferes with social or occupational functioning. Treatment for it is slow and many times ineffective. Identifying this disorder is still very important so unnecessary medical and surgical treatment can be minimized.