- mind and being home
- signs and symptoms
- conditions and disorders
- mental health assessment
- psychotherapy
- psychotropics
Mind & Being Links
Somatization Disorder
- causes and risk factors
- signs, symptoms, and diagnosis
- pathophysiology
- management
- consequences and course
- the patient
- health care team
- community involvement
- resources and references
Somatoform disorders are those in which physical signs and symptoms lack a known medical basis, in the presence of psychological factors judged to be important. They cause significant distress or impairment. Symptoms are produced unconsiously, not by malingering or factitious disorder.
The primary gain of somatoform disorder is a symbolic release of unconscious conflict, such as anxiety or anger. The secondary gain is the sick role, and external benefits that come along with being incapacitated.
Causes and Risk Factors
Somatization should never be diagnosed by exclusion
unconscious feelings can lead to unconscious defenses, ie conversion. They can also lead to unconscious anxiety
Abbass called this treatment "evangelism busted"
Signs, Symptoms, and Diagnosis
Diagnosis requires at least 8 physical symptoms with no underlying pathology, including each of:
- four pain symptoms, at four dufferent sites/functions
- two GI symptoms, not including pain
- one sexual symptom, not including pain
- one pseudo-neurological symptom, not including pain (ie numbness, paresthesias)
if no signals?
- plans to injure or kill themself or others
- fear, paranoia, or no trust
- too sedated/drug use/meds/illness
- going along with you/defying you
- there is no unconscious process at work
- test is not done properly, with no emotions coming up
Pathophysiology
Anger turned inwards
motor conversion
with a rise in feelings, instead of becoming tense, the person becomes weak in one or more areas. when conversion is active, there is no unconscious anxiety in the striated muscle
It sounds like the striated muscle pathway is more superficial than the smooth muscle pathway
tension becomes stored in the striated muscle pathway
- moves up the homunculus
- thumbs, hands, arms, shoulder, neck, intercostal (sighs), legs and feet
- fibromyalgia
this one guy could say he was feeling emotion (ie rage), but he could not explain how
smooth muscle pathway
ie hypertnesion, IBS, migraine
- GI
- vascular, coronary arteries
- bronchi
- bladder
when anxiety is going to the gut, the patient is not tense in muscles and is calm. this can fool the GP
Cognitive-perceptual disruption
- drifting, dissociation, going blank, losing track of thoughts, poor memory, fainting
- visual blurring, tunnel vision, blindness
- dysfunction/loss of other senses
- hallucinations in all 5 senses
these neurological symtpoms won't appear as tension
Somatization of emotions
"to the degree emotions are being experienced, they cannot simultaneously br somatized or converted into symptoms"
Get the emotions out
Diagnosis of Somatization
If they experience emotions AND simultaneously maintain physical symptoms, start looking for medical causes, as symptoms are likely
Management
Brief, frequent visits are helpful, as is limiting the number of physicians involved in care.
Focus on the psychosocial experience, not the physical symptoms.
Minimize medical investigations while coordinating necessary tests.
Somatization can often be triggered by the therapist - just the new relationship itself
observe
ask what makes it worse or better (ie stressful things)
ask how strong emotions/anger affect them
observe the physical response
review what you observe with the patient
usually can be done in 15 minutes and will often bring some improvement
make sure you're on the same side as the patient - work with them to figure out what is going on
Consequences and Course
The Patient
Health Care Team
Community Involvement