Somatoform Disorders

Somatoform Disorders

Dr. C. George Boeree

Somatoform disorders are characterized by a concern with the body. Stress and trauma lead to anxiety, but instead of developing one of the anxiety disorders or depression, some people somaticize: They experience the anxiety as fatigue, loss of appetite, body aches, headaches, gastrointestinal problems, and so on. Somatization is actually the most common manifestation of anxiety, especially in non-western countries.

It has been noted, since the 1800s, that people with these disorders are uncommonly easy to hypnotize. This suggests that they may also find it easy to convince themselves of physical ailments that don't really exist. This can be understood as a matter of dissociation (which we discuss under dissociative disorders). Some people (usually nervous extraverts) are able to focus their attention on some aspects of their bodies (such as aches and pains) and focus attention away from other aspects (such as the ability to feel their hands or use their legs). This accounts for the way hypnosis and folk remedies are able to help people with somatoform disorders.

There are several variations:

People with somatization disorder have a history of complaints concerning their physical health, yet show little or no signs of actually having the problems they think they have. It is a rare disorder in western societies, affecting .2 to 2% of women and less than .2% of men. These people seem to have a very broad variety of problems, including pain in different parts of the body, gastrointestinal problems, sexual and menstrual symptoms and neurological problems. It has been a concern, however, that this diagnosis has been misused in the past, especially in regards to women who may very well have had real medical conditions beyond the abilities of their doctors to diagnose!

In China, somatization disorder is a relatively common problem, and is labelled neurasthenia. Neurasthenia combines somatization with feelings of anxiety, depression, irritability, and distraction. In Korea, there is a version called hwa-byung ("anger illness"). It is most commonly found in less educated, middle aged women who are trapped in bad marriages.

Conversion disorder was formerly known as hysteria, and became famous as the disorder that inspired Sigmund Freud to develop psychoanalysis. It is similar to somatization, but is more focused on neurological problems such as paralysis of limbs, muscle weakness, balance problems, inability to speak, loss of sense of touch, deafness, vision problems, even blindness, and yet involves no underlying neurological problems! It is very rare, but is considerably more common in women. It is often seen in context of accidents or military activity, and is more common among rural and other people who are medically naive. As Freud and other early psychiatrists noted, the symptoms often disappear with hypnosis - but other symptoms usually arise to fill in the gap.

People with pain disorder have a history of complaints specifically concerning pain. These people are not lying, and are not malingering - they really feel pain, even though the cause is not found. It is relatively common, but many are concerned with using this diagnosis: There have been real medical problems discovered that had previously been "dismissed" as psychological, such as fibromyalgia. Nevertheless, we have to be careful not to underestimate our ability to intensify or even create suffering in ourselves. Simply focussing attention on small aches and pains can intensify them.

(Note that hypochondriasis is also, officially, a part of the somatoform disorders. We discuss it under anxiety disorders.)