Psychosomatic Disorder

September 23, 2011

The term psychosomatic disorder generally refers to a medical disorder that is caused by psychological factors. Although the term continues to be used extensively in the medical community, “psychosomatic disorders” largely has been replaced by the term “somatoform disorders,” and is referred to as such in the most recent version of Diagnostic and Statistical Manual of Mental Disorders. There are several types of somatoform disorders including conversion disorder, somatization disorder, and hypochondriasis. The fundamental commonality of all somatoform disorders is the experience of physical symptoms that are not fully explained by a medical condition or by another mental disorder and cause significant functional impairment in life realms such as family, career, and social activity. The physical symptoms are not voluntarily or consciously produced. In fact, the individual who experiences these symptoms truly believes there to be an underlying physical condition in spite of the medical evidence demonstrating otherwise. The combined prevalence rate for somatoform disorders varies greatly by sample, although findings of 10% or more are not uncommon in medical settings.

Conversion disorder is one type of somatoform disorder in which there are motor symptoms (paralysis, difficulty swallowing) and/or sensory symptoms (blindness, deafness) that suggest a neurological condition but do not have medical basis and often appear or worsen during or after stressful life events. For a diagnosis of somatization disorder, there must be an established history of somatic complaints prior to the age of 30 that include multiple pain sites, gastrointestinal problems (diarrhea, nausea), sexual problems (sexual dysfunction,
irregular menses), and one pseudoneurological symptom such as those experienced with conversion disorder. With hypochondriasis, the ability of individuals to function in their lives becomes impaired due to a preoccupation with having a serious illness related to the misinterpretation of bodily experiences (rapid heartbeat, sweating). This preoccupation continues to exist despite thorough medical workup and continual reassurance. Individuals with somatoform disorders are often seen with great frequency in medical clinics and are considered costly to the health care system due to the number of medical tests and specialist consultations they often receive before a psychiatric diagnosis can be reached. Somatoform disorders as a whole seem to occur more frequently in women although the gender makeup does vary from culture to culture.

The etiology of somatoform disorders is often unclear and the complex interaction of biological, environmental, social, and psychological factors produces a symptom presentation unique to the individual. However, theories on somatoform disorders continue to remain grounded in the belief that individuals who involuntarily block psychological distress and/or traumatic experiences from the conscious mental state will experience the distress on a physiological level. It has been theorized that women may experience somatoform disorders in greater numbers related to the higher rates of lifetime sexual and physical abuse (traumas) that they experience. Subsequently, when trauma is combined with female gender role expectations like internalizing (vs. expressing) negative emotions and a caretaking focus on others (vs. themselves), the result is limited outlets for the body to express distress. Additionally, physical illness is generally considered a more “legitimate” and less stigmatized malady than psychological illness in American society; hence, there is even greater reason to keep psychological distress buried and continue to manifest it physically. This reality often makes the treatment of these individuals difficult and lengthy for medical and mental health providers. Alternatively, some feminist theorists have speculated that the higher rates of somatoform disorders in women may be grounded in the inherent power differential in the male-dominated medical profession such that a woman’s somatic complaints are often minimized and hastily attributed to a psychiatric origin, particularly when the medical diagnosis is challenging to ascertain.

Recent medical interest in mind-body relationships and research advances in fields like psychoneuroimmunology have increased awareness about the meaningful reciprocal relationship between emotional and physical states in psychological disorders (depression, posttraumatic stress disorder) and in physical disorders (HIV, autoimmune disorders, cancer). Consequently, a wide array of research-based treatments such as biofeedback, relaxation, and cognitivebehavioral therapy are now available to treat individuals with the more commonplace psychosomatic symptoms of everyday stress as well as the more disabling somatoform disorders.

SEE ALSO: Anxiety disorders, Cognitive-behavioral therapy, Mood disorders

Suggested Reading

  • Asaad, G. (1996). Psychosomatic disorders: Theoretical and clinical aspects. New York: Brunner/Mazel.
  • Schumacher Finell, J. (Ed.). (1997). Mind body problems: Psychotherapy with psychosomatic disorders. Northvale, NJ: Jason Aronson.
  • Shorter, E. (1993). From paralysis to fatigue: A history of psychosomatic illness in the modern era. New York: The Free Press

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