Psychosomatic Illness / Somatoform Disorder

Shalini (48), has been suffering from constant headaches for two years. They began as an ache in her temples, and on the top of her head. A few months later, she began experiencing pain in her arms and tingling in her fingertips. She also began to feel constantly fatigued. Some days, she says, are better than others, but for the last few weeks, the bad days have far outnumbered the good ones. The constant pain makes her worry that something's wrong with her—even though she's consulted a general physician, a neurologist, a gastroenterologist and even a gynecologist. All of her tests and scans have returned negative. But she can't stop worrying about her health, and her worry keeps her from focusing on her daily routine.

Somatoform disorders are conditions in which the person experiences physical symptoms such as body aches that have no underlying physical cause. The existence of physical symptoms prompts the person to approach a physician and undergo several medical tests. The medical test results fail to indicate the the cause behind the physical symptoms. But that's not to say that these symptoms are imaginary; the persons do actually experience the aches, pains and other symptoms of bodily distress.

Persistent somatoform pain disorder: The person experiences extreme pain in the limbs and muscles, and headaches that disrupt the person's daily life.

Somatoform autonomic dysfunction: The person experiences uncontrollable tremors in the body, sweating and palpitation. The person presents with symptoms that seem to be connected with organs or systems that are not in their control, for instance, the respiratory system.

Hypochondriasis : We all have fears about our health from time to time: constant headaches due to stress, stomach ache before important meetings, etc. But hypochondriasis is where a person identifies a minor health symptom and perceives it to be a serious illness. The person fears that a minor headache may be brain tumor, or a mild chest pain could be a heart attack. 

Since there is no evidence of a physical illness, it may seem to others that the person is lying about their condition or is being dramatic, but it is important to acknowledge that their distress is real and requires immediate professional help.  

Somatoform disorders can be caused by several factors including:

• Pre-existing physical or common mental illness
• Stressful life events, such as the death of a loved one
• Anxiety

The most common physical symptoms that are reported by people with psychosomatic illness include:

• Gastrointestinal issues, including Irritable Bowel Syndrome
• Skin issues, such as tingling sensation in fingers
• Aches in the head, muscles and all over the body
• Sexual problems

A person with psychosomatic illness may also report feeling fatigued, experience low moods which are similar to that of depression. They may also seek comfort in substance abuse to mask their pain or reduce their anxiety. Psychosomatic illness is a physical expression of the psychological distress that the person is experiencing.

Persons with a somatoform disorder may approach a general physician to find the root cause for their aches and physical distress, and feel helpless when they are unable to. Somatoform disorders take time in being diagnosed as the person is desperate to find the 'right doctor' who can diagnose their illness but fail repeatedly. This can make them feel exhausted, frustrated and sometimes helpless too.

Experts suggest that before concluding that the person has a somatoform disorder, the following health symptoms need to be ruled out:

• Migraine
• Hypertension
• Nutritional deficiency
• Anemia

The treatment for somatoform disorders usually involves therapy and medication. The treatment works on finding the source of pain or distress, which could be the result of an emotional or behavioral issues or in some cases, an underlying mental illness. Cognitive behavioral therapy is considered the preferred form of therapy as it helps to break the thought and behavioral patterns that cause the symptoms. In due course, the physical distress goes away as the psychological distress is treated. 

If there is an underlying mental illness (such as such as depression or anxiety) associated with the physical distress, the person may also need medication.

It can be distressing for the person to not find a medical reason for their physical health condition. As a caregiver, here are a few things you could do:

• Support the person through their illness and assure them that you understand their illness 
• Don't dismiss their symptoms and understand that the pain is real
• Accompany them for regular checkups and treatment
• Help them improve their daily functioning such as eating and sleeping schedules
• Encourage them to take up daily exercise or a physical acitivity to help keep the stress levels of the person with illness under control