Long-term insomnia, nausea, stomachaches, migraines, dizziness are not always caused by a physical illness. These symptoms are annoying, which can lead to anxiety, restlessness, difficulty concentrating and even aggression, affecting the ability to work and socialize. In such cases, patients tend to search for the existence of a physical disease for a long time, although they fail to discover it! The analyzes have not changed, the doctors deny the existence of the disease, but it is bad. In such a case, it is a question of the manifestation of stress in physical symptoms, or somatization [6].
The amount of such patients suffering from somatization disorders can reach up to 30% in health care institutions [1]. The first symptoms usually start at the age of 18-30. Women get sick more often than men. The main signs that indicate this are frequent, repeated requests for medical help, examinations, even though no new disease can be detected during the examination and many complex examinations deny any deviations. The doctor’s efforts to convince the patient that he is physically healthy and that the symptoms are not caused by damage to the organ system are ignored, and the patient, who would benefit from psychotherapy, does not believe that he has a psychological problem. Symptoms can be varied and variable. They repeat themselves for years. It’s not pretending to be sick. Symptoms:
- headache;
- nausea;
- stomach ache;
- problems with bowel movements;
- fatigue and weakness;
- sexual dysfunction;
- chest pain;
- dizziness;
- back pain [6].
These symptoms are based on:
- 1) alexethymia, or a difficult ability to recognize and express emotional experiences and feelings in words. A person is able to keep a cool head and knows how to control himself, but unexpressed negative emotions are cultivated, accumulated and over time manifest as apparent symptoms of a physical illness [3].
- 2) resomatization; it is based on upbringing and communication style in the family – family members are inattentive to the patient’s emotions in childhood [2], as a result of which the patient has not developed protective mechanisms and later in life, in psychotraumatic situations, regression occurs, i.e. the adult returns to a state similar to early-age children in his emotional response and reacts to stress ” with the whole body’ or apparently physical symptoms[4].
- 3) The theory of resomatization is closely related to the “expulsion of emotions” – an emotional block due to a psychological conflict; the conflict initially leads to behavioral disorders and neurotic symptoms such as tearfulness, easy irritability, increased sensitivity to bright light or loud sounds, rapid fatigue; a person is easily offended, sulks, becomes angry; if the protective mechanisms become insufficient, then the pushing out of emotions progresses into a physical conflict; during which physical symptoms appear; if the problem is not solved, then the neurotic symptoms can start to mix with physical symptoms and often return when the physical symptoms “are cured” [4].
In other words, focusing on bodily symptoms reduces the psychological discomfort caused by unbearable emotions or forbidden fantasies [2]. There is an interesting example: in a study in which 196 students participated. A questionnaire was conducted, during which students answered questions about the frequency and presence of various gastrointestinal symptoms. In parallel, the level of conscious anxiety was assessed for each student according to a special scale, the results statistically proved an interesting regularity: the higher the score for the level of anxiety, the less often this respondent has symptoms from the gastrointestinal tract (stomach pain, bloating, quick feeling of satiety, feeling of fullness stomach, burning sensation, belching, nausea, vomiting). [7].
There are specially developed questionnaires and scales for determining somatization. “The Patient Health Questionnaire – PHQ-15i” [6] is used to assess somatization (available online here: https://patient.info/doctor/patient-health-questionnaire-phq-9 ). The “Toronto Alexithymia Scale (TAS-20)” [8] is used to assess alexithymia: (on-line: http://www.alexithymia.us/test-alex.html )
TEST - Somatization scale: PHQ-15i.
How often did you have the following symptoms in the last 4 weeks?
Possible answers: 0 points – “not at all”, 1 point – “rarely”, 2 points “often”.
- Stomach pain
- Pain in the back
- Pain in arms, legs, joints (knees, hips, etc.)
- Menstrual cramps or other problems related to the menstrual cycle (for women only)
- Headaches
- Chest pain
- Dizziness
- Loss of consciousness
- Palpitations or palpitations
- Lack of breath
- Pain or other problems during intercourse
- Constipation, diarrhea
- Nausea, flatulence, indigestion
- Weakness, weakness
- Sleep disorders
Total points:______
- The minimum number of points is – 0, the maximum – 30 points.
- Less than 5 points – no symptoms of somatization;
- 5-9 points – mild somatization;
- 10-14 points – medium somatization;
- 15 and more points – severe somatization.
Somatization Panacea!
Treatment is often difficult because people with somatization disorder usually do not recognize that their symptoms are psychological. Another factor that complicates the diagnosis and treatment of somatization disorders is that these patients may suddenly develop a physical illness. Some people with somatization disorder tend to have other mental health problems, such as depression and substance abuse, that also require treatment. So, the most difficult task for the doctor is to convince the patient to consider the possibility that the problem causing the symptoms is on a psychic level. The most effective treatment for somatized patients is psychotherapy and medication – antidepressant therapy, because this condition tends to go hand in hand with masked depression or other psychiatric disorders.
Sources of information:
Treatment is often difficult because people with somatization disorder usually do not recognize that their symptoms are psychological. Another factor that complicates the diagnosis and treatment of somatization disorders is that these patients may suddenly develop a physical illness. Some people with somatization disorder tend to have other mental health problems, such as depression and substance abuse, that also require treatment. So, the most difficult task for the doctor is to convince the patient to consider the possibility that the problem causing the symptoms is on a psychic level. The most effective treatment for somatized patients is psychotherapy and medication – antidepressant therapy, because this condition tends to go hand in hand with masked depression or other psychiatric disorders.
- [1] Understanding Somatization in the Practice of Clinical Neuropsychology
- Authors: Greg J. Lamberty
- [2] Fredric N. Busch, Weill Cornell Medical College, Wiley Periodicals, Clinical Approaches to Somatization. Inc. J. Clin. Psychol.: In Session 70:419–427, 2014.
- [3] https://www.psyportal.net/699/comatizaciya/
- [4] https://www.psyportal.net/698/resomatizaciya-m-shur-i-dvuxfaznoe-vytesnenie-a-mitsherlix/
- [5] http://www.spkc.gov.lv/ssk10/index1e60.html?p=%23119#g_119
- [6] https://patient.info/health/somatisation-and-somatoform-disorders
- [7] https://dukonference.lv/files/2017_978-9984-14-797-0_DU%2059%20starpt%20zinatn%20konf%20tezes.pdf
- [8] http://www.alexithymia.us/test-alex.html
- [9] PHYSICAL SYMPTOMS (PHQ-15) Developed by Drs. Robert L. Spitzer, Janet BW Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. http://www.phqscreeners.com/sites/g/files/g10016261/f/201412/English_0.pdf
- [10] “РУКОВОДСТВО ПО ИСПОЛЗОВАНИЮ шкале “Оценка здоровья пачаница” (PHQ) и GAD-7″ https://newpsyhelp.ru/files/PHQ/Instructions_PHQ.pdf