Somatoform disorder

Introduction to physical form disorders Somatoformdisorders are the main complaints of various physical discomforts. Although many medical treatments have been confirmed by various medical examinations, there is no organic damage or a clear pathophysiological mechanism, but it is still unable to dispel the doubts. disease. basic knowledge The proportion of illness: 0.004% Susceptible people: no specific population Mode of infection: non-infectious Complications: anxiety disorder depression

Cause of somatoform disorders

(1) Causes of the disease

The exact cause of the disorder in this group is unknown. Studies in recent years have suggested that such diseases are related to the following factors:

1. Genetic reports suggest that somatoform disorders are associated with genetic predisposition, and a study of a group of chronic functional pains has shown that the positive family history is significantly higher than organic pain; multivariate analysis shows that family genetic history and pain are positive Related.

2. Personality authors' research found that both male and female patients have MMPI profiles of 1, 2, 3, and 7 types, and their two-point coding basically conforms to the personality characteristics of neurosis. Patients with "nervous" personality are more likely to Attention is focused on one's physical discomfort and related events, resulting in decreased sensory threshold, increased sensitivity to somatosensory, and prone to various physical discomforts and pains. Sterm's study found that patients with somatoform disorders often have a certain personality. Obstacles, passively dependent, performance-type, sensitive attack types are more common.

3. Neurophysiological and neuropsychological studies It has been found that patients with somatoform disorders have changes in brainstem reticular structure attention and arousal function. Studies on brain function asymmetry transform the feelings, attention and mood changes of the disorder with the right hemisphere of the brain. The way the information processing process is linked, the brain research on somatoform disorders points to the second sensory area (S11), which seems to be particularly suitable for explaining the dynamics of its neurophysiology and neuropsychology. Some people think that in the case of emotional conflicts Neuroendocrine, autonomic and blood biochemical changes lead to changes in blood vessels, internal organs, muscle tone, etc. These physiological responses are perceived by the patient as physical symptoms.

4. Psychosocial factors

(1) Subliminal benefit: The psychoanalytic school believes that such physical symptoms can provide patients with two benefits in the subconscious. One is to relieve emotional conflict through disguised venting, and the other is to avoid the problem by presenting a sick person. Willing to take responsibility and get care and care.

(2) Cognitive role: the patient's personality characteristics and bad mood can affect the cognitive process, leading to sensitivity and enlargement of perception, making the person's feelings about the body information stronger, selectively paying attention to the body sensation and interpreting it with physical diseases. This tendency enhances the association and memory associated with the disease and the negative evaluation of one's own health.

(3) Alexithymia: Some people think that low-cultural people are not good at expressing their deep feelings in words, that is, the so-called alexithymia. Lesser believes that alexithymia is a long-standing personality trait, patients Not good at expressing inner conflicts, describing the body is no easier than emotional expression, even reaching the difficulty of distinguishing between inner feelings and physical feelings. Some people think that patients have serious defects in the self-perception and verbal expression of emotional experience, and their emotional experience is not conveyed. The cerebral cortex is expressed by linguistic symbols, but is released by the so-called "organ language" formed by the nerves.

(4) Life events: Dantzer emphasizes the connection between life events and the body. Bacon found that life events are directly proportional to the body complaints. The author's research also found that the negative event stimulus group was higher than the control group, life events and pain. Positive correlation, the study group's total social support score was significantly lower than the control group, negatively correlated with the amount of pain, long-term stress in life events.

(5) Social and cultural factors: Some studies have found that physical form disorders are particularly common in middle-aged and older women with lower cultures. Studies have also shown that chronic functional pain is also more common in women with lower levels of education. Some people think that emotional expression is affected by Specific socio-cultural influences, whether in Western societies before the 20th century or in grassroots societies in developing countries or developed regions today, negative emotions are often seen as incompetent manifestations, thus hindering the directness of such emotions. The main complaint of physical discomfort is a legal approach. Under this cultural background, patients will consciously or unconsciously conceal, deny, and even not feel their emotional experience, but pay attention to their physical discomfort. Although the occurrence and persistence of symptoms are closely related to unpleasant life events, difficulties, psychological factors or inner conflicts, patients often deny the existence of psychological factors and refuse to explore the possibility of psychological causes.

(two) pathogenesis

There have been many studies on the psychosocial mechanisms of somatization disorders, but there are few reports on the biological basis of their occurrence. The role of somatization can be understood as social and emotional communication, and can also be interpreted as the result of psychodynamics.

1. Social communication mainly refers to the patient's use of physical symptoms to achieve the purpose of controlling others (such as a young woman showing persistent abdominal pain, thereby preventing his parents from going out on weekends).

2. Emotional communication Sometimes patients can not express their emotions verbally, so they may use physical symptoms or physical complaints to express, some patients may also use physical complaints to deal with stress, physical symptoms may also be a way to alleviate psychological conflicts, psychological testing In terms of research, the MMPI-R score of patients with somatization disorder was significantly higher than that of the control group.

3. Psychodynamic factors Classical psychodynamic theory believes that somatization disorder refers to the replacement of suppressed non-instinctive impulses with physical symptoms. Such physical symptoms of patients can provide patients with two benefits in the subconscious. First, it can be disguised to relieve emotional conflicts. Second, through the role of somatization disorders, you can avoid the unwillingness to bear responsibility, and you can also get the care and care of family and colleagues.

The patient's bad personality characteristics and bad mood can lead to sensitivity and enlargement of perception, selectively gradually pay attention to the body's feelings, and explain this tendency with physical diseases, and enhance the negative evaluation of their own health, and some Patients are not good at expressing inner conflicts, describing physical discomfort is easier than emotional expression, and even reaching difficulty in distinguishing between inner feelings and physical discomfort. Some people think that patients have serious defects in self-perception and verbal expression of emotional experience, and their emotional experience has to pass the so-called emotional experience. The "organ language" was released.

4. Biological factors Neuropsychiatric examination confirmed that patients with somatization disorders were associated with functional deficits in the bilateral frontal lobe of the cerebral hemisphere and dysfunction of the non-dominant hemisphere. However, some studies have shown that patients with predominantly left-sided physical symptoms may be prompted. The right hemisphere of the brain is more severely affected than the left side. Basic research has also confirmed that patients with somatization disorders are often associated with cortical dysfunction. This result is also confirmed by auditory evoked potential examination. Compared with the control group, patients with somatization disorders have related stimuli and Irrelevant stimuli are similar, suggesting that patients with selective attention loss, pathophysiology studies show that the increase in physical complaints is related to the following factors: living alone, receiving less external environmental stimuli, depression and anxiety, in addition, personality characteristics, nerves People with allergies and introversion have lower somatosensory thresholds and are also associated with the development of somatization disorders.

Prevention of somatoform disorders

At present, the causes of many mental illnesses are not detailed. Over the years, professional workers have continuously and carefully observed many mental diseases according to their living and working practices, and have formed some simple concepts, recognizing that many mental diseases are human individuals and The anomalous results of social or natural environment interactions, in quite a few cases, although the external conditions are similar, the disease can be completely different, suggesting that individual characteristics play an important role in the occurrence of disease, therefore, people prevent it from happening This type of disease advocates improving the mental health of people so that they can withstand the harmful effects of the outside world. This is:

1Cultivate the whole body, including the development of brain function, and support it to be in a healthy state, so that the body is strong and full of spirit.

2 Cultivate the healthy development of personality and strengthen exercise so that it can be adapted to the social environment.

Complications of somatoform disorders Complications, anxiety, depression

This disease is generally uncomplicated.

Symptoms of somatoform disorders Common symptoms Inability to gastrointestinal symptoms Absence of appetite, diarrhea, abdominal pain, suffocation, dizziness, fatigue, abdominal discomfort

Somatic symptoms can be involved in various systems of the body. There are many symptoms at the same time, which can be manifested as various discomforts or pains. The patient may have been seeking medical treatment for a long time. No evidence of organic lesions can be found, and even surgical exploration has nothing. However, all kinds of negative medical examinations and doctor's explanations can not dispel their doubts, often accompanied by obvious anxiety and depression, which can lead to social function defects. The main clinical types are as follows:

1. Somatization disorder Somatization disorder, also known as Briquet syndrome, is characterized by the presence of one or more, often repeated changes, that may involve physical symptoms of any system or organ in the body, many of which cannot Explained by medicine, it is not confirmed by various medical examinations that any organic lesions are sufficient to explain the physical symptoms, often leading to long-term repeated medical treatment and significant social dysfunction. The disease usually lasts for at least 2 years before the age of 30. Above, most of the common clinical symptoms are multiple, recurring, often changing physical discomfort and pain, such as headache, abdominal discomfort, other parts of the pain, dizziness, palpitations, other anxiety symptoms, constipation or diarrhea (intestinal irritation syndrome) , depression or anxiety, etc., these patients are more difficult to deal with specific, isolated physical symptoms, in addition, due to specific, repeated concerns about their own health, physical (physical) complaints, physical form disorders see .

Patients with somatization disorders have multiple, repeated and frequently changing somatic symptoms for many years. In some cases, patients are completely immersed in the experience of physical symptoms. They are not willing to link the disease with psychological factors. Therefore, the diagnosis of psychiatrics is not Help, the patient's treating physician will play a key role in dealing with this situation, the doctor can limit the patient to further examination and drug treatment, provide time-limited, regular appointment, reasonable new signs and symptoms deal with.

The course and prognosis of somatization disorders are unknown. However, the link between physical symptoms and psychological pain cannot be recognized and handled improperly, which will cause patients to go to many doctors and experts repeatedly, have received multiple drug treatments, and even injurious medical treatment. Examinations and surgeries, therefore, lack of awareness of this problem, and continue to refer to the experts further, causing a great waste of both personal and health care systems.

The most common symptoms of somatization disorders can be summarized into the following four categories:

(1) Pain: This is a group of frequently existing symptoms. The parts are often very wide, such as the head, neck, abdomen, back, joints, limbs, chest, rectum and other pains of various natures. They are not fixed at one place. May occur during menstruation, sexual intercourse or urination.

(2) Gastrointestinal symptoms: such as hernia, acid reflux, nausea, vomiting, abdominal pain, bloating, diarrhea or certain foods cause special discomfort, gastrointestinal examination sometimes only superficial gastritis or intestinal irritation syndrome, and The patient's severe physical symptoms do not match, and it is difficult to explain the serious symptoms that often exist in patients.

(3) genitourinary symptoms: such as urinary sleepy, urinary retention, or frequent urination, genital or surrounding discomfort, sexual dysfunction visibility cold, erection and ejaculation disorders, menstrual disorders, excessive menstrual blood, abnormal or large Vaginal secretions, etc.

(4) pseudo-neuropathic symptoms: common are: ataxia, limb paralysis or weakness, difficulty swallowing or pharyngeal obstruction, loss of voice, urinary retention, tactile or analgesia, diplopia, blindness, deafness, convulsions and ataxia Limb paralysis or weakness, difficulty swallowing or pharyngeal obstruction, loss of voice, touch or pain, diplopia, blindness, deafness, abnormal skin feeling such as itching, burning sensation, stinging and other symptoms, but the nervous system can not be found Corresponding neurological evidence of organic damage or positive signs.

(5) Symptoms of respiratory circulatory system such as shortness of breath and chest pain.

2. Undifferentiated somatoform disorder Patients with undifferentiated somatoform disorder complain of one or more physical symptoms, which is painful; but medical examinations cannot find evidence of physical illness and any organic lesions, and the course of disease is high. Over half a year, there are significant social dysfunctions, common symptoms such as fatigue, lack of appetite, and gastrointestinal or urinary system discomfort. This clinical type can be regarded as an atypical somatization disorder, and its symptoms are involved. Not as wide as physical disorders, not so rich, the course of the disease may not be more than 2 years.

3. Hypochondriasis is a type of somatoform disorder with suspected symptoms as the main clinical features. The course of the suspected disorder is chronic and fluctuating. The preoccupation concept of the disease can cause pain, anxiety and seeking behavior. Most patients have normal functions in other aspects. Some patients control or manipulate family and social relationships due to the presence of symptoms. They are a persistent feature (suspicion) that is worried or believed to have serious physical illnesses. Physical form disorder, the patient is overly concerned about his or her own health or illness, fearing that he or she is suffering from a serious illness, or that he or she has developed a serious illness; feeling very annoyed, the severity of the trouble is not commensurate with the actual health of the patient. These patients are particularly alert to changes in their bodies. Any minor changes in the body's function, such as heartbeat and bloating, can cause the patient's attention. These seemingly insignificant changes in normal people make the patient pay special attention and unconsciously exaggerate or Misinterpretation, becoming evidence of serious illness, based on the improvement of alertness level, The general slight feeling can also cause the patient to be obviously uncomfortable or seriously uncomfortable and feel unbearable, so that the patient is convinced that he is suffering from a serious disease. Although the results of various tests do not support the patient's speculation, the doctor patiently explains and repeatedly guarantees the patient. Without serious illness, patients are often skeptical about the reliability of the test results, disappointed with the doctor's explanation, still adhere to their own concept of doubt, continue to repeatedly ask for examination or treatment in the hospitals, due to the patient's attention all or most concentrated Health issues, as well as study, work, daily life and interpersonal relationships are often significantly affected. Some patients rely on the presence of symptoms to control or manipulate family and social relationships, with a persistent dominance of worrying or believing in serious physical illnesses ( The concept of "suspicion of illness" is a "conceptual suspected condition" with basic characteristics. It is very obvious with physical discomfort. It is called "sensory suspected condition" with anxiety or depression, and some expresses specific symptoms with a single suspect. And clearly called "single symptom suspected disease", the patient's concept of doubt is very solid, afraid or recognized I am suffering from a serious illness, I am overly worried about my own health or disease, I am overly concerned about my own health, I am particularly alert to my body's minor discomfort, I feel unbearable, I feel unbearable, unconsciously exaggerate or misinterpret, and suffer as a problem. There are evidences of serious diseases, and even pathological explanations for some physiological phenomena that occur daily, but they are not delusions; patients know that their disease evidence is not sufficient, so they are eager to further confirm the diagnosis and treatment through repeated examinations. Repeated medical treatment, despite the negative medical examinations, the doctor's patient explanation and repeated assurances can not dispel their doubts, and even doubt the reliability of the test results, disappointed with the doctor's explanation, dissatisfaction, still adhere to their own concept of doubt, continue to The hospitals repeatedly requested examinations or treatments. The patients pay great attention to the various readings of the diseases. After reading, they often sit in the same position and strengthen the concept of suspected diseases.

4. Body deformation disorders Body dysmorphic disorders, also known as dysmorphophobia, mainly found in adolescents or early adulthood, patients firmly believe that their body appearance, such as the nose, lips and other parts, there are serious defects, or become very It is ugly and requires orthopedic surgery; but the actual situation is not the case. Even if the appearance is slightly variated, it is far from the ugly thought of the patient. This kind of concept is not shaken by explanation, with obvious emotional color, on the cultural background of the patient. In fact, it can be understood that it is not ridiculous, and therefore has the characteristics of over-price concept. The patient has no other psychiatric symptoms and does not meet the diagnostic criteria for mental illness. For such single-symptom cases, the treatment is difficult and the prognosis is poor; some cases Long-term follow-up is required to finally rule out the diagnosis of schizophrenia or paranoid status.

5. Somatoform pain disorder (somatoform pain disorder) is also called psychogenic pain. Sometimes, some chronic pains of unknown cause are collectively referred to as chronic pain syndrome. Persistent pain in various parts can cause pain to the patient or affect his or her social function. However, medical examination cannot find any organic lesions in the painful part. It cannot be reasonably explained by physiological or physical disorders. There are any organic lesions, persistent, severe pain symptoms, pain can occur in any part of the body, but the typical pain areas are headache, atypical facial pain, low back pain and chronic pelvic pain; pain can be located on the body surface , deep tissue or internal organs; nature can be blurred dull pain, pain, soreness or sharp pain, clinical evidence that psychological factors or emotional conflicts play an important role in the occurrence, aggravation, persistence and severity of such pain effect.

The peak age of onset is between 30 and 50 years old, female patients are twice as many as males; most of them are physically laborers, and there is a tendency of family aggregation. Patients often use chronic pain as their prominent symptom and repeatedly seek medical treatment. They often use multiple drug treatments. Physical therapy, even surgical treatment, failed to achieve definite results, often leading to sedative, analgesic drug dependence; accompanied by anxiety, depression and insomnia, prolonged course, often lasting more than 6 months.

6. Somatic autonomic disorders are neurosis-like syndromes caused by somatic disorders in organs or systems that are mainly innervated and controlled by autonomic innervation. The systems often involved are cardiovascular, gastrointestinal, respiratory, and genitourinary systems. Wait.

(1) Symptoms are dysfunction of the organ system that is predominantly or completely controlled and controlled by the autonomic nervous system.

(2) Symptoms often involve one or more organ systems, the most common being the cardiovascular system, the respiratory system or the gastrointestinal system.

1 The chest system can be seen in the cardiovascular system or in the precordial area.

2 Gastrointestinal system can be seen in hernia, hiccups, burning sensation in the chest or upper abdomen, or upper abdominal discomfort, or stomach tumbling or stirring, as well as bowel, bloating, increased stool frequency.

3 respiratory system can be seen breathing difficulties or excessive ventilation.

4 genitourinary system can be seen frequent urination or difficulty urinating, genital or surrounding discomfort.

(3) Symptoms are usually characterized by two types, one based on the objective signs of autonomic stimulation, such as palpitations, sweating, dry mouth, blushing (or flushing), tremors, etc.; second, subjective symptoms, such as uncertain parts. Pain, burning sensation, heavy feeling, tightness, swelling and so on.

Examination of somatoform disorders

1, symptom standard

(1) Comply with the diagnostic criteria of neurosis.

(2) Mainly with physical symptoms, at least one of the following:

1 Excessive concern about physical symptoms (severity is obviously not commensurate with the actual situation), but not delusion.

2 Excessive care for physical health, such as excessive concern about the usual physiological phenomena and abnormal feelings, but not delusions.

(3) Repeated medical treatment or medical examination, but the negative results of the examination and the reasonable explanation of the doctor can not dispel their concerns.

2, serious standards

Impaired social function

3, the disease standard

Symptoms have been met for at least 3 months (somatic disorders require at least 2 years, undifferentiated somatoform disorders and somatoform pain disorders require at least half a year.

4, exclusion criteria

Exclude other neurological disorders, depression, schizophrenia and paranoid mental disorders.

Diagnosis and identification of somatoform disorders

Diagnostic criteria

A variety of physical symptoms as a common feature of these diseases, although different clinical types have their corresponding outstanding performance, but medical evidence can not find evidence of organic lesions, or although there are physical symptoms, but with the persistence of symptoms It is very disproportionate to the severity. Patients are deeply concerned about their physical illnesses and their social functions are often damaged. There is evidence that the occurrence, persistence and aggravation of physical symptoms are closely related to psychological factors, and the duration can be more than half a year. Consider the corresponding diagnosis, summarized as follows:

1. There are many physical symptoms that cannot be explained by medicine, or these discomfort experiences are much more serious than the pathological changes that exist (which must be determined by their own medical history and physical examination).

2. Excessive care for physical illnesses.

3. All kinds of medical examinations are negative, and there is no clinically positive evidence corresponding to the physical symptoms of the patient's pain.

4. Although there are no organic diseases in repeated examinations, there is still a frequent medical history.

5. Adhere to the doctor's instructions that there is no serious physical illness or abnormal advice, the patient still insists that there is a serious disease, and shows symptoms, with these two conditions, should suspect the suspected disease.

Differential diagnosis

1. Physical illnesses These diseases may not be able to find objective medical evidence in the early stage, but in the end, objective medical evidence can be found. Therefore, the diagnosis of various somatoform disorders requires at least half a year of disease, when the onset age is over 40 years old, the body Symptoms are single, the site is relatively fixed, and the trend of continuous aggravation, should first consider the possibility of organic lesions, and close observation, should not rush to make a diagnosis of somatoform disorders, clinical practice shows: according to the onset of mental incentives, preliminary examination No positive signs were found, and patients were easy to accept the suggestion of these points. The diagnosis of lower body form disorders may lead to misdiagnosis and should not be inadvertent.

2. Depressive Disorders and Anxiety Disorders Depression and anxiety are often found in somatic disorders, but to a lesser extent, with less complaints about physical discomfort, with core symptoms of depression and anxiety, and the body Depression and anxiety are more common, and depression patients often present a depression triad, accompanied by a small number of physical symptoms, and mainly concentrated in the gastrointestinal system, ICD-10 pointed out that after the age of 40, In particular, the physical symptoms of men are likely to be early manifestations of primary depressive disorder.

3. Fraud occurs in prisons, courts, work-related injuries and traffic accidents. The parties consciously create or exaggerate various physical symptoms; the symptoms of somatoform disorders are unconscious and involuntary.

4. Suspected delusional patients' physical illness beliefs are absurd and out of touch. Patients with delusional disorder or depression may have weird physical beliefs, such as "an organ or part of the body is rotting", and debates, explanations, etc. cannot make It is shaken and often has other psychotic symptoms at the same time.

5. Identification of the disease and the following diseases:

(1) Patients with depressive disorder may have a preconceived notion that they have a serious disease. However, depression may also be secondary to a suspected disorder. It is important to know which one first appears.

(2) Unexplained physical complaints or somatization disorders are concerned with symptoms rather than the presence of a disease and consequences.

(3) Beliefs related to suspected illnesses are not as fixed as depression or schizophrenia with physical delusions. Patients with long-standing suspected complaints are classified as personality disorders because they feel that medical staff cannot handle them. When it comes to problems, it often becomes dissatisfied and even hostile.

(4) Anyone may have short-term concerns about health issues.

(5) Many anxiety disorders also have the characteristics of suspected complaints.

(6) One of the concerns of generalized anxiety disorder (GAD) is the fear of physical illness of oneself or family members. However, GAD's disease anxiety is only one of many concerns, not the only one.

(7) In the panic attack period, the concept of avoidance and preoccupation for physical or mental illness is prominent (ie fear of death, madness or loss of control), however, patients with panic disorder tend to misinterpret their acute anxiety response (as the anxiety increases) The symptoms of misunderstanding are misunderstood and are not related to anxiety (such as lumps and small spots). Secondly, the misunderstanding of horror tends to be acute, and anxiety symptoms (such as heart attack) occur, and fear of illness Mostly long-term (such as cancer).

(8) OCD patients are worried that they or their families have serious diseases like AIDS or cancer. As a result, they have forced thinking about infection. They will perform forced posture movements (washing or checking) to avoid infection.

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