How the mind and the body interact to influence health is much discussed, but little understood. One aspect of this interaction is somatisation. Somatisation is a normal, common – almost universal – phenomenon.
The term refers to the phenomenon wherein physical symptoms are caused by emotional factors. For example, many of us would have experienced occasional headaches brought on by work-related stress. Not just stress, but many other mental health problems, such as worry and sadness, can cause physical discomfort. Examples of such physical symptoms include dizziness, chest pains, low backache etc.
Sometimes physical symptoms result from the body's automatic response to emotional stress, as when heart rate and blood pressure increase in response to fear. Sometimes a physical symptom appears to be a metaphor for an emotional experience, as when people with a “broken heart” have chest pain.
Usually, we can relate the physical symptom to a recent stressful situation. Even when we do not, such symptoms tend to be mild and transient, settling down when the underlying emotional symptoms ease.
What are somatoform disorders?
Somatoform disorders represent the extreme end of the scale of somatization. So, the physical symptoms persist long-term, or are severe, but no physical disease can fully explain the symptoms. A battery of medical tests are invariably done, but the results are either normal or don't explain the person's symptoms.
People with a somatoform disorder experience problems functioning in their daily lives due to the physical symptoms that they experience. The patients often become very worried about their health because they don't know what's causing their health problems. Seeing multiple doctors in an effort to find a physical cause for the reported symptoms is typical of people with these disorders. The term “worried well” is frequently used by family physicians to describe these patients.
It is important to understand that people with a somatoform disorder are not faking. They sincerely believe that they have a serious physical problem. Their symptoms are real – not imagined.
Examples of somatoform disorders include conversion disorder, hypochondriasis and body dysmorphic disorder.
In conversion disorder, the physical symptoms resemble those of a neurologic disorder. The symptoms appear suddenly and are typically triggered by emotional conflict. An arm or leg may be paralyzed, or people may lose their sense of touch, sight, or hearing. Some patients have seizures (“fits”). Conversion disorder is predominantly – almost exclusively – an illness afflicting adolescent girls and young adult women.
Many doctors are consulted and a variety of investigations (blood and urine tests, EEG, brain scans etc.) are usually done, before a diagnosis of conversion disorder is suspected and the patient referred to a psychiatrist. Unfortunately, the longer the delay in seeking psychiatric help, the lesser the chance of a swift, complete recovery.
Medication and psychotherapy help most people recover in a matter of weeks. Treatment is directed at the underlying cause, such as excessive stress, anxiety and depression.
Patients with hypochondriasis are convinced that the physical symptoms they are experiencing are the signs of a major illness. Alternately, they may simply have an obsessive fear of contracting or developing a major illness. HIV / AIDS and brain tumor are common examples of hypochondriacal fears. These feelings are usually based on a misinterpretation of normal bodily sensations or minor physical symptoms.
Examination and reassurance by a doctor do not relieve the concerns of people with hypochondriasis. They tend to believe that the doctor has somehow failed to find the underlying disorder. Unlike patients with other somatoform disorders, who seek relief of symptoms, patients with hypochondriasis seek to confirm the diagnosis they have in mind.
Javier Barden, the Spanish actor who won an Oscar (best supporting actor) for his performance in the movie No Country For Old Men (Oscar for best picture, 2008) is a self-confessed hypochondriac. Florence Nightingale and Charles Darwin are other famous examples.
Body Dysmorphic Disorder (BDD)
For those suffering from body dysmorphic disorder, the mirror lies. Patients with BDD believe they have a flaw or defect in their physical appearance that, in reality, is nonexistent or slight. Put simply, it is a preoccupation with imagined ugliness. Pop icon Michael Jackson is believed to have suffered from BDD.
The clue to BDD is the patient’s irrational focus on one or more “defective” body parts. Typically, patients spend many hours a day worrying about their perceived defect, which may involve any body part. For example, some patients are concerned about wrinkles or skin color. Others focus on the shape or size of a body part, such as the nose, ears or breasts. Some men with normal or even athletic builds think they are puny and obsessively try to gain weight and muscle; this is referred to as muscle dysmorphia.
To try and compensate for their perceived ”defect”, people with BDD may try a number of different routes: pick at their skin until it bleeds, try to camouflage their imperfections with make-up, check the mirror frequently, seek reassurance excessively, wear disguises, skip-out on social occasions, and the like. They consult a number of specialists like dermatologists and plastic surgeons to have the imagined or trivial defect corrected.
The casual observer may not notice the acne, the scar or the wrinkle, the facial asymmetry, or the skin discoloration. But to the patient with BDD, it may be all they think about. Studies have found that BDD patients spend anywhere between three and eight hours a day thinking about the aspect of their appearance that plagues them.