Somatoform Disorders

Hypochondriasis, hysteria, and phantom pain: these are all presentations of somatoform disorders. A somatoform disorder is diagnosed when a patient feels pain or the symptoms of an organic disease, but when examined, there is no reason to think there is indeed a disease or disorder, and there is reason to think that symptoms are caused by psychological factors.

People presenting with somatoform disorders are not voluntarily controlling their pain, and they really do feel sick. Unfortunately, they are usually dismissed as wanting sympathy or taking up a doctor’s time. In a variation called Munchausen’s syndrome, patients may harm themselves in order to appear sick when they show up at the doctor’s office. A related disorder is Munchausen’s syndrome by proxy, in which a parent shows up at a doctor’s office with a child he or she insists is sick. Though the child may show symptoms of illness, this is generally because the parent has resorted to harming the child in some way to make them appear sick – syrup of ipecac to induce vomiting, for instance. This can be a particularly dangerous disorder, as parents who are dismissed may resort to truly harming the child in order for their complaints of illness to be taken seriously. Again, in true Munchausen’s syndrome by proxy, this behavior is beyond the parent’s ability to control.

Throughout history, you can find somatoform disorders presenting in a wide variety of ways; doctors as far back as the Greeks recognized the illness. During the Salem witch trials, the afflicted girls who were accusing dozens of people of witchcraft may have suffered from a form of hysteria that falls under somatoform disorder; their complaints of torment and pain and uncontrolled behavior and convulsions fall well within the definition.

In its purest form, hypochondriasis, or the belief that you are sick, seems to be a form of phobia in which the patient fears illness so much he or she can actually make themselves ill. Along with other somatoform disorders, it may also be a form of depression. It can occur in conjunction with other mental illness, and it may even occur in conjunction with real physical illness. The last example, when real physical illness is present, is the most dangerous form of hypochondriasis; who’s going to take seriously someone who complains about illness all the time?

Other somatoform disorders include eating disorders, where the body is seen in a distorted manner, usually as too fat. There are lurid examples of somatoform disorders in which the patient desperately wanted a body part cut off, and sought medical help repeatedly until they found a doctor who would do it.

Somatoform disorders are fairly common, occurring in about one percent of the population, and are much more prevalent among women. The most important part of the treatment of these disorders is to take them seriously, but to also not treat the patient’s complaint, and discourage others from doing so as well. Instead, a psychotherapist should search for the underlying cause and treat it with talk therapy. Some drugs may be effective with somatoform disorders as well.

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