All patients with chronic physical pain are not alike and shouldn't be treated the same. That's the basis of this article on somatoform disorders. Somatoform disorders refer to aches and pains that are amplified (blown out of proportion) because of underlying psychologic or emotional distress. Vague complaints of muscle or joint pain, fatigue, stomach problems, numbness and tingling, headaches, and so on are typical physical complaints associated with somatoform disorders. But despite all medical tests and lab work ordered, the physician is unable to find anything wrong. Treatment is general, rather than specific to the problem.
Somatoform disorders include a number of different problems all placed in this one category. These include somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, and factitious disorder. The common feature of all these disorders is symptom amplification. The main symptom is usually, but not always, pain. The lack of any evidence that there's anything physically wrong to explain these disorders has led some experts to suggest dropping somatoform disorders as a real diagnosis.
But that's where the authors of this article differ. They suggest that there's a definite need to look deeper and not only find ways to diagnose these problems but also to treat each one specifically. That's a concept they refer to as diagnosis-specific and patient specific treatment. And after briefly describing each condition, they offer some treatment guidelines with the hope that someday we will have specific guidelines for each different disorder, rather than general management techniques.
Health care professionals, especially psychologists and psychiatrists, depend on a publication put out by the American Psychiatric Association called the Diagnostic and Statistical Manual or DSM as it is more commonly referred to. The DSM includes criteria for each somatoform disorder such as signs and symptoms and known causes or risk factors. In addition to a brief review of each disorder, the authors added an extensive table comparing each disorder and offering physicians some treatment guidelines for each one.
Here's a brief summary of the main disorders. Somatization disorder includes vague reports of pain, gastrointestinal problems, sexual problems, and symptoms that suggest a neurologic problem but with no identifiable cause. The problems described by patients last for years and no medical condition can be found to explain them. Conversion disorder describes neurologic symptoms (e.g., numbness, paralysis, blindness, unable to speak) in response to mental, psychologic, and/or emotional stress. Usually, there is a conflict or stress that occurs just prior to the conversion taking place. In the past, conversion was referred to as hysteria. Women are affected more often than men (2:1 ratio).
Most people are familiar with the term hypochondriac -- someone who is always sick, afraid of getting sick, and preoccupied with various physical symptoms or bodily functions. Hypochondriasis is a chronic problem that doesn't go away with time. Men and women are affected equally. Many of these folks have additional disorders such as anxiety, depression, panic, obsessive-compulsive disorders, and high rates of substance abuse.