Psychosomatic disorders

• ANATOMY OR SYSTEM AFFECTED: All
• CAUSES: Psychological stressors, genetic or environmental factors
• SYMPTOMS: Wide ranging; may include headaches, paralysis, seizures, coordination problems, visual disorders
• DURATION: Acute to chronic
• TREATMENTS: Psychiatric medications, physical and emotional relaxation skills, psychotherapy

DEFINITION: Physical disorder influenced by psychological stressors, or disorders characterized by symptoms that result from unconscious psychological factors instead of an underlying medical condition

Causes and Symptoms

In the 1950s, the diagnosis of “psychosomatic disorders” was coined to refer to medical conditions for which there were no clear medical causes, but there was a subtle distinction between psychological processes and physical illness in its definition. However, modern understanding of medical illnesses has progressed, and health professionals now recognize the important link between psychological or sociological factors and physical illnesses. Thus, the diagnosis of psychosomatic disorders has undergone refinement and a more specific diagnostic classification. The American Psychiatric Association's 2022 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) eliminated the term somatoform disorders; it classifies these conditions as Somatic Symptom Disorders (SSDs) and related disorders, and in medical practice, some physicians use the term psychological factors affecting other medical conditions (PFAOMC).

The diagnosis of psychological factors affecting a medical condition (formerly psychophysiological disorders) describes any physical condition or disorder that is influenced by psychological factors. These psychological factors can range from true psychiatric disorders such as depression to emotional stressors in the person’s environment, such as the death of a loved one, anger toward a coworker, or the inability to cope with life changes. Common environmental stressors can lead to the initiation or the exacerbation of physical conditions, including headache, ulcer, asthma, arthritis, acne, irritable bowel syndrome, diabetes mellitus, muscular disorders, and essential hypertension. In certain cases, such as headache, the stressor causes the onset of symptoms. In others, such as diabetes, the stressors might exacerbate existing symptoms because of their influence on the person’s attitude about the illness and the resultant quality of life, the willingness or the ability of the person to comply with treatment, or the person’s capacity to understand the illness and its treatment. For example, in a situation in which a person is faced with the death of a loved one, it would not be unusual to see a corresponding increase in headache frequency or uncontrolled blood sugar levels in a person with diabetes.

Somatic Symptom Disorders (SSDs; formerly Somatoform disorders). A person with an SSD may display symptoms that suggest a physical disorder, but for an SSD diagnosis, the DSM-5-TR does not require the absence of medical findings. In these cases, it is believed that psychological stresses, conflicts, or needs manifest themselves in physical symptoms. The distinction between SSD and PFAOMCs is that in PFAOMCs, the patient has an underlying medical condition that is worsened or complicated by stress, maladaptive coping mechanisms, or anxiety. In SSDs, physical symptoms may or may not be medically explained, but the individual's excessive thoughts, feelings, or behaviors directly relate to their symptoms.

People with SSDs are unable to tolerate certain forms or intensities of emotional stress, leading to an expression of their emotional distress through physical symptoms. SSDs typically afflict people in their adolescence or young adult years and cause considerable disruption in life. The symptoms or focus on physical attributes are not intentionally produced or controlled. They are, at the time, outside the person’s capacity to control them. These disorders can have a genetic component, and neurobiological factors play a role.

One SSD is now called functional neurological symptom disorder (formerly conversion disorder). People with this condition display an alteration or loss of physical functioning characterized most often as paralysis, seizures, coordination problems, or visual problems. No physical causes are found for these symptoms. Instead, psychiatric evaluation suggests that the symptoms serve a role in helping the person cope with some type of stress, conflict, or need. A person might become temporarily blind or paralyzed in the right arm as an unconscious way of dealing with an upcoming stressful situation, such as a marriage.

Formerly called somatization disorder, people with SSDs complain of unexplained symptoms for which no physical evidence exists. Such people believe that they have acquired a serious physical disorder and often seek out many health care providers to locate a cause for their symptoms. The disorders are often very disruptive to the person’s life.

Treatment and Therapy

Treatment for SSDs and PFAOMCs can include using psychiatric medications to manage intense depression or anxiety; educating the patient about the relationship between stressors and physical illness; challenging maladaptive health care beliefs or any unrealistic assumptions or expectations that the person might possess; teaching physical and emotional relaxation skills; developing and utilizing social support from others in the person’s life; and instructing the patient in personal skills to manage better the event or situation causing the stress. These treatments can be very effective.

Treatment for SSDs involves the use of individual, group, or family therapy to address the stresses, conflicts, or needs that are believed to be at the root of the problem. When patients identify the underlying problems, change their thoughts about these problems, and learn skills to deal more adaptively with them, their physical symptoms typically subside.

Perspective and Prospects

The relationship between the mind and the body has intrigued humankind for centuries. Beliefs about the contribution of the mind to the functioning of the human body have had a mixed history. Scientists and clinicians currently appreciate the influence of psychological and social factors in physical illness and dysfunction, but this has not always been the case. Theories of personality and its influence on health and illness can be found in ancient writings as early as 400 BCE. In the late sixteenth and early seventeenth centuries, the view that psychological factors could influence physical illness lost favor as the medical profession began an era of strict scientific study of the body and bodily processes. During this era, an illness or treatment would be considered legitimate only if a scientific explanation could be found for the process. Because of the limits of scientific methodology at the time, many of the traditional beliefs of this mind-body link were abandoned. The mind and body were theoretically separated until the early twentieth century, when the field of psychobiology emerged, introducing the scientific study of the mind's influence on the body.

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