SOMATISATION DISORDER:
Have you ever been told you may be suffering from a Somatisation Disorder with
some fear of vomiting, rather than the problem being Emetophobia?
Somatisation Disorder is defined as 'the expression of psychological problems as physical symptoms'. When no organic cause can be found for these symptoms (assuming the patient actually receives a medical assessment), then a psychological cause is suspected. Usually, the physical symptoms are brief and subside either spontaneously or upon the patient being reassured by an explanation of the symptoms being a reaction to stress or other benign cause.
Such physical symptoms can be caused by an overlooked or undetected medical condition, physiological changes (e.g. fluctuating hormone levels, palpitations resulting from anxiety) or a misinterpretations of normal physiological sensations (e.g. rapid heart rate following unaccustomed exercise).
Somatisation Disorder usually begins in adolescence or early adult life and can be a long-term problem with patients consulting many doctors to seek further investigations and reassurance. Accompanying anxiety and depression is very common.
The most common symptoms and syndrome associated with Somatisation Disorder include:
 | Headaches: a dull, generalised sensation of tightness or pressure around the head can be associated with stress, anxiety and depression. |
| Chest Pain: this is often accompanied by palpitations, breathlessness, a 'tight' chest and, occasionally, hyperventilation. |
| Irritable Bowel Syndrome (IBS): IBS is defined as abdominal pain or discomfort with a change in bowel habit lasting for more than 3 months, in the absence of any diagnosed physical disease. |
| Chronic pain: a persistent pain in the absence of any diagnosed physical cause which could account for the severity of the pain. Treatment can include teaching the patient distraction measures and techniques to reduce focusing attention on the pain. |
Interestingly, nausea and vomiting do not appear in the usual lists of Somatisation disorder symptoms.
The treatment is to limit the possibility of harm by inappropriate treatment and teach the patient to manage the condition, limit the distress caused and reduce the impact of the disorder. The management of such physical symptoms should include:
- Assessment and investigation of physical causes
- If no organic cause can be found, review of psychological causes and the patient's concerns
- Explanation of the symptoms together with help with psychological problems and a follow-up to check progress
If symptoms continue to persist:
- Review the need for further investigation of physical symptoms
- Assess psychiatric history - is there any evidence of depression, anxiety or other psychiatric disorder?
- Further explanation of the symptoms with treatment of any psychiatric disorder, interview any relatives, consider anxiety management training and/or cognitive therapy.
- If the patient still fails to improve then the physical assessment should be reconsidered. Again, if no organic cause can be found the patient may be referred to a psychiatrist or clinical psychologist.