What happens when someone has physical symptoms without a physical cause? In this lesson, we'll look at undifferentiated and not otherwise specified somatoform disorders, including what they are and diagnostic issues surrounding them.
Jackie's daughter is dating a man that Jackie doesn't like or approve of. Ever since she found out that they were dating, about eight months ago, Jackie has been experiencing abdominal cramps and numbness in her right foot. They're really painful and have kept her out of work a lot. But, her doctor can't find anything wrong with Jackie.
Jackie might be experiencing a type of mental illness called somatoform disorders, which occur when a patient has physical symptoms without a physical reason for those symptoms.
There are many types of somatoform disorders, including undifferentiated somatoform disorder and somatoform disorder not otherwise specified. Undifferentiated somatoform disorder comes with one or more physical symptoms over an extended period of time. On the other hand, somatoform disorder not otherwise specified does not have the time requirement of the undifferentiated variety.
Many psychologists believe that somatoform disorders are caused, at least in part, by psychological stress. The patient takes their psychological pain and turns it into physical distress. For example, Jackie finding out that her daughter is dating a man she doesn't like could have caused her such distress that her mind converted that stress into physical pain in her abdomen and numbness in her foot.
Let's look closer at two somatoform disorders and some issues with diagnosing them.
Imagine for a moment that you are a psychologist. Jackie's doctor refers her to you because he can't find anything wrong with her despite the fact that she's in a lot of pain. When you first talk to her, you think that she might have somatization disorder, which is one type of somatoform disorder.
But wait! For you to diagnose Jackie with somatization disorder, she has to have a combination of at least four different pain symptoms: two different gastrointestinal symptoms, one sexual symptom, and one pseudo-neurological symptom. All Jackie has are abdominal cramps and foot numbness, so she can't have somatization disorder.
In response to the fact that sometimes patients don't present with all of those symptoms, the American Psychiatric Association came up with a new disorder called undifferentiated somatoform disorder. This syndrome is very similar to somatization disorder; the main difference is that it has fewer required symptoms.
For you to diagnose Jackie, she has to have at least one physical symptom that is not explained by a medical condition, or one physical symptom that is too intense to be explained by a medical condition. She can't be faking the symptoms, and they can't be part of another mental illness. Finally, the symptoms must have been present for at least six months and must cause her distress or impairment in her everyday life.
Jackie's doctor can't find anything wrong with her, but he's pretty sure she's not faking, and she doesn't have any other mental illness. She's been experiencing these symptoms for eight months, and they are keeping her from being able to live her life. Since she hits all of the criteria for undifferentiated somatoform disorder, you are able to diagnose her with it.
Treatment for the disorder is mostly focused on talking with Jackie and resolving issues that are underlying the syndrome. For example, you might work to try to make her feel better about her daughter's relationship or to change her thought patterns about it. In serious cases, antidepressant medications might also be prescribed.
Not Otherwise Specified
Jackie's daughter Rose thinks that she might be pregnant. She's used two different types of birth control with her boyfriend, but there's no denying it. She's got morning sickness. Her breasts are larger and more tender. She's missed several of her periods, and her stomach is growing larger. But, when she goes to the doctor, he says that she's not pregnant! What's going on?
When someone has some symptoms of a somatoform disorder but doesn't quite fit the criteria for it, they are diagnosed with somatoform disorder not otherwise specified. It's kind of a catch-all diagnosis for all the patients who are obviously suffering from a somatoform disorder, but can't be diagnosed because they have one or more criteria missing.
Somatoform disorder not otherwise specified is most commonly seen in three different circumstances:
- Fewer than six months of symptoms. In somatoform disorders, including somatization disorder, one of the requirements is that a patient's symptoms have lasted for at least six months. But, what happens if someone shows up and has only been displaying their symptoms for three months? Do you send them home and tell them to come back in three months when you can diagnose them? Of course not! But since they don't quite meet the criteria, they are often diagnosed with somatoform disorder not otherwise specified until six months has elapsed and the diagnosis can be changed.
- Pseudocyesis. This is a big, fancy word for false pregnancy. Remember Jackie's daughter Rose? She has all the signs of being pregnant, but there's not a baby inside of her. She is suffering from pseudocyesis. Since this is not a psychological disorder on its own, patients with it are diagnosed with somatoform disorder not otherwise specified.
- Mass psychogenic illness. This is when a group of people all begin to display the same symptoms, even though none or only a few of them actually have the disease associated with the symptoms. Mass psychogenic illness, a type of somatoform disorder not otherwise specified, used to be called 'mass hysteria' because somatoform disorders used to be called 'hysteria.'
As you can imagine, there are some issues with diagnosing undifferentiated somatoform disorder and somatoform disorder not otherwise specified. The main issue centers around the question of what makes someone mentally ill.
For example, if you have a strange pain in your chest for a few days and no one can find a reason for it, does that mean that you have somatoform disorder not otherwise specified? Since somatoform disorders are psychological in nature, many people would not want to be diagnosed with them; after all, there's still a social stigma against mental illness.
So, on one hand, perhaps there are issues with the broadness of these disorders. But, on the other hand, they serve a purpose: there are some people who genuinely have psychological issues that aren't covered by other disorders. To do away with them would leave those people without diagnosis and treatment.
There are no easy answers, but the psychiatric community continues to refine and redefine the classification system to address some of these issues.
Somatoform disorders are psychological disorders that involve experiencing physical symptoms without a medical condition to explain them. Undifferentiated somatoform disorder comes with one or more physical symptoms over an extended period of time. On the other hand, somatoform disorder not otherwise specified does not have the time requirement of the undifferentiated variety.
Once you've completed this lesson, you'll be able to:
- Describe somatoform disorders
- Explain the differences in undifferentiated somatoform disorder and somatoform disorder not otherwise specified
- Summarize what symptoms a patient must exhibit in order for a psychologist to diagnose the patient with one of these disorders
- List the circumstances under which somatoform disorder not otherwise specified is commonly found
- Identify the issues surrounding diagnosis and treatment of somatoform disorders