What happens when psychological pain becomes physical pain? In this lesson, we'll look at the category of mental illness known as somatoform disorders, including the history and current views on them.
Alice's doctor is stumped. For a while now, she has been in to see the doctor regularly with symptoms of illness, like pain in her abdomen and paralysis in her right leg. Her doctor knows that Alice is not faking these symptoms, but he can't find anything wrong with her. He just doesn't know what the problem could be.
Alice might be suffering from a somatoform disorder. Somatoform disorders are psychological disorders that involve experiencing physical symptoms without a physical illness. No one is exactly sure what causes somatoform disorders, though it's clear that psychological stress has some impact on the patients.
Psychologists use a book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, in order to diagnose patients like Alice. The most popular version of the DSM is the DSM-IV-TR, which was published in 2000.
In that version, there are seven disorders that fall under the umbrella of somatoform disorders:
- Conversion disorder involves having something specifically wrong with you without any physical illness. For example, someone might become blind, even though their eyes and their brain are fine.
- Somatization disorder is similar to conversion disorder, but the symptoms are more general and might involve several areas of the body.
- Pain disorder is just what it sounds like: chronic pain that's brought on by or exacerbated by psychological issues.
- Hypochondriasis involves reacting to minor physical issues as though they were life threatening. For example, a patient might believe that a normal headache is actually a brain tumor.
- Body dysmorphic disorder is when an imagined flaw in a person's physical appearance gives them psychological distress. For example, a patient might become convinced that their nose is too large, even though it is a normal size.
- Undifferentiated somatoform disorder is kind of like conversion disorder and somatization disorder, but occurs when a patient has only one symptom in the past six months.
- Somatoform disorder not otherwise specified is a general diagnosis given when a person has physical symptoms without physical illness but does not fit the criteria for one of the other somatoform disorders.
Somatoform disorders have been around for most of history. The ancient Egyptians reported cases of somatoform disorders, as did the ancient Greeks, Romans and most modern societies. The history of somatoform disorders makes it clear that they have been around a long time, but the way they have been viewed has changed with the times.
No one knows why, but somatoform disorders are more common in women than in men. In ancient Egypt, perhaps because men were seen as unmanly if they reported physical symptoms, it was believed that somatoform disorders only happened in women. Egyptian doctors suggested that perhaps the problem was that the womb had detached and was floating around inside the body. Wherever the symptoms showed up, the Egyptians believed, that was where the wandering womb was.
Remember Alice? Among other symptoms, she has experienced paralysis in her right leg. According to the ancient Egyptians, her womb would have traveled down to her leg and was causing problems there. If she then experiences pain in her chest, it would be because her womb had traveled up to her chest.
The ancient Greeks gave somatoform disorders the name hysteria, which stuck with the disorders for thousands of years. The word hysteria came from the Greek word for uterus and reflected the Greek agreement with the Egyptians that a wandering womb was responsible for somatoform symptoms.
In the 19th century, Sigmund Freud finally gave hysteria a new name. He called it conversion disorder, because he believed that it was caused by converting psychological pain into physical pain. Freud and his colleagues still believed that conversion disorder was just a female problem, though.
Finally, in the 20th century, the American Psychiatric Association distinguished between the various types of disorders and gave the group of them the name somatoform disorders. By this time, psychologists recognized that both men and women could suffer from somatoform disorders, though even today they are much more commonly diagnosed in women. Again, this might be because men are less likely to report problems for fear of being seen as weak.
Somatic Symptom Disorder
As we saw earlier, psychologists use the Diagnostic and Statistical Manual of Mental Disorders, or DSM, to diagnose mental illnesses, including somatoform disorders. Though the most commonly used version of the DSM is the DSM-IV, a new version, the DSM-5, was published in the first half of 2013. In the newer DSM-5, somatoform disorders as a category was replaced with a new disorder, somatic symptom disorder.
Because many of the somatoform disorders in the DSM-IV overlapped, there were some problems with diagnosing a patient. For example, does Alice have conversion disorder or somatization disorder? Could she be suffering from hypochondriasis? All of these are possible, and different psychologists might diagnose her differently.
To address the issue of overlap, the DSM-5 did away with the individual somatoform disorders. Instead, patients could all be diagnosed with somatic symptom disorder, as long as they are experiencing physical symptoms that make it hard for them to function normally; have excessive thoughts, behaviors or emotions about those symptoms; and have had the symptoms for at least six months.
The hope in the new DSM is that somatic symptom disorder will make it easier for psychologists to diagnose patients who are suffering from what has traditionally been called somatoform disorders.
Somatoform disorders are psychological disorders that involve physical symptoms without a medical condition to explain them. They are more common in women than men. Throughout most of history, the cause was seen to be a wandering uterus, and it was called hysteria. The most recent change in the psychiatric community involves doing away with the many types of somatoform disorders and lumping them all under the umbrella term somatic symptom disorder.
After this lesson, you'll be able to:
- Realize what somatoform disorders entail
- Report on the historical background of somatoform disorders
- Know about the different somatoform disorders identified in the DSM-IV-TR
- Exchange ideas about the DSM-5's attempt to reclassify and combine somatoform disorders