The Psychosomatic diseases Are physical illnesses that arise from stress, psychological or psychiatric disorders. It is most commonly applied to diseases in which a physical anomaly or other biomarker has not yet been identified.
In the absence of"biological"evidence of an underlying disease, it is often assumed that the disease must have a psychological cause, even if the patient shows no signs of being under stress or having a psychological or psychiatric disorder.
There are problems with the assumption that any medically unexplained disease must have a psychological cause. There may be genetic, biochemical or electrophysiological abnormalities that may be present but we do not have the technology to identify them.
People who have a psychosomatic disorder, currently referred to as somatic symptom disorders and related disorders in DSM-5, often suffer much social misunderstanding, since this type of disorder is characterized by people suffering physical conditions that are not the consequence of any medical problem.
Because of the nature of this disorder, the relatives and acquaintances of the patient usually think that he is inventing the symptoms, that he is exaggerating and that nothing really happens to them.
But, far from the truth, psychosomatic reactions and symptoms are real and it is necessary to go to the doctor to diagnose and treat it in an appropriate way.
List of 5 major psychosomatic diseases
1- Somatic symptom disorder
People who suffer from this type of disorder often have several physical symptoms that cause discomfort and prevent them from carrying out the tasks of daily life that previously carried out. The symptoms they suffer are not explained by any medical illness.
The majority of people formerly diagnosed with hypochondria Would now fall within this category.
Symptoms can be general or specific and, at times, normal sensations (such as feeling hungry) or symptoms of mild illness (such as a cold) are sometimes identified as symptoms. The most common symptom in patients suffering from this disorder is pain.
The physical symptoms they suffer do not have a medical explanation, but this does not mean that the disorder is unreal or that the person is"inventing"it. The suffering of people suffering from this disorder is real therefore it is important to diagnose and treat it.
The fact that the person suffers a medical illness does not exclude the diagnosis of somatic symptom disorder, provided that the disease does not explain the symptoms suffered.
For example, a person suffers from a mild myocardial infarction that leaves no sequelae, a week later begins to experience somatic symptoms such as chest pain or paralysis, these symptoms are not caused by myocardial infarction, but cause significant discomfort, Therefore, the person would be diagnosed with a somatic symptom disorder.
People with this disorder have to be very concerned about the symptoms they suffer and about overall health. Identifies these symptoms erroneously as threatening, harmful or annoying and is very pessimistic about their health, thinking that something happens to them even when the evidence indicates that they are physically healthy.
These types of people often go to the doctor often, often seeking a second opinion from several doctors.
This does not help the person because he still thinks that something bad happens to him, even if they tell him the opposite, besides the fact to carry out many diagnostic tests and the taking of medicines can aggravate the symptoms that he feels.
Diagnostic criteria (according to DSM-5)
- One or more somatic symptoms that cause discomfort or lead to significant problems in daily life.
- Excessive thoughts, feelings, or behaviors related to somatic symptoms or associated with health concerns, as evidenced by one or more of the following:
- Disproportionate and persistent thoughts about the severity of the symptoms themselves.
- Persistently high degree of anxiety about health or symptoms.
- Excessive time and energy devoted to these symptoms or concern for health.
- Although some somatic symptoms may not be continuously present, the symptomatic state is persistent (usually more than six months).
Specify
With predominance of pain (Formerly painful disorder): this specifier applies to individuals whose somatic symptoms mainly involve pain.
Specify
Persistent: A persistent course is characterized by the presence of intense symptoms, significant alteration and prolonged duration (more than six months).
Specify The current gravity:
Mild: Only one of the symptoms specified in Criterion B is met.
Moderate: Two or more of the symptoms specified in Criterion B are met.
Serious: Two or more of the symptoms specified in Criterion B are met and there are multiple somatic complaints (or a very severe somatic symptom).
2- Disease Anxiety Disorder
The disease anxiety disorder involves an excessive concern to suffer a serious illness, although no symptoms are felt or the symptoms that are suffered are light. Some of the people previously included in the hypochondria criterion
People who suffer from this disorder often go to the doctor frequently and have medical tests in which there are no indications that the individual suffers from any condition that may explain their concern.
Unlike somatic symptom disorder, anguish Of people suffering from this disorder is not caused by symptoms, but by an irrational belief that one is suffering from a disease.
Sometimes they report symptoms, but these are normal physical sensations (eg, dizziness) or discomfort that can not be associated with a serious illness (eg, belching).
These types of people are often easily alarmed when they hear that someone around them has become ill or some health news (eg, that they are experiencing illnesses such as Ebola).
Diagnostic criteria (according to DSM-5)
- Concern about suffering or contracting a serious illness.
- There are no somatic symptoms or, if they are present, they are only mild. If there is another medical condition or a high risk of a medical condition (eg, a significant family history), the concern is clearly excessive or disproportionate.
- There is a high degree of anxiety about health, and the individual is easily alarmed by his state of health.
- The individual has excessive health-related behaviors (eg, repeatedly checks on his or her body for signs of illness) or has avoidance due to maladaptation (eg avoid visits to the clinician and hospital).
- Concern for the disease has been present for at least six months, but the specific feared disease may vary over that period of time.
- Concern about the disease is not best explained by another mental disorder, such as a somatic symptom disorder, a panic disorder, a generalized anxiety disorder, a body dysmorphic disorder, an obsessive-compulsive disorder or a somatic-type delusional disorder .
Specify
Type with request for assistance: Frequent use of medical care, which includes visits to the clinician or tests and procedures.
Type with avoidance of attendance: Medical care is rarely used.
3- Conversion disorder
Conversion disorder, also called functional neurological symptom disorder, is characterized by the presence of one or more symptoms that are usually motor or sensory that can not be explained by a physiological illness.
Within the group of motor symptoms are weakness or paralysis, abnormal movements (such as tremor or dystonias), changes in gait and abnormal posture of the limbs.
The sensory symptoms that can be found are related to the alteration or absence of the sensitivity of the skin, the sight or the ear.
People who suffer from this disorder may have seizure-like episodes or epileptic coma.
Other frequent symptoms are the reduction or absence of voice volume (dysphonia / aphonia), altered joint (dysarthria), the sensation of a lump in the throat (balloon) or double vision (diplopia).
Diagnostic criteria (according to DSM-5)
- One or more symptoms of impaired motor or sensory function.
- Clinical findings provide evidence of the incompatibility between the symptom and recognized neurological or medical conditions.
- The symptom or deficiency is not best explained by another medical or mental disorder.
- The symptom causes clinically significant discomfort or impairment in social, occupational, or other important areas of functioning.
Coding note: The code CIE-9-MC for conversion disorder is 300.11 , Which is assigned regardless of the type of symptom. The ICD-10-MC code depends on the type of symptom (see below).
Specify The type of symptom:
(F44.4) With weakness or paralysis
(F44.4) With abnormal movement (Eg, tremor, dystonic movement, myoclonus, gait disorder)
(F44.4) With symptoms of swallowing
(F44.4) With symptoms of speech (Eg, dysphonia, poor articulation)
(F44.5) With seizures or seizures
(F44.6) With anesthesia or sensory loss
(F44.6) With special sensory symptom (Eg, visual, olfactory or auditory impairment)
(F44.7) With mixed symptoms
Specify
Acute episode: Symptoms present for less than six months.
Persistent: Symptoms for six months or more.
Specify
With psychological stress factor (Specify stress factor)
No psychological stress factor.
4- Psychological factors that influence other medical conditions
The main characteristic of this disorder is the presence of at least one psychological or behavioral factor that produces clinically significant damage and that influences a medical condition making it worse and increasing the likelihood of suffering a disability or even death.
Among the psychological factors that can affect are psychological distress, patterns of interpersonal interaction, coping styles and some maladaptive behaviors such as denial of symptoms or little or no adherence to medical therapy.
Anxiety is one of the psychological factors that most commonly negatively affects medical illness. Anxiety can aggravate diseases such as asthma, cardiovascular disease or stomach conditions.
Diagnostic criteria (according to DSM-5)
- Presence of a medical symptom or condition (other than a mental disorder).
- Psychological or behavioral factors that negatively affect the medical condition in one of the following ways:
- Factors have influenced the course of medical condition as evidenced by a close temporal association between psychological factors and development or exacerbation or delayed recovery from medical condition.
- Factors interfere with the treatment of the medical condition (eg, poor compliance).
- Factors constitute other well-established risks to the health of the individual.
- Factors influence the underlying pathophysiology, because they precipitate or exacerbate symptoms, or need medical assistance.
- Criterion B's psychological and behavioral factors are not best explained by another mental disorder (eg, panic disorder, major depressive disorder, post-traumatic stress disorder).
Specify The current gravity:
Mild: Increases medical risk (eg, inconsistency with compliance with antihypertensive treatment).
Moderate: The underlying medical condition worsens (eg, anxiety that worsens asthma).
Serious: It gives rise to the hospitalization or visit to the emergency department.
Extreme: It produces an important life threatening hazard (eg, ignoring symptoms of a heart attack).
Factitious disorder
People who suffer from this disorder simulate medical or psychological signs or symptoms, in themselves or in others. Usually, they go to the doctor to"treat"the conditions that they supposedly have.
Some methods that these people often use are exaggeration, simulation or even injury. For example, they could simulate eating disorder symptoms by not eating their family's delta, but they could sneak in or could falsify laboratory tests.
Diagnostic criteria (according to DSM-5)
Factitious disorder applied to self:
- Falsification of physical or psychological signs or symptoms, or induction of injury or illness associated with an identified deception.
- The individual presents himself to others as ill, incapacitated or injured.
- Misleading behavior is evident even in the absence of an obvious external reward.
- The behavior is not best explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Specify:
Single episode
Recurring episodes (Two or more events of disease falsification and / or induction of injury)
Factitious disorder applied to another (before: Factitious disorder by proxy)
- Falsification of physical or psychological signs or symptoms, or induction of injury or illness in another, associated with an identified deception.
- The individual presents another individual (victim) to others as ill, disabled or injured.
- Misleading behavior is evident even in the absence of obvious external reward.
- The behavior is not best explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Note: The diagnosis applies to the perpetrator, not the victim.
Specify
Single episode
Recurring episodes (Two or more events of disease falsification and / or induction of injury).
Others
Another disorder of specified somatic symptoms and related disorders
This category encompasses all clinical settings in which somatic symptoms predominate and cause clinically significant discomfort or deterioration in important areas of the patient's life (social, work-related deterioration...) but do not meet all the necessary criteria to diagnose any Of the above disorders.
Some examples of this type of disorders are the following:
- Brief Somatic Symptom Disorder: The duration of symptoms is less than six months.
- Brief Anxiety Disorder: The duration of symptoms is less than six months.
- Disease-related anxiety disorder without excessive health-related behaviors: Criterion D for disease anxiety disorder is not met.
- Pseudociesis: False belief of being pregnant that is associated with signs and symptoms of pregnancy.
When it is not possible to perform a more specific diagnosis, the category Disorder of somatic symptoms and relationship disorders Not specified.
References
- (2015). Diagnostic and Statistical Manual of Mental Disorders DSM-5. Washington: APA.
- DeAngelis, T. (s.f.). When symptoms are a mystery . Obtained from APA.
- Gea, A. (s.f.). Psychosomatic disorders . Recovered on May 20, 2016, from COP.
- Safarti, Y., & Kipman, A. (2012). Somatizations. Treaty of Medicine, 16 (3), 1-8. Doi: 10.1016 / S1636-5410 (12) 61928-X