Somatoform Disorders - Science topic

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Maybe my papers presented in Research Gate might be helpful. In particular my last paper might be useful. I agree with Martin L Pall

As ever when this topic is discussed hackles go up about the use of different terms. Typically the phrase ‘psychosomatic’ is understood to mean that conditions are generated psychologically without physiological basis but a unity of the words psyche and soma should mean just that – recognising the role of psyche in somatic symptoms and distress. Nahal is right to say that nearly all physical conditions have psychological components to them, but the use of phrases such as ‘psychosomatic’ tend to be reserved for conditions where psychological factors are discernible. In the UK, medical practitioners opt for alternative phrases such as ‘functional symptoms’ or ‘persistent physical symptoms’ in part to recognise that these are nonetheless real physical symptoms.

In many cases psychological factors are not merely secondary to physiological factors and the evidence base already exists. Conditions such as fibromyalgia and irritable bowels have been associated frequently with higher incidences of childhood adversity, highly stressful life events, and present stress and anxiety. Psychological stress stimulates release of hormones including cortisol, known to inhibit various aspects of immune activity. Hence we can often become susceptible to colds and bugs because we’ve got tired and run down. Depression can have tangible physical symptoms such as constipation, interruption in menstrual cycle, and loss of libido.

And in addition to observed physiological incidence of symptoms, our mental state can determine how we interpret physical sensations, and indeed how intensely we experience them. Psychological factors are often not just downstream consequences of physiological distress but implicit in the generation and experience of that distress. I know in my experience as a practitioner that my client’s somatic symptoms ‘flare up’ in certain scenarios that are stressful to them, and I know this personally as a sufferer of chronic pain.

The point being that conditions should be neither ringfenced as psychological or physiological but that all our life systems, including our central nervous system, are involved in the maintenance of health and disruptions to one system have influences over the others.

There are a lot of reasons of recurrent syncope.

Actually, the diagnostic role of Tilt table test is now not clear.

In my opinion, Implantable event recorder should be preferred test in the Tilt negative recurrent syncope. 

Hypothyroidism may delay the emergence

Dear Aniko Huizer-Pajkos or Pajko,

concerning pain in a case of arthritis, you will find nociceptive signs and it is evident, that the nervous system ist  n  o  t   affected, for there is no lesion of the PNS/ZNS. So It's more difficult to diagnose cases of " mixed pain"  (nociceptive spondylarthrosis + neuropathic radiculopathy)  or even pure neuropathic pain (trigeminus neuralgia).  In my opinion, we have to underline the importance of pain symptoms and signs, realizing objective and subjective phenomena in  most cases of "low back pain", Zoster neuralgia and complex regional pain syndrome. There are no "somatoform" signs, I agree with you in this point. But how do you classify the rest of all, the  big group of dissociative disorders and the so called Medical unexplained physikal symptoms (MUPS)?

I have a degree in Physiology and Psychology. I have a great problem with the entire concept of somatisation. How can anyone guarantee that the symptoms are not due to an organic disease? There are many rare illnesses during which the patient deteriorates slowly over many years and experiences many symptoms and which require specific tests for diagnosis. Examples include Addison's Disease and many autoimmune conditions. In addition there are many rare illnesses that we do not yet know about but do exist.

Is it ethical to treat a patient as having a somatisation disorder especially as the "cure rate" is negligible? In my opinion it is highly irresponsible of physicians, psychologists and psychyatrists to stop looking for an organic cause and taking the chance of treatment away from the patient, especially as at the end a patient may  even die. However, as this could occur years down the track and the cause would appear unrelated, no one would think that the diagnosis of somatisation disorder in fact stopped the patient from receiving adequate medical care.

In conditions like Addison's disease and in autoimmune conditions where a lot of conditions overlap the patient presents with numerous complaints that can be explained once a diagnosis is found.

I especially despair for the patients who do suffer from psychological and/or psychyatric complaints as they will never get the benefit of a proper work up.

I think it is time to re-think whether somatisation really exists and it is also crucial to address how such a diagnosis impacts on the patient psychologically and socially. In my opinion the patient will never get a proper work up as it would be easier for the doctor to go along with the somatisation diagnosis especially if they are worried about being ridiculed for believing that the patient indeed has an organic illness. 

I really would like someone to explain to me how a limited number of tests, especially non-specific tests for a condition can exclude an organic cause for the patient's symptoms. 14 years ago I was diagnosed with Addison's disease, polymyositis and vasculitis and with many allergies and I had practically every symptom possible before my diagnosis that took about a year only because of my knowledge of physiology and  supportive doctors. Now I have small airways and almost died a year ago because due to ignorance and arrogance it was easier for the attending doctor to put the hyperventilation down to psychological causes and not considering neuromuscular, lung and heart causes (neuromuscular patients can hyperventilate due to various organic causes). And this is my point exactly. Why should patients suffer just because certain doctors etc think that they know everything. I think with complicated medical cases the results should be reviewed by researchers who studied physiology and see how the puzzle pieces fit together.

That's absolutely correct Dr. Rooban. But to refer such patients for specific trained professionals, we need to access that whether those patients have relevant psychosomatic issues associated or not. That's what is required. Proper training of dental professionals is required so that they can effectively and efficiently access and diagnose such patients. As you have said, the training in psychology is already there in several dental curriculum's seen worldwide. The same must be instituted in indian dental curriculum too.

Kind regards,

Dr. Deepak Gupta