Cognitive-Affective Neuroscience of Somatization Disorder and Functional Somatic Syndromes: Reconceptualizing The Triad of Depression-Anxiety-Somatic Symptoms

CNS Spectrums ◽  
2008 ◽  
Vol 13 (5) ◽  
pp. 379-384 ◽  
Author(s):  
Dan J. Stein ◽  
Jacqueline Muller
Keyword(s):  
Major Depression ◽  
Somatoform Disorders ◽  
Somatic Symptoms ◽  
Somatoform Disorder ◽  
Somatization Disorder ◽  
Affective Neuroscience ◽  
Depression And Anxiety ◽  
Functional Somatic Syndromes ◽  
Evolutionary Mechanisms ◽  
High Comorbidity

ABSTRACTSomatization disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders. Proposals have been made for revising the category of somatoform disorders, for simplifying the criteria for somatization disorder, and for emphasizing the unitary nature of the functional somatic syndromes in future classifications. A review of the cognitive-affective neuroscience of somatization disorder and related conditions suggests that overlapping psychobiological mechanisms mediate depression, anxiety, and somatization symptoms. Particular genes and environments may contribute to determining whether symptoms are predominantly depressive, anxious, or somatic, and there are perhaps also overlaps and distinctions in the distal evolutionary mechanisms that produce these symptoms.

Psychosomatic Findings in Musician Patients at a Department of Hand Surgery

2001 ◽  
Vol 16 (4) ◽  
pp. 144-151
Author(s):  
Claudia Spahn ◽  
Nikolaus Ell ◽  
Karin Seidenglanz
Keyword(s):  
Psychosocial Factors ◽  
Somatoform Disorders ◽  
Low Frequency ◽  
Somatic Symptoms ◽  
Decisive Role ◽  
Hand Surgery ◽  
Physical Symptoms ◽  
Somatoform Disorder ◽  
Minor Role ◽  
Depression And Anxiety

In the present study, the degree and frequency of symptoms of depression and anxiety as well as signs of somatoform disorders were ascertained in former musician patients of a department of hand surgery by means of standardized psychometric instruments. It was also the goal of the study to find out to what extent musicians seeking somatically oriented therapy ascribe significance to psychosocial factors regarding the etiology and the course of their ailments, and to what extent they feel psychologically stressed by their somatic symptoms. Sixty-nine musicians were evaluated. The results of the study showed a low frequency of significant ratings for depression and anxiety compared with clinical and nonclinical populations of nonmusicians, whereas there was a clear tendency toward somatization in the sample investigated. A fourth of the musicians had ratings compatible with those of psychosomatic patients, and can be classified as an at-risk group for a somatoform disorder. Three fourths of the musicians evinced a somatically oriented subjective ailment model. This means that, from their point of view, psychosocial factors play but a minor role in the etiology and the course of somatic symptoms. Three fourths of the musicians, however, stated in retrospective evaluation that they had felt psychologically stressed by their physical symptoms. All in all, the results suggest that psychosomatic aspects play a decisive role in somatic problems of musicians, and that it would seem particularly important for hand surgeons to take note of psychosocial aspects in the etiology and the course of their symptoms.

CS03-04 - Concept of somatoform disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 1777-1777
Author(s):  
H.-P. Kapfhammer
Keyword(s):  
Anxiety Disorders ◽  
Somatoform Disorders ◽  
Diagnostic Category ◽  
Somatic Symptoms ◽  
Somatoform Disorder ◽  
The Other ◽  
Critical Issues ◽  
Medically Unexplained ◽  
The One ◽  
Medically Unexplained Somatic Symptoms

Patients presenting with bodily symptoms and complaints that are not sufficiently explained by organic pathology or well known pathophysiological mechanisms present a major challenge to any health delivery system. From a perspective of psychiatric classification these medically unexplained somatic symptoms may be diagnosed as primary psychiatric disorders such as depressive and anxiety disorders on the one hand, as somatoform disorders on the other. Among medical specialties a separate diagnostic approach is taken to conceptualize functional somatic syndromes. Unfortunately, both diagnostic systems do not conform to each other very well.The concept of somatoform disorders as outlined in DSM-III to DSM-IV-TR and in ICD-10 refers to a group of heterogeneous disorders with prominent somatic symptoms or special body-focussed anxieties, or convictions of illness. These disorders seem to indicate medical conditions that cannot, however, fully be explained either in terms of medical diagnostics or of other primary psychiatric disorders. There is one major conceptual assumption that postulates a decisive impact of psychosocial stress on the origin, onset and/or course of these somatic symptoms and complaints. And there is one major path of diagnostic steps to be taken, i.e. just to count the number of medically unexplained somatic symptoms, to determine their reference to any main organ system, to prove that they are not self-induced, to put special stress on prevailing pain symptoms and to separately assess dominant health anxieties or illness convictions.Since introduction of the diagnostic concept of somatoform disorders there have been arising many critical issues regarding the soundness of this diagnostic category. These issues, among other things, refer to a problematic mind-body dichotomy overemphasizing psychosocial and psychological factors and neglecting major neurobiological processes, to the impracticable criterion of “medically unexplained”, to the demand of conceptual clarity and coherence of this diagnostic category, to the rather trivial diagnostic procedure of just counting the number of medically unexplained somatic symptoms whereas not assessing typical dimensions of illness behaviour in a corresponding way, to the major overlap between subgroups of somatoform disorders on the one hand and factitious disorders, anxiety disorders and depressive disorders on the other, to a principal focus on the epidemiologically rare condition of somatisation disorder as core disorder thereby undervaluing much more prevalent subthreshold conditions, to the difficult communication of the whole diagnostic group to medical colleagues dealing with the same problems by using a different conceptual approach, however.These critical issues surrounding the concept of somatoform disorder will be reflected in respect of some major revisions projected in future diagnostic classification systems of DSM-V and ICD-11.

scholarly journals Somatization: A Riddle Wrapped Up in an Enigma

2020 ◽  
Keyword(s):  
Somatoform Disorders ◽  
Medical Condition ◽  
Somatic Symptoms ◽  
Holistic Approach ◽  
Physical Symptoms ◽  
Somatoform Disorder ◽  
Anxiety And Depression ◽  
General Medical Condition ◽  
Detailed Evaluation ◽  
Psychiatric Conditions

A propensity to experience psychological distress and their expression in the form of somatic symptoms and to seek medical help for them is called Somatization. It is basically an inception of some psychiatric conditions like Affective Disorders (anxiety and depression) and Somatoform Disorders. A Somatoform Disorder is a category of mental disorder in which physical symptoms that suggest physical condition or injury cannot be explained fully by a general medical condition. This possibility must always be considered when patient has recurring somatic complaints for at least six months. Depression and Somatic Symptoms Disorder can easily be recognized when they present separately or in association with each other. But the main hurdle is to develop a holistic approach and strategy to not be misguided by the intimidating nature of presenting physical symptoms. For that detailed evaluation should be carried out and every single possibility along with somatization should be kept under consideration, which would enable to recognize and treat the illness earlier and save considerable amount of time and resources as well.

Somatization disorder and related disorders

2012 ◽  
pp. 999-1011
Author(s):  
Per Fink
Keyword(s):  
Clinical Picture ◽  
Essential Feature ◽  
Medically Unexplained Symptoms ◽  
Somatic Symptoms ◽  
Basic Mechanism ◽  
Somatization Disorder ◽  
Depression And Anxiety ◽  
Diagnostic Categories ◽  
Medically Unexplained ◽  
Unexplained Symptoms

The essential feature of somatization disorder and related disorders is that the patient presents multiple, medically unexplained symptoms or functional somatic symptoms. These physical complaints are not consistent with the clinical picture of known, verifiable, conventionally defined diseases, and are unsupported by clinical or paraclinical findings. The phenomenon of medically unexplained symptoms cannot simply be classified into one or a few diagnostic categories, but must be regarded as an expression of a basic mechanism by which people may respond to stressors as in the cases of depression and anxiety. Somatization disorder and related disorders must thus be considered to possess a spectrum of severity. In this chapter, the focus will be on the chronic and multisymptomatic forms.

scholarly journals Somatoform Disorders

Psychology ◽  
2013 ◽  
Author(s):  
Karl Julian Looper ◽  
Laurence J. Kirmayer
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Somatoform Disorders ◽  
Medical Condition ◽  
Diagnostic Category ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Somatoform Disorder ◽  
Somatization Disorder ◽  
Diagnostic Challenge

Around the world, physical symptoms are the most common manifestation of psychological distress. This seeming contradiction presents a diagnostic challenge for health care professionals who are consulted to provide treatment and illness management. In many situations, it is difficult to clearly identify the psychological cause of physical symptoms, and, at times, it is equally difficult to exclude the possibility of an underlying biomedical process. This clinical challenge has led to the construction of the diagnostic category of somatoform disorders, a group of psychiatric disorders characterized by the presence of physical symptoms causing significant distress or functional impairment that cannot be fully explained by a general medical condition, substance use, or any other mental disorder. This category of disorders was established based on clinical utility and the need to exclude medical causes in health care settings rather than on a theoretical model of psychopathology or shared etiology. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association 2000, cited under Classification), the somatoform disorders include somatization disorder, hypochondriasis, body dysmorphic disorder, conversion disorder, pain disorder, undifferentiated somatoform disorder, and somatoform disorder not otherwise specified. Some authors prefer other terminology, including use of the terms medically unexplained symptoms, emphasizing the uncertainty about diagnosis, or functional somatic syndromes, suggesting that symptoms are due to disturbances in the function of psychophysiological systems rather than structural or anatomical pathology.

Somatization disorder treated with electro convulsive therapy

2011 ◽  
Vol 26 (S2) ◽  
pp. 1569-1569
Author(s):  
M. Gahr ◽  
C. Schoenfeldt-Lecuona ◽  
B. Connemann
Keyword(s):  
Rating Scale ◽  
Somatoform Disorders ◽  
Behavioral Therapy ◽  
Somatic Symptoms ◽  
Somatization Disorder ◽  
Clinical Impression ◽  
Convulsive Therapy ◽  
Patient Reported ◽  
Before And After ◽  
Pain Symptoms

Electroconvulsive therapy (ECT) is predominantly being recommended for treatment of severe mood disorders and of catatonia. We report improvement with ECT in a patient suffering from somatization disorder.The patient, a 55-year-old man, suffered from intractable somatization disorder for more than thirty years. Numerous diagnostic and several futile surgical procedures had been performed in the past. On admission there had been no psychopharmacological therapy for one month. Subsequently treatment trials with duloxetine, mirtazapine, and venlafaxine were performed, but remained ineffective. Pregabalin lead to only slight amelioration of anxiety and no improvement of pain symptoms. After 3 months of unsuccessful clinical treatment, including pharmacotherapy, cognitive behavioral therapy, and regularly scheduled interdisciplinary medical consultations, ECT was first considered. A trial of right unilateral ECT was initiated. After five sessions the course had to be terminated due to severe ECT-related hypertension. During and following the ECT course, the patient reported rapid and significant improvement of somatic symptoms. In order to evaluate the effects of ECT the patient passed an assessment before and after the ECT (Hamilton Depression Rating Scale, Whiteley-Index, Quantification Inventory for Somatoform Syndroms, and an observer-rated version of the Screening for Somatoform Disorders). Assessment scores were in line with our clinical impression. Follow-up examination four months later showed no further change.Though somatic anxiety and hypochondriasis have been described to be negative predictors of successful remission with ECT, in our patient ECT has been particularly effective with regard to somatic symptoms of somatization disorder.

Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

2006 ◽  
Vol 11 (2) ◽  
pp. 1-3, 9-12
Author(s):  
Robert J. Barth ◽  
Tom W. Bohr
Keyword(s):  
Clinical Practice ◽  
Complex Regional Pain Syndrome ◽  
Somatoform Disorders ◽  
International Association ◽  
Pain Syndrome ◽  
Somatoform Disorder ◽  
Syndrome Type ◽  
Previous Issue

Abstract From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).

scholarly journals Factors related to age at depression onset: the role of SLC6A4 methylation, sex, exposure to stressful life events and personality in a sample of inpatients suffering from major depression

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simon Sanwald ◽  
◽  
Katharina Widenhorn-Müller ◽  
Carlos Schönfeldt-Lecuona ◽  
Christian Montag ◽  
...  
Keyword(s):  
Major Depression ◽  
Life Events ◽  
Depressive Disorders ◽  
Stressful Life Events ◽  
Depressive Symptomatology ◽  
Age At Onset ◽  
Stressful Life ◽  
Entire Group ◽  
Affective Neuroscience ◽  
Depression Severity

Abstract Background An early onset of depression is associated with higher chronicity and disability, more stressful life events (SLEs), higher negative emotionality as described by the primary emotion SADNESS and more severe depressive symptomatology compared to depression onset later in life. Additionally, methylation of the serotonin transporter gene (SLC6A4) is associated with SLEs and depressive symptoms. Methods We investigated the relation of SLEs, SLC6A4 methylation in peripheral blood, the primary emotions SADNESS and SEEKING (measured by the Affective Neuroscience Personality Scales) as well as depressive symptom severity to age at depression onset in a sample of N = 146 inpatients suffering from major depression. Results Depressed women showed higher SADNESS (t (91.05) = − 3.17, p = 0.028, d = − 0.57) and higher SLC6A4 methylation (t (88.79) = − 2.95, p = 0.02, d = − 0.55) compared to men. There were associations between SLEs, primary emotions and depression severity, which partly differed between women and men. The Akaike information criterion (AIC) indicated the selection of a model including sex, SLEs, SEEKING and SADNESS for the prediction of age at depression onset. SLC6A4 methylation was not related to depression severity, age at depression onset or SLEs in the entire group, but positively related to depression severity in women. Conclusions Taken together, we provide further evidence that age at depression onset is associated with SLEs, personality and depression severity. However, we found no associations between age at onset and SLC6A4 methylation. The joint investigation of variables originating in biology, psychology and psychiatry could make an important contribution to understanding the development of depressive disorders by elucidating potential subtypes of depression.

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