Somatoform dysfunction of the autonomic nervous system: bodily symptoms of a psychotic disorder

Somatoform dysfunction of the autonomic nervous system is a disease accompanied by signs of dysfunction of internal organs.
However, numerous examinations reject the presence of organic pathology: the condition is due to a psychogenic nature. Often the concept is replaced by the terms vegetative-vascular dystonia or neurocirculatory dystonia, which are not included in the official international medical classification. ICD-10 classifies somatoform dysfunction as a neurotic disorder, defining it with code F 45.3.

Formation mechanism

The autonomic nervous system is the main regulator of the activity of internal organs, blood vessels and glands. Therefore, this system is often called visceral. The ANS regulates the functioning of organs in accordance with changes in environmental conditions.

The autonomic system is represented by two departments: sympathetic and parasympathetic, which have mutually opposite effects:

• The sympathetic nervous system mobilizes the body's defense reactions, preparing it for vigorous activity. Intensifies metabolism, increases arousal;
• The parasympathetic nervous system restores wasted energy. Stabilizes the body's condition. Supports its work during sleep.

Both departments have opposite effects on internal organs.

The opposite influence of systems with balanced work helps to balance the condition of the internal organs. The ANS is not subject to human will. For example, we cannot make the heart stop beating. But vegetative activity is subject to the influence of stress factors. This is easy to check. Remember how your heart begins to “rumble” when you are scared. The mouth becomes dry, intestinal colic appears, and the urge to urinate increases. This activates the sympathetic department, mobilizing the body's protective resources.

The fear went away - the heart calmed down, breathing returned to normal. This is the merit of parasympathetics.

Problems begin when the activities of both departments are separated. There are several reasons for this imbalance:

• heredity;
• hormonal changes;
• chronic stress;
• powerful simultaneous stress impact;
• overwork;
• chronic intoxication;
• alcohol abuse;
• radiation;
• action of high temperatures.

Disharmony in the activity of the ANS triggers the formation of somatoform dysfunction of the autonomic nervous system. Vegetative control over organs decreases. Their work is disrupted, giving rise to painful symptoms, but there are no organic changes. The main reason is stress.

Somatic symptoms are a way of experiencing stressful situations at a physiological level. This was also discussed by Adler, who developed the concept of the symbolic language of organs. The theory said: organ systems specifically mirror mental processes.

Clinical manifestations

Patients with anxiety-hypochondriasis syndrome are so distressed by the idea that they are ill or may become ill that their hypochondriasis interferes with social and occupational functioning or causes significant discomfort. Patients may or may not have physical symptoms, but in the latter case they worry more about the possible consequences than about the symptoms themselves.

Some patients examine themselves repeatedly (eg, examine their throat in a mirror, check their skin for damage). They immediately begin to worry when any new somatic sensations appear. Some patients visit doctors frequently (a type of health care seeking); others - extremely rarely (type of avoidance of medical care).

The course of the disease is often chronic - variable in some, constant in others. Some patients recover.

General picture of the disorder

The main symptom of the disorder is the appearance of somatic symptoms affecting one or more organ systems.
The pathological manifestations are multiple, reminiscent of the clinical picture of a separate disease, but are characterized by blurriness, uncertainty, and rapid variability. A peculiarity of the presentation of complaints by patients is a special dramatism. Patients present symptoms emotionally vividly, exaggeratedly, using all kinds of epithets. They visit a huge number of doctors of various specialties and require examinations. When examinations refute the presence of physical pathology, the patient resists this news, is confident in the examination’s error and continues further vigorous diagnostic and treatment activities. Patients often spend years on “treatment” before a correct diagnosis is made.

Such people are quite sensitive to their own feelings, tend to exaggerate them, and often call an ambulance and are hospitalized. Numerous examinations and ineffective treatment fuel patients’ confidence in the presence of the disease. This situation causes distrust in individual specialists and medicine itself.

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Hypochondriacal disorder is a concern and fear of having a serious illness or the possibility of getting one. The diagnosis is considered confirmed if fear and symptoms (if present) persist for more than 6 months, despite a medical examination that excludes pathology. Treatment involves developing a trusting relationship between physician and patient; Cognitive behavioral therapy and SSRIs may also be effective.

Hypochondriacal disorder (hypochondriasis is a term no longer used in English due to its pejorative connotations) most often begins in early adulthood and appears to occur with equal frequency among men and women.

The patient's fears may arise from misinterpretation of non-pathological physiological symptoms or normal body functions (for example, rumbling or bloating, cramping discomfort, the feeling of one's own heartbeat, sweating).

Somatic symptoms of dysfunction

The main target organs of somatoform dysfunction are the heart, lungs, and digestive tract.

Frequent complaints are heart pain that is not clearly localized. Cardialgia is attributed to a different character: stabbing, cutting, aching, squeezing, pressing, “scorching.” The intensity is variable: from unpleasant to painful, depriving sleep. The pain can persist for several minutes or hours and affects the area of ​​the shoulder blade, arm, and right side of the chest.

The cause of pain is fatigue, anxiety, and weather changes. These appear after physical activity. This circumstance is important to take into account when differentiating VNS DM from angina pectoris, characterized by the appearance of pain during physical activity.

Cardialgia is accompanied by anxiety, restlessness, weakness, and lethargy. There is a feeling of lack of air, internal trembling, tachycardia, increased sweating.

You may feel a change in rhythm. Tachycardia is usually limited to 90-140 beats per minute, but is situational. It is provoked by changes in body position, drinking strong tea, coffee, alcoholic beverages or smoking. It goes away quickly. Often there is a feeling of fading, interruptions in the heart.

Pressure during somatoform dysfunction rises to reasonable limits, changes many times during the day, at night and stabilizes in the morning.

An indicative symptom of the respiratory system is shortness of breath, caused by a state of emotional stress. There is a pressing sensation in the chest. It's hard to take a breath. The patient experiences shortness of breath. Experiencing this, a person suffering from somatoform dysfunction constantly ventilates the premises and feels discomfort when being in closed spaces.

Patients are accompanied by frequent, shallow breathing, interrupted by periodic deep sighs. Attacks of neurotic cough occur.

Changes in the digestive system are characterized by:

• epigastric pain that occurs regardless of food intake;
• difficulty swallowing;
• stool disorder. The patient suffers from constipation or diarrhea;
• poor appetite;
• belching, heartburn, vomiting;
• improper salivation.

Somatoform dysfunction of the autonomic nervous system may be accompanied by hiccups, which are intrusive and quite loud.

VNS diabetes provokes urinary disorders. The urge becomes more frequent, and there is a need to empty the bladder in the absence of a toilet. Difficulty urinating in public toilets is typical.

Other signs of the disorder include low-grade fever, joint pain, fatigue, and decreased performance. Patients often suffer from insomnia, they become irritable and excitable.

It should be noted that the symptoms of somatoform dystonia are provoked by stress, nervous strain and are not caused by circumstances that cause the manifestations of an actual disease.

Somatoform dysfunction of the ANS has the following features:

• multiplicity of symptoms;
• non-standard nature of the symptoms shown;
• strong emotional reaction;
• discrepancy with the results of objective diagnostics;
• too intense severity of symptoms or, conversely, lack of brightness of symptoms;
• lack of response to standard provoking factors;
• futility of somatotropic therapy.

Somatization and chronic somatoform pain disorder

Somatized dysfunction, in addition to organ manifestations, causes a decrease in the functioning of analyzers: vision, hearing, touch, smell. Coordination of movements is impaired: patients become clumsy and have an unsteady gait. Movement disorders manifest themselves in the form of paresis and paralysis.

They describe failures in the functioning of internal organs colorfully and with charm. For example, my head hurts, as if a hoop was put on it and was gradually being squeezed. Or your stomach is swollen like a balloon.

Unlike a hypochondriac, who expresses anxiety about his health, such a patient responds more rudely and persistently. He is convinced that he is sick. And if the doctor tries to hint at the psychogenic nature of the disorder, he screams and is indignant, rejecting what was said, and demands additional examination. This patient is constantly dissatisfied and complains.

The course of the disease is chronic, with wide variability of symptoms that persist for 2 years or more.

Often, a person, due to his anxiety and aggressiveness, experiences social maladjustment and family conflicts.

A pain disorder is distinguished by the presence of severe, debilitating pain that occurs for no reason. Usually it has a clear localization - the stomach, the heart. The pain characteristics do not change, there are no other symptoms.

During somatoform dysfunction, an undifferentiated disorder is also distinguished. With it, a person suffers all the typical symptoms of the disease, but it is not possible to classify them into any known group.

Associated mental disorders

Somatoform dysfunction is accompanied by other mental disorders.

The disease is often accompanied by phobic disorders . Characterized by fear of death, agoraphobia, cancerophobia, fear of blushing.

Panic attacks are an extremely common companion to the disorder. It is caused by a state of extreme fear and emotional stress. Characterized by an increase in the intensity of symptoms of the disease. It often provokes the development of depersonalization, fear of loss of consciousness, madness, and death.

Generalized anxiety disorder causes extreme tension, anxiety, and fears about the future. In addition to the characteristic manifestations of the disease, it contributes to the development of ideological and emotional phenomena. Worried about dizziness, weakness, feeling of lightheadedness. It is possible to develop derealization, when existing objects seem unreal, as well as depersonalization. The individual becomes hypersensitive, reacts sharply to extraneous stimuli, expecting danger.

Autonomic dysfunction: main types

The following types of autonomic dysfunction are distinguished (not to be confused with vegetative-vascular dystonia (VSD), which is only a manifestation of a number of diseases of the nervous system and other organs):

• Somatophoric disorder . This is a neurosis that manifests itself in the form of symptoms of chronic diseases that the patient does not have. Panic attacks, coughing attacks and shortness of breath of psychogenic origin, digestive problems, periodic dizziness, etc. are possible. This type of dysfunction in most cases is caused by severe or prolonged stress, so it is quite easy to treat.
• Violation of subcortical structures . Damage occurs as a result of previous brain injuries or residual pathology of the central nervous system (often diagnosed in children). The disease is characterized by low blood pressure, fainting, diarrhea and frequent urination.
• Irritation of peripheral autonomic structures , provoked by damage to the sympathetic cervical plexus or urolithiasis.

Autonomic dysfunction, which affects about 70% of adults and 25% of children, always indicates the presence of problems in the body, which means it is a serious reason to consult a specialist. The effectiveness of the prescribed treatment largely depends on the timely making of the correct diagnosis. You can make an appointment with a pediatric neurologist in Ufa by phone.

Treatment

• Cognitive behavioral therapy

Even those patients who have established a trusting relationship with their attending physician should be referred to a psychiatrist for consultation. Pharmacological treatment of comorbid psychiatric disorders (eg, depression) may help; however, psychotherapy, especially cognitive behavioral therapy, is needed first.

Patients also benefit from having a positive relationship with their primary care physician, who coordinates care, suggests ways to relieve symptoms, monitors them regularly, and protects them from unnecessary tests and procedures.

Clinical manifestations

Recurrent somatic complaints usually begin before age 30; Most patients have multiple physical symptoms, but some have only one major symptom, usually pain. Symptoms vary in severity, but they persist and long-term remission is rare. Symptoms or excessive concern about them cause serious discomfort or interfere with the patient's daily life. In some cases, overt depression may develop.

When a psychosomatic disorder accompanies a physical illness, patients become excessively anxious about the consequences of this illness; for example, patients who have fully recovered physically from an uncomplicated myocardial infarction may continue to act sick or constantly fear another infarction.

Whether the symptoms are related to a physical illness or not, patients become overly anxious about these symptoms and their potentially catastrophic consequences, and can be very difficult to reassure. Attempts to reassure are often perceived as the doctor not taking the symptoms seriously.

Fears about one's health often take a central place in the patient's life, and sometimes begin to play an all-consuming role. Patients are very concerned about their health and are often unusually sensitive to the side effects of medications.

This disorder can affect any part of the body, and the symptoms and prevalence of the disorder vary across cultures.

Regardless of presentation, the essence of a psychosomatic disorder is the patient's disproportionately intense or maladaptive thoughts, feelings, or behaviors in response to symptoms.

Patients may become dependent on others for help, emotional support, and may become angry when their needs are not met. They may also threaten or attempt suicide. Patients are often dissatisfied with the quality of medical care, they usually switch from one doctor to another or see several doctors at once.

The intensity and persistence of symptoms may reflect their strong need for care. Symptoms enable patients to shirk their responsibilities, but also reduce quality of life and act as a punishment, causing feelings of inferiority and guilt.