Somatoform disorder of the nervous system: debunking the myth of malingering

Everyone in their circle of friends has a person who constantly complains about their health: they have a stabbing pain, they are sick, or they simply don’t feel well. But no matter how many times he goes to doctors, no one finds a specific reason for this condition. He’s pretending, we think. But don't rush to conclusions. These symptoms may be a sign of a somatoform nervous system disorder. It does not have an organic background, but leads to a mental imbalance of the individual.

Why does the disorder develop?

Somatoform disorder is a disease of a psychological nature in which the symptoms of damage to internal organs are functional, not organic.

Such dysfunction is detected in 0.5% of the world's population, and it affects mainly women. The reason lies, first of all, in the psychological state of a person.

The first group of factors influencing the occurrence of the syndrome is heredity and character traits. For example, people with asthenoneurotic and hysterical types of character are more likely to develop it. They are characterized by hypersensitivity, timid or demonstrative behavior. Such people are characterized by rapid nervous exhaustion; as a rule, they are pessimistic.

The second group is psychogenic traumatic external influences. These include acute stress factors, when a powerful psychological blow at once leads to a disorder of nervous activity. This could be the loss of a loved one, a decrease in social status, or a situation of severe fear.

Chronic stress occurs as a result of systematic mental and physical overstrain, lack of positive emotions, unmet needs and excessive demands on oneself.

It is worth noting that somatoform disorder very often develops in people who are emotionally stingy, hide their feelings, and do not know how to express them. And since emotions need a way out in any case, they find it in this unique way. A similar state can accompany members of religious families, where an atmosphere of strict morality reigns.

Other factors that provoke the disorder include complicated pregnancy, trauma, infections, and some somatic diseases.

Signs of illness

Symptoms of somatoform disorder are quite varied and manifest themselves in malfunctions of almost all body systems.

As a rule, several symptoms associated with different systems occur simultaneously.

There are the following types of this disorder:

• hypochondriacal;
• somatized;
• somatoform dysfunction of the autonomic nervous system (SDVNS);
• chronic somatoform pain disorder;
• undifferentiated somatoform disorder.

Patients with somatoform dysfunction are distinguished by several features. This includes a peculiar, emotional or overly specific narrative about one’s condition. For example, a man comes to a cardiologist with pain and discomfort in his heart. But at the same time, he speaks not only about their character, but also about the fact that they cause him a lot of inconvenience. Such attacks occur at work, at the moment when he is supposed to make a report on his achievements. As a result, he cannot concentrate, paying all attention to his heart.

The reason here is this aspect: perhaps the man is psychologically not ready to talk about his work (for example, due to his failures), and the heart is assigned to the extreme. And it is precisely this that reacts to this stressor in order to divert attention from it.

Other distinguishing features are:

• exaggeration of pathological sensations;
• denial of the role of psychological factors in their development;
• increased irritability towards others.

Autonomic dystonia syndrome

Autonomic dystonia syndrome is all forms of disturbance of autonomic regulation, most often secondary manifestations of various pathologies.

There are 3 forms of SVD:

• psychovegetative – a feeling of tightness in the chest, changes in heartbeat, stomach pain, frequent vomiting, headache, dizziness, neuralgia of various locations, problems with urination, increased sweating, changes in the menstrual cycle, feeling cold;
• peripheral autonomic failure syndrome - (see autonomic failure);
• angiotrophalgic - vascular (marbling of the skin, redness, pallor, cyanosis, feeling of numbness, tingling), trophic (peeling and thinning of the skin, spots of pigmentation or depigmentation, ulcers, more often in the area of ​​​​the hands and feet, brittle nails) and painful manifestations (paroxysmal prolonged pain , having a shooting, aching, burning, tingling, etc. character.

Hypochondriacal dysfunction

Hypochondriacal disorder is characterized by a person's extreme concern about his or her health. He is sure that he is developing a severe, sometimes fatal disease. But their types may vary from case to case. One time the patient thinks that he has cancer, another time it is a severe heart pathology, etc.

The degree of sensation also changes. Either it seems to the individual that he is on the verge of death, then the manifestations become quite bearable.

It has been established that about 14% of patients visiting doctors of various specialties suffer from hypochondria. Most often it occurs in childhood and adolescence, as well as in mature people.

Basically, the patient is accompanied by the following symptoms:

• from the cardiovascular system - pain in the heart, disruptions in its functioning. The patient's conclusion is heart defects, heart attack;
• from the digestive system - abdominal pain, diarrhea, constipation. Conclusion – stomach and intestinal cancer;
• on the part of the excretory system – fear of uncontrolled urination, and therefore patients even limit leaving the house. Pain in the lower abdomen.

Important criteria for recognizing pathology are the presence of senestopathies and mood disorders.

Senestopathies are manifested by unusual and painful tactile sensations. This may be itching and burning, a feeling of cold, compression and constriction, pulsation of blood in the vessels, twisting, displacement and other similar phenomena.

Mood disorders manifest themselves in increased anxiety, sadness, melancholy, and a feeling of hopelessness. Patients focus only on themselves, and do not hear others at all. At the same time, they believe that no one needs them, everyone has abandoned them.

Such people systematically seek help from doctors. And if a specific disease is not found, they insist on re-examination.

The following nuances will help determine pathology:

• constant belief that a person has a serious illness, often with other concomitant illnesses. And even numerous normal examination results cannot convince them;
• lack of trust in doctors, despite their regular visits;
• the activity of such a patient is not aimed at alleviating the condition, but at confirming the presence of a progressive pathology;
• constant concentration on your illness;
• independent diagnosis.

As hypochondria worsens, it can develop into a paranoid state or hypochondriacal depression.
The diagnosis of hypochondriacal disorder is made when schizophrenia and schizotypal disorders, bipolar affective disorder are excluded.

Hypochondriacs are often found among famous people. Actor and director Woody Allen is one of them. One day, his illness saved him from food poisoning. The entire crew ate pizza, which only he refused due to concerns about his health. As a result, everyone except him developed an eating disorder.

Diagnostics

• Clinical assessment

The diagnosis of an anxiety disorder is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), including the following:

• The patient is concerned about the fear of having a serious illness or the possibility of getting one.
• Patients have no or minimal physical symptoms.
• The patient is extremely concerned about his health and easily becomes worried about personal health problems.
• The patient constantly checks the health status or inadequately avoids following doctor's orders and hospitals.
• The patient has been consumed by the disease for ≥ 6 months, although specific concerns about the disease may change during this period of time.
• The symptoms are not consistent with those of depression or another mental disorder.

Patients who have severe physical symptoms and who are primarily concerned about the symptoms themselves are diagnosed with a psychosomatic disorder.

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.

How is the treatment carried out?

The basis of the rehabilitation course includes both taking medications and periodic work with a psychiatrist.

Patients are prescribed the following groups of drugs:

— Tranquilizers with sedative effects (for example, phenazepam); — Antidepressants that improve emotional state and neutralize the state of apathy; - Neuroleptics (for example, Sonapax), which block the feeling of panic and anxiety; - Beta blockers (for example, propranolol), which neutralize trembling, sweating and other manifestations of autonomic manifestations.

Somatoform dysfunction of the autonomic nervous system

The syndrome develops when there is a malfunction of the autonomic nervous system, which controls the functioning of internal organs, blood vessels, and is responsible for the course of physiological processes and the mobilization of the body as a whole.

The ANS consists of 2 sections: parasympathetic and sympathetic.

The sympathetic nervous system increases the heart rate, constricts blood vessels and increases blood pressure. Increases sweating and slows down intestinal motility. It relaxes the bladder, dilates the bronchi and pupil. Sympathy speeds up metabolism and activates the body as a whole.

The parasympathetic system has the opposite effect. But, despite the opposition of departments, normal well-being of a person is ensured by their coordinated work. Any malfunctions in the functioning of both systems cause various pathological sensations and syndromes, in particular, somatoform dysfunction.

There are 3 types of disorders:

• with a predominance of sympathy;
• with a predominance of parasympathetics;
• mixed.

According to the flow, stable and paroxysmal, with vascular and other types of crisis are distinguished.

Pathology can be primary, that is, it develops on its own, or secondary, after previous illnesses. Its symptoms manifest themselves under the influence of a psychotraumatic factor.

Such patients are characterized, first of all, by the appearance of vegetative signs: severe sweating, tremors of the limbs, paleness and redness of the skin.

Another group of signs expresses the dysfunction of internal organs under the control of the ANS:

• cough, shortness of breath, laryngeal spasm;
• tachycardia, arrhythmia, blood pressure changes. Heart pain does not have a clear localization and can be of various types. It happens that they are accompanied by a feeling of anxiety or fear. They are worse at rest, but go away during physical activity. Lasts from a few minutes to several days. Heart symptoms are so believable that they sometimes confuse even specialists;
• abdominal pain, bloating, difficulty swallowing; “bear disease” - diarrhea under the influence of stress;
• difficulty urinating, urinary incontinence;
• headaches, fatigue, poor sleep.

The complaints are numerous, but lack specifics. They signal a disruption in the functioning of several organs at once.

Patients are concerned about their condition, but still not to the same extent as hypochondriacs. They strive to find a way out of the situation and receive adequate treatment.

SDVNS in children

Often, somatoform autonomic disorder appears in children at puberty, that is, during the period of maturation. This is due to a hormonal surge and intensive growth of the body.

The following factors can provoke the process:

• heredity;
• stress;
• mental, physical stress;
• infections;
• bad habits;
• surgical interventions;
• large body weight;
• sedentary lifestyle;
• staying at the computer for a long time.

The appearance of teenagers is typical. If sympathy predominates, then the skin of such children is moist and oily, with acne. She alternately turns red and pale. A bluish tint appears. Cold, with a marbled pattern called a vascular necklace. When pressed with a finger, the skin turns pale and red dermographism is observed.

When parasympathetics dominate, the skin is dry, with pink or white dermographism. These children have an increased appetite, but they do not gain weight.

The disorder is accompanied by a sudden rise in temperature under the influence of stress. A typical occurrence is fainting.

All characteristic changes in internal organs are present.

The psycho-emotional sphere is also undergoing changes. Such a child becomes distracted and nervous. He quickly gets tired, drowsiness and apathy appear, and his memory deteriorates.

In most cases, the course of the disease is stable. But periodically panic attacks and crises occur:

• sympatho-adrenal - accompanied by tachycardia, elevated blood pressure, headaches, thirst, chills and hyperthermia. Anxiety and feelings of fear develop;
• vagoinsular – migraine-like attacks, nausea, vomiting, pain in the abdominal area. Hyperhidrosis, decreased blood pressure and fainting, slow heart rate, increased urine output, breathing disorders;
• mixed.

The attack can last up to several hours.