Bodily Harm: Recognizing and Treating Somatoform Disorders

Isla had always been healthy, even remarkably so. At age 24 she had never taken a sick day in her life, never had surgery, never been diagnosed with anything more than a cold. But in the fall of 2011, that changed. One evening, she was overcome by pelvic pains that left her doubled over and faint. “When it originally happened I assumed they were just really bad ovulation cramps and they went away within a few hours so I didn’t think to go to the doctor,” she tells me. But while the pains were occasional at first, soon she was unable to leave the house or even her bed for days at a time due to the excruciating pain. “My doctor was told me it was probably either a side-effect from my IUD or endometriosis, so she removed the IUD and scheduled me for an ultrasound.” But the pains persisted despite the IUD removal and nothing turned up on the ultrasound. “At that point I wasn’t that worried because ultrasounds don’t always detect symptoms of endometriosis. I scheduled laparoscopic surgery as soon as possible because I just wanted to get a diagnosis, start treatment, and move on with my life.” The surgery turned up nothing. In the year that followed, Isla would consult more doctors than she could count and undergo test after test as her ability to participate in everyday life diminished daily. Her test results were always normal, but her lived experiences were anything but. “I was taking painkillers and muscle relaxants that did nothing, I couldn’t make plans to go out with friends because chances were that I’d be in too much pain to do anything, I had to work from home because I couldn’t go to an office regularly, I couldn’t have sex because it was so uncomfortable. At first I was so hopeful and thought, ‘This will be the thing that fixes everything!’ every time I went to a new doctor, but after a while I couldn’t even let myself hope anymore because it was too depressing to be let down every time.”

After over a year of fruitless searching for answers, Isla had almost given up. Then she went for a routine physical with a new GP. “I had to do a full intake interview with the nurse and one of the questions was if I had ever experienced any form of childhood abuse. It was the first time any medical professional had asked.” Isla had been sexually abused from ages 11 to 14. She had never received treatment for her trauma, and led what she considered a relatively psychologically healthy life—she didn’t think the abuse affected her. Her new doctor suspected she might be wrong about that. “She told me that my pain might be a kind of Somatoform Disorder called Pain Disorder. Instead of my emotional pain coming out as depression or anxiety or PTSD, it transformed into physical pain. As soon as she said it, everything made sense.”

The Mind-Body Connection

In Western culture, the mind and body are often thought of as discrete entities that happen to occupy the same physical housing unit. But our psychological and somatic selves are in fact intimately connected and have a complex, reciprocal relationship that many of us only become aware of in short bursts, such as the nausea that arises before a public speaking engagement or the trembling that may accompany great fear. However, for some, physical expressions of psychological states are more than normal, momentary blips, and become enduring, debilitating somatic symptoms or preoccupations with no underlying physiological cause. Referred to as Somatoform Disorders, this phenomena can manifest in a variety of physical and psychological experiences that interfere with your quality of life and ability to function. In contrast to Factitious Disorders, people with Somatoform Disorders are not faking symptoms, but experiencing very real physical and emotional distress that requires specialized mental health interventions.

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Types of Somatoform Disorders

Somatoform Disorder is not a specific diagnosis, but an umbrella term for a number of mental health disorders:

  • Conversion Disorder. Conversion disorder is a mental health condition in which you experience a loss or alteration of bodily functioning due to overwhelming psychological distress, and without a physiological reason. Your physical symptoms may be movement or sensory-based, and often include paralysis, difficulty swallowing, seizures, numbness, blindness, or hearing difficulties. While some conversion disorder symptoms may be random, others experience highly specific functional losses as the result of particular traumas.
  • Pain Disorder. People with pain disorder experience clinically significant physical pain in one or more parts of the body that causes significant distress or functional impairment and has no physiological cause. Often, pain disorder arises from a period of extreme psychological stress or traumatic event and typically manifests as headaches, stomach pains, or back pain.
  • Undifferentiated Somatic Symptom Disorder. Undifferentiated somatic symptom disorder occurs when you experience one or more physical symptoms that do not have an underlying physical cause and do not fit into another somatic disorder category for a period of more than six months. People with this type of mental health disorder may experience a wide variety of symptoms, including gastrointestinal problems, fatigue, pain, and appetite loss, and physical complaints may multiply or change over time.
  • Illness Anxiety Disorder. People with illness anxiety disorder, formerly known as hypochondriasis, experience an intense preoccupation with getting or having an illness. You may see normal bodily functions and minor discomforts such as headaches as cause for major concern, and this anxiety persists despite medical exams and tests indicating that you are healthy. You may avoid certain places, people, or activities for fear of potential health hazardous and spend a substantial amount of time researching possible illnesses online.
  • Body Dysmorphic Disorder. Body dysmorphic disorder involves an overwhelming obsession and dissatisfaction with your physical appearance. You experience great distress over your perceived physical flaws, and may compulsively examine yourself in mirrors, spend excessive time grooming, and take drastic measures to correct the features you regard as unbecoming, including cosmetic surgery and dangerous diet or exercise regimes. Many people with BDD are convinced that they are too unsightly to be seen in public and avoid participating in normal activities to avoid being looked at by other people. In some cases, you may be unable to work or even see family and friends due to extreme self-consciousness.

Treating Somatoform Disorders

Somatoform Disorders are typically diagnosed only after medical exams have been unable to find a physical cause for your symptoms. For many, the process of eliminating physiological causes can be extensive and feel exhausting, as it did for Isla. However, receiving a diagnosis of a Somatoform Disorder can give you answers to the mystery of your suffering and open the door to healing. “Part of me was frustrated at first that I had been living like this for a year and my GP was the only one who made the connection between my abuse and my pain,” Isla says. “But there was such tremendous relief in finally understanding what was happening to me and having a path on which to move forward.”

Once a diagnosis has been made, it is critical that you seek the guidance of clinicians with the experience to effectively treat your disorder to alleviate both the physical symptoms and the sources of psychological distress. Because your somatic symptoms or preoccupations arise from psychological rather than bodily conditions, treatment of Somatoform Disorders seeks to investigate and alleviate the emotional turmoil that is fuelling those physical experiences or preoccupations to remove the root of your suffering. Due to the complex nature of these disorders, high level of functional impairment among many who suffer from them, and high probability of experiencing a co-occurring mental health disorder, residential mental health treatment is often the most effective way of ensuring lasting recovery.

At Bridges to Recovery, our highly skilled clinicians will design a personalized treatment program to address your unique situation using the most effective therapies available today. Treatment begins with an in-depth assessment of your symptoms, personal history, and psychological and cognitive function to ensure that we have a full understanding of what you are experiencing. This is particularly critical for those living with Somatoform Disorders because “as many as 80% of patients [with a Somatoform Disorder] meet DSM criteria for another lifetime Axis I disorder, usually an anxiety or mood disorder,” and true healing relies on treating all sources of distress simultaneously. With a complete picture of your diagnosis and needs, our multidisciplinary team of clinicians will engage you in a comprehensive therapeutic process that allows you to gain the insight and skills you need to relieve your symptoms and emotional distress to allow you to move forward with your life. Through intensive individual psychodynamic therapy, Cognitive Behavioral Therapy, therapy groups, and holistic therapies, you are able to give expression to unresolved psychological pain, learn how to cope with overwhelming emotions, and create a positive, nurturing relationship with your body. If your Somatoform Disorder arose from a history of trauma, we offer the most cutting-edge trauma-focused therapies, such as EMDR and Somatic Experiencing to help you create true recovery. With the support of compassionate doctors, therapists, and peers, you can heal from your Somatoform Disorder and create a more rich, fulfilling life free from disabling physical and emotional pain.

Bridges to Recovery offers comprehensive mental health treatment for people suffering from Somatoform Disorders. Contact us to learn more about how we can help you or your loved one on the path to healing.