Somatisation - what it is, how it shows and treatment through neurofeedback
Somatisation is a process through which stress and emotional tension are turned into physical symptoms. Diagnosis and treatment.
What is somatisation?
Somatisation is a complex phenomenon in which stress and negative emotions show themselves through physical symptoms or bodily sensations, without a clear medical cause. From persistent headaches and an upset stomach to severe somatic conditions such as fibromyalgia and irritable bowel syndrome, these manifestations can affect a person’s quality of life and can often be difficult to diagnose and treat.
Throughout history, somatisation has attracted the interest of researchers and of professionals in mental health and medicine, because of its complexity and of the devastating effects it can have on those affected. In what follows we will explore in depth the concept of somatisation, the way it shows itself, the factors that contribute to its onset and the diagnosis and treatment options available today. We will also focus on the major role of brain training therapy in managing and addressing this phenomenon, in the hope of offering a deeper understanding and effective solutions for those affected by somatisation.
Somatoform disorders are a broader class of mental disorders in which physical symptoms persist and cause significant suffering or discomfort, but cannot be fully explained by a known medical condition or by the effects of substances. These disorders include, among others, somatic symptom disorder, somatisation disorder, illness anxiety disorder and somatoform pain disorder.
Somatic symptom disorder
It is characterised by persistent physical symptoms that cause significant suffering or discomfort and require medical care, but cannot be fully explained by a known medical condition or by the effects of substances.
Somatisation disorder
It is characterised by the presence of several diverse and painful physical symptoms that persist over a long period, without an identifiable medical cause. These symptoms cause significant suffering or social and occupational dysfunction.
Illness anxiety disorder
This involves intense concerns about health and an excessive fear of having or of developing a serious illness, even in the absence of obvious symptoms or despite medical assessments that indicate physical health.
Somatoform pain disorder
It is characterised by persistent and severe pain that cannot be fully explained by a known medical condition or by the effects of substances, and the pain causes significant suffering or dysfunction.
Causes and risk factors in somatoform disorders
The causes and risk factors in somatisation are often interconnected and can vary from one individual to another. Some of these causes and risk factors include:
- Genetic and biological factors: There is evidence that somatoform disorders can have a genetic or biological component. People with a family history of somatoform disorders or of other psychological conditions can be more likely to develop such disorders.
- Previous traumatic experiences: Trauma and stress in childhood or in adult life, such as physical, sexual or emotional abuse, or other traumatic events, such as the loss of a loved one or serious accidents.
- The pattern of behaviour and communication: People who have been taught to express their emotions or their anxiety through physical symptoms can be more likely to develop somatoform disorders. For example, in a family where emotional expression is discouraged or ignored, an individual might learn to express their emotions through physical manifestations.
- Psychological and emotional factors: They are often associated with anxiety, depression and other mental health disorders. People dealing with chronic stress, unresolved interpersonal conflicts or difficulties in managing emotions can be more vulnerable to developing somatoform disorders.
- Sociocultural factors: Certain societies or cultures can promote or perpetuate certain beliefs or behaviours related to health and illness, which can influence the way a person expresses or interprets their physical symptoms. For example, in some cultures physical symptoms can be more accepted than the expression of emotions or anxiety.
- Previous medical experiences: People who have had traumatic or negative medical experiences in the past, such as misdiagnoses or ineffective treatments, can develop an increased sensitivity to physical symptoms and can have a higher risk of developing somatoform disorders.
It is important to underline that somatoform disorders are complex and multifactorial, and that each case can be influenced by a unique combination of factors. The treatment and management of these disorders can involve addressing all the biological, psychological and social aspects of the individual in order to improve quality of life and reduce the suffering associated with the physical symptoms.
Common symptoms associated with somatisation disorders
The symptoms associated with somatisation disorders can vary from one individual to another and with the specific nature of the disorder, but there are certain common symptoms that are often encountered.
The psychological symptoms of somatisation can be varied and can include a wide range of emotional and cognitive symptoms that can be present together with, or can be associated with, the physical symptoms. Here are some of these common psychological symptoms:
- Anxiety: Anxiety is a psychological symptom frequently associated with somatisation. Those affected can experience a persistent state of restlessness, fear or excessive worry, which can be difficult to control and can affect their ability to function day to day.
- Depression: Depression is another mental health condition that can be associated with somatisation. Those affected can show persistent sadness, a lack of pleasure in usual activities, a loss of energy and interest, changes in sleep and appetite, and other symptoms characteristic of depression.
- Sleep disturbances: Somatisation can affect sleep, leading to insomnia, frequent waking during the night, restless sleep or other sleep disturbances. These problems can contribute to the stress and emotional discomfort associated with somatisation.
- Dissociation: Some people affected by somatisation can experience episodes of dissociation, in which they feel disconnected from themselves or from the reality around them. This can include the feeling of being outside their body or of not being able to control their own thoughts or actions.
- Chronic stress: Chronic stress can be a psychological symptom of somatisation and can be caused by the anxiety and restlessness associated with persistent or recurring physical symptoms. Chronic stress can affect the physical and emotional health of the individual and can worsen the somatic symptoms.
- Eating disorders: Some people affected by somatisation can develop eating disorders, such as bulimia or anorexia, which can be linked to the stress and anxiety associated with the condition. These eating disorders can have serious consequences for the physical and mental health of the individual.
These psychological symptoms can be present together with the physical symptoms and can contribute to the complexity and severity of the condition. The treatment of somatisation has to address both the physical and the psychological aspects of the condition, and it can involve cognitive behavioural therapy, counselling, medication, neurofeedback therapy, or other forms of intervention depending on the individual needs of the patient.
The common physical symptoms include:
- Pain and bodily sensations: Those affected can experience diffuse or localised pain in different parts of the body, such as migraines, headaches, back pain, abdominal pain or muscle pain. This pain can be persistent or recurring and can vary in intensity.
- Tiredness and exhaustion: There can be a persistent tiredness that is unexplained, even after adequate rest or sufficient sleep. Those affected can feel a lack of energy and can have difficulty carrying out daily activities.
- Gastrointestinal disturbances: Gastrointestinal symptoms, such as abdominal pain, bloating, nausea, vomiting, constipation or diarrhoea, are frequent in somatisation disorders.
- Breathing problems: Some people can show shortness of breath, a feeling of suffocation or other breathing problems without an obvious medical cause.
- Sleep disturbances: Insomnia, frequent waking during the night or other sleep disturbances can appear, and they can contribute to the general state of tiredness and exhaustion.
- Neurological symptoms: Some somatisation disorders can include neurological symptoms, such as numbness or tingling in the limbs similar to those present in peripheral neuropathy, muscle weakness or coordination difficulties.
- Cardiac symptoms: Those affected can feel sensations of rapid or irregular heartbeat, sensations of pressure or discomfort in the chest, without an identifiable cardiac cause.
- Dermatological symptoms: Sensations of itching, burning or other unpleasant manifestations on the skin can appear, without an obvious dermatological cause.
These physical symptoms can cause significant suffering or dysfunction in the everyday life of the individual, even if there is no obvious medical cause. The treatment of somatisation disorders can involve addressing both the physical and the psychological aspects of the condition.
Diagnosing somatoform conditions
Diagnosing somatoform conditions usually involves a complex assessment that can include several steps and ways of investigating:
- Primary medical assessment: The first step in diagnosing somatoform conditions is usually a complete medical assessment carried out by a doctor or by a health specialist. This assessment often includes a detailed medical history, a physical examination and, in some cases, laboratory or imaging tests in order to rule out any possible medical causes for the individual’s physical symptoms.
- Psychiatric and psychological assessment: After the possible medical causes are ruled out or treated, the next step involves a psychiatric and psychological assessment carried out by a psychologist or a psychiatrist. This can involve a detailed discussion about the patient’s medical history, their current symptoms, their level of functioning and the stress factors in their life.
- Differential diagnosis: The doctor has to carry out a differential diagnosis in order to rule out other medical conditions that could produce symptoms similar to those of somatoform disorders. This can involve investigating and assessing medical conditions such as autoimmune diseases, infections, endocrine disorders or neurological disorders.
- Diagnostic criteria: In order to establish a diagnosis of a specific somatoform disorder, the doctor can use the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) or other psychiatric assessment instruments. These criteria often include the presence of specific physical symptoms, their duration and frequency, as well as the absence of a known medical cause.
- Collaboration between specialists: The diagnosis and management of somatoform conditions can often involve a multidisciplinary team of health professionals, such as family doctors, psychiatrists, psychologists, physical therapists or occupational therapists. Close collaboration between these specialists can contribute to a more effective assessment and treatment for the patient.
Diagnosing somatoform conditions can sometimes be difficult and requires a comprehensive and individualised approach for each patient. It is also essential that the diagnosis is made ethically and that it respects the individual needs and experiences of the patient.
Treatment options in somatisation
The treatment of somatisation often involves a multidisciplinary approach that addresses both the physical and the psychological aspects of the condition. Here are some usual treatment options:
- Cognitive behavioural therapy (CBT): CBT is an effective form of therapy for treating somatisation. It focuses on identifying and changing the thoughts and behaviours that can contribute to the manifestation of the physical symptoms. CBT can help the patient understand and manage better the stress, the anxiety and other emotions that can be linked to the physical symptoms.
- Psychodynamic therapy: This form of therapy focuses on exploring the individual’s past and interpersonal relationships in order to understand better the origin and the meaning of the somatic symptoms. Psychodynamic therapy can help identify and resolve internal conflicts and other psychological factors that can contribute to somatisation.
- Relaxation and stress management therapy: Relaxation techniques, such as deep breathing, meditation or yoga, can be useful in reducing stress and anxiety, which can reduce the intensity and frequency of the somatic symptoms.
- Medication: In some cases, medication can be used to treat the symptoms associated with somatisation, such as anxiety or depression. Antidepressants and anxiolytics can be prescribed depending on the individual needs of the patient.
- Physical therapy: For people who experience chronic pain or other physical symptoms, physical therapy or physiotherapy can be beneficial for improving physical function and reducing pain.
- Education and counselling: Informing the patient about somatisation and about the way stress and other psychological factors can influence the physical symptoms can be useful in managing the condition. Counselling and education can help the patient understand the condition better and take an active role in managing the symptoms.
- Social support: Support from family, friends or support groups can play an important role in managing somatisation. Having someone with whom to share experiences and from whom to receive emotional support can help the patient cope better with the condition.
- Brain training therapy: Neurofeedback is a non-invasive biofeedback technique that involves monitoring an individual’s brain activity and providing feedback in real time in order to teach their brain to regulate this activity in a healthier way. In the context of somatisation, neurofeedback can be useful in several ways:
- Reducing stress and anxiety: Neurofeedback can help reduce levels of stress and anxiety, which can be triggers or aggravating factors for somatisation. By training the brain to regulate activity in the areas associated with responses to stress and anxiety, neurofeedback can help manage these emotions and reduce the associated somatic symptoms.
- Improving the functioning of the autonomic nervous system: Somatisation can be associated with dysfunctions in the autonomic nervous system, which controls the involuntary functions of the body, such as heart rate, breathing and digestion. Neurofeedback can help regulate these physiological functions, thereby contributing to a reduction in the somatic symptoms.
- Increasing body awareness: Neurofeedback can increase awareness and connectivity between the brain and the body, helping the individual become more aware of their body’s sensations and reactions. This can help towards a deeper understanding of the link between emotional stress and the physical manifestations associated with somatisation.
- Regulating emotions and emotional reactivity: Neurofeedback can train the brain to regulate more effectively the exaggerated or dysfunctional emotional responses that can contribute to the somatic symptoms. By improving the ability to regulate emotions, neurofeedback can help reduce the somatic manifestations associated with somatisation.
It is important to underline that the treatment of somatisation has to be individualised and adapted to the needs and experiences of each patient. An integrated approach that addresses both the physical and the psychological aspects of the condition can be the most effective in managing the symptoms and improving the patient’s quality of life.
Complications associated with somatisation
Somatisation can have numerous complications that affect both the physical health and the mental and social wellbeing of the individual. Here are some common associated complications:
- Physical health problems left unaddressed: One of the major risks associated with somatisation is the possibility that the physical symptoms are signs of an underlying medical condition that has not been identified or treated properly because of the focus on the psychological aspects of the condition.
- Excessive use of health services: People affected by somatisation can frequently seek medical care and can undergo numerous unnecessary tests and medical procedures in an attempt to find a cause for their physical symptoms. This can lead to high financial costs and to an excessive use of medical resources.
- Difficulties in interpersonal relationships: Somatic symptoms can affect the individual’s interpersonal relationships, because they can be hard for those around them to understand or accept. This can lead to social isolation, loneliness and stigma.
- Associated mental health disorders: Somatisation is often associated with mental health disorders, such as anxiety and depression. Somatic symptoms can worsen these disorders or can be worsened by them, creating a vicious circle of emotional and physical suffering.
- Difficulties in everyday functioning: Somatic symptoms can affect the individual’s ability to function normally in everyday life. They can interfere with work, school, social activities and other aspects of daily life, thereby reducing quality of life and causing discomfort or suffering.
- Dependence on medication: In an attempt to manage the somatic symptoms, some people can resort to the excessive use or abuse of medicines, such as painkillers or other prescribed or self-administered medication. This can lead to substance dependence and to other health complications.
It is essential to pay attention both to the physical and to the psychological aspects of somatisation and to offer an appropriate and integrated treatment that addresses the individual needs of each patient. A multidisciplinary approach, involving collaboration between doctors, psychologists and other health professionals, can be essential for managing somatisation effectively and for preventing the associated complications.
Somatisation in children
Somatisation in children can have a significant impact on their healthy development and on their quality of life. It is important to focus on this aspect and to identify ways of improving the management and treatment of this condition among children. Children dealing with somatisation can experience physical discomfort, anxiety and other mental health disorders that can affect their general wellbeing. Through proper management of somatisation, we can help improve their physical and emotional health.
Somatic symptoms can affect children’s ability to concentrate at school and to interact positively with their classmates and with other people in their social environment. By treating somatisation, we can contribute to improving children’s school performance and interpersonal relationships.
Children who learn to manage emotions and stress in a healthy and effective way are more likely to develop coping skills and resilience in the long term. By approaching somatisation in children in a way that promotes strategies for managing stress and anxiety, we can contribute to their healthy development and to the formation of effective coping mechanisms.
How we can improve the management of somatisation in children:
- Education and awareness: It is important to educate children and their parents about somatisation and to explain to them the way stress and emotions can affect physical and emotional health. Developing a deeper understanding of the condition can help reduce the fear and the stigma associated with it.
- Promoting a supportive family environment: Creating a safe and supportive family environment is essential for managing somatisation in children. Parents can be supportive and empathetic towards their children’s symptoms and can promote an open dialogue and effective communication in the family.
- Counselling and therapy: Cognitive behavioural therapy (CBT) or other forms of therapy such as neurofeedback can be useful in teaching children effective strategies for managing stress and anxiety. A specialised therapist or counsellor can help children identify and change the thoughts and behaviours that can contribute to somatisation.
- Promoting a healthy lifestyle: A healthy lifestyle, which includes a balanced diet, regular physical exercise and enough sleep, can contribute to reducing the somatic symptoms and to improving children’s physical and emotional health.
- Involving the school and the community: Schools and other institutions in the community can play an important role in supporting children who are dealing with somatisation. Promoting a positive school environment and offering resources and support for children and parents can contribute to managing the condition effectively.
- Brain training therapy: brain training therapy can be suitable and beneficial for children, being adapted to the needs and particularities of each child.
By approaching somatisation in children in a comprehensive and collaborative way, we can help promote healthy development and improve their quality of life.
Preventing somatisation disorders
Preventing somatisation disorders involves adopting strategies and approaches that reduce the risk of these conditions appearing or that lessen their severity and their impact on individuals. Here are several ways in which we can contribute to preventing them:
- Promoting mental health: Improving mental health can play a crucial role in preventing somatisation. This can include managing stress, developing skills for managing emotions and negative thoughts, as well as encouraging a positive attitude towards life.
- Education and awareness: Education about somatisation and about the way stress and emotional factors can influence physical health can help prevent the onset of somatisation disorders. Promoting awareness and understanding of this condition can reduce the associated stigma and can encourage people to seek help when needed.
- Promoting a healthy lifestyle: Adopting a healthy lifestyle, which includes a balanced diet, regular physical exercise, adequate sleep and effective stress management, can contribute to reducing the risk of somatisation. It is important to encourage healthy behaviours from childhood and to promote healthy living habits among all members of the community.
- Promoting healthy social relationships: Social support and positive interpersonal relationships can play an important role in preventing somatisation. Promoting healthy social bonds and encouraging open communication and supportive relationships can contribute to managing stress and other emotional factors that can be linked to somatisation.
- Identifying and managing stress factors early: Identifying and managing stress factors and other emotional factors early can help prevent the onset of somatisation disorders. For example, cognitive behavioural therapy or other forms of counselling can be useful in teaching skills for managing stress and anxiety.
- Promoting open communication and help-seeking: Encouraging open communication and the seeking of help when it is needed can contribute to preventing the worsening of somatic symptoms and to managing the condition effectively. It is important to encourage a culture of openness and support in our community.
By adopting these preventive strategies and approaches, we can contribute to reducing the risk of somatisation disorders appearing and to promoting optimal physical and mental health among the population. It is essential to approach somatisation and mental health in general in an integrated and collaborative way, involving individuals as well as communities, health institutions and decision makers.
References:
- Nanke, A. and Rief, W. (2003). Biofeedback-based interventions in somatoform disorders: a randomized controlled trial. Acta neuropsychiatrica, [online] 15(4), pp. 249-256. doi:https://doi.org/10.1034/j.1601-5215.2003.00028.x.
- Schmidt, K., Drazena Barac-Dammeyer, Kowalski, A., Per Teigelack, Pfeiffer, C., Robitzsch, A., Dörrie, N., Skoda, E.-M., Bäuerle, A., Fink, M. and Teufel, M. (2023). Implementing biofeedback treatment in a psychosomatic-psychotherapeutic inpatient unit: a mixed methods evaluation of acceptance, satisfaction, and feasibility. Frontiers in psychiatry, [online] 14. doi:https://doi.org/10.3389/fpsyt.2023.1140880.
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