Psychosomatic Illness

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is psychosomatic illness?

Psychosomatic is defined as concerning or involving both mind and body. Psychosomatic illnesses can be classified in three general types. The first type includes people who have both a mental (psychiatric) illness and a medical illness, and these illnesses complicate the symptoms and management of each other. The second type includes people who have a psychiatric problem that is a direct result of a medical illness or its treatment, such as having depression due to cancer and its treatment.

The third type of psychosomatic illness is somatoform disorders. Somatoform disorders are psychiatric disorders that are displayed through physical problems. In other words, the physical symptoms people experience are related to psychological factors rather than a medical cause.

Somatoform disorders are the focus of this article and include the following:

  • Body dysmorphic disorder is an obsession or preoccupation with a minor or imaginary flaw, such as wrinkles, small breasts, or the shape or size of other body parts. Body dysmorphic disorder causes severe anxiety and may impact a person’s ability to function normally in daily life.

  • Conversion disorder is a disorder in which a person experiences neurological symptoms that affect his or her movement and senses and that do not appear to have a physical cause. Symptoms can include seizures, blindness or paralysis.

  • Hypochondriasis is an obsession or fixation with the fear of having a serious disease. People with hypochondriasis misconstrue normal body functions or minor symptoms as being serious or life threatening. For example, a person with hypochondriasis may become convinced that he or she has colon cancer when having temporary flatulence after eating cabbage.

  • Somatization disorder is a disorder in which a person experiences physical complaints, such as headaches, diarrhea, or premature ejaculation, that do not have a physical cause.

The exact cause of somatoform disorders is not completely understood. Somatoform disorders are thought to be familial, meaning that genetics may play a role. Somatoform disorders may also be triggered by strong emotions, such as anxiety, grief, trauma, abuse, stress, depression, anger or guilt. People who suffer from somatoform disorders will generally not recognize the role these emotions play in their physical symptoms. However, they are not intentionally producing these physical symptoms or making up their physical problems. Their physical symptoms are real, but are caused by psychological factors.

Women are more likely than men to have a somatoform disorder. Symptoms usually begin before age 30 and persist for several years. The severity of the symptoms may vary from year to year, but there are rarely times when symptoms are not present. Examples of somatoform symptoms include digestive problems, headaches, pain, fatigue, menstrual problems, and sexual difficulties.

Currently, there is no cure for somatoform disorders. Treatment focuses on establishing a consistent and supportive relationship between the patient and his or her primary care doctor. Often, referral to a psychiatrist can help people with somatoform disorders manage their symptoms. While treatment can be difficult, people who suffer from somatoform disorders can lead normal lives even with continuing symptoms.

Somatoform disorders are generally not considered life-threatening conditions. However, they can lead to episodes of major depression and suicide attempts. Seek immediate medical care (call 911) if you, or someone you are with, have or express any thoughts about hurting yourself or committing suicide.

Seek prompt medical care if you experience symptoms of mild to major depression, including sleep problems, persistent feelings of sadness or emptiness, feelings of hopelessness or worthlessness, constant fatigue, irritability, and loss of interest in activities or hobbies.

What are the symptoms of psychosomatic illness?

Somatoform disorders are the major forms of psychosomatic illness. The physical symptoms of somatoform disorders are real. However, they have psychological roots rather than physical causes. The symptoms often resemble symptoms of medical illnesses. As such, people suffering from somatoform disorders may undergo extensive testing and medical evaluations to determine the cause of their symptoms.

Somatoform disorders include somatization disorder, hypochondriasis, body dysmorphic disorder, and conversion disorder. These disorders can cause difficulties in everyday life, including social, academic and occupational problems.

Common symptoms of body dysmorphic disorder

People who suffer from body dysmorphic disorder become obsessed with minor flaws in their physical appearance or may see flaws where none exist. Common concerns include hair loss; the size and shape of features, such as the eyes, nose or breasts; weight gain; and wrinkles. Symptoms and associated behaviors of body dysmorphic disorder may include:

  • Anxiety and depression

  • Avoiding being seen in public and withdrawal from social situations

  • Avoiding mirrors

  • Constantly checking yourself in a mirror

  • Seeking reassurance from others about your looks

Common symptoms of conversion disorder

Symptoms of conversion disorder usually look like neurological problems and can include:

Common symptoms of hypochondriasis

Hypochondriasis is the condition of thinking that normal body functions or minor symptoms represent a serious medical condition. A person with hypochondriasis can interpret a headache as a brain tumor or muscle soreness as a sign of impending paralysis. Typical symptoms of hypochondriasis include:

  • Anxiety and depression

  • Feeling that their doctor has made a mistake by not diagnosing the cause of their symptoms

  • Repeated doctor visits until a diagnosis is made

  • Seeking constant reassurance from friends and family about their symptoms

Common symptoms of somatization disorder

Somatization disorder is characterized by physical symptoms without a physical cause. Symptoms of somatization disorder include:

Symptoms that might indicate a serious or life-threatening condition

People with somatoform disorders are at risk for suicidal thoughts and actions. Seek immediate medical care (call 911) if you, or someone you are with, have attempted to hurt or kill oneself or have had thoughts about hurting or killing oneself.

People with somatoform disorders are also at risk of developing major depression. Seek prompt medical care if you, or someone you are with, have any of these symptoms:

  • Changes in eating habits, such as overeating or loss of appetite

  • Difficulty concentrating or remembering things

  • Fatigue or lack of energy

  • Feelings of hopelessness, guilt or worthlessness

  • Irritability and restlessness

  • Loss of interest in activities and hobbies including sex

  • Persistent feelings of sadness or emptiness

  • Sleep problems, such as insomnia or excessive sleeping

What causes psychosomatic illness?

The exact cause of somatoform disorders, which are the major type of psychosomatic illness, is not known. Somatoform disorders tend to run in families and may have a genetic component. Somatoform disorders may be a coping strategy, a learned behavior, or the result of a personality characteristic. They may also be linked to problems with nerve impulses that carry false signals to the brain. While the cause of somatoform disorders is not known, the symptoms are real to the person experiencing them. They are not imagined or made up.

Triggers of somatoform disorders may include strong emotional or psychological experiences, such as:

  • Abuse

  • Anger

  • Anxiety

  • Depression

  • Grief

  • Guilt

  • Stress

  • Trauma

What are the risk factors for psychosomatic illness?

Because the exact cause of somatoform disorders, the major types of psychosomatic illness, is not known, it is difficult to identify specific risk factors. However, somatoform disorders are thought to run in families. If a member of your family has suffered from a somatoform disorder, you may also be at risk of developing a somatoform disorder. Other risk factors include:

  • History of sexual, emotional or physical abuse

  • Major childhood illness

  • Poor or reduced ability to show or express emotions

How is psychosomatic illness treated?

Treatment of somatoform disorders, which make up the majority of psychosomatic illnesses, can be challenging. After ruling out physical causes of your symptoms, it generally focuses on establishing a trusting, supportive relationship between you and your primary care doctor. Your doctor will recommend regular checkup appointments as one of the most important parts of your treatment.

Psychiatric treatment of somatoform disorders

Your primary care doctor may refer you to a psychiatrist for help in managing your disorder. Psychotherapy, specifically cognitive-behavioral therapy, may be effective in relieving some of the underlying psychological factors that are causing your physical symptoms. Learning to manage stress in a healthy way through stress management techniques may be part of your therapy. If a specific mental disorder, such as depression, can be identified, treatment with medications may also help.

Symptomatic treatment of somatoform disorders

Symptoms of a somatoform disorder may continue despite efforts at cognitive-behavioral therapy. When this occurs, treatment can be aimed at providing symptomatic relief and helping people live normal lives. Medications can be used to help provide relief from symptoms, such as headache, fatigue, pain, and digestive problems. However, medications may not be needed in all cases.

What you can do to improve your disorder

You may be able to help control your somatoform symptoms by:

  • Following the treatment plan you and your healthcare professional design specifically for you

  • Keeping your regularly scheduled checkup appointments

  • Practicing stress management techniques

What are the potential complications of psychosomatic illness?

If you have a psychosomatic illness, specifically a somatoform disorder, you are at increased risk of:

  • Difficulty functioning effectively in everyday life, such as in school, at work, and in relationships

  • Disability

  • Lower quality of life

  • Major depression

  • Suicidal thoughts or actions

You can best treat your somatoform disorder and lower your risks of complications by following the treatment plan you and your healthcare professional design specifically for you. This includes keeping your regularly scheduled checkups and therapy appointments.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 30
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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