Undifferentiated somatoform disorder
Undifferentiated somatoform disorder occurs when a person has physical complaints for more than six months that cannot be attributed to a medical condition. If there is a medical condition present, the complaints must be far more severe than can be accounted for by the presence of the medical problem.
The physical complaints that are expressed by people with undifferentiated somatoform disorder are many and varied. The similarity between all physical complaints associated with undifferentiated somatoform disorder is an absence of medical evidence for the symptoms or for their severity.
The physical complaints usually begin or worsen when the patient is under stress. People with undifferentiated somatoform disorder experience problems functioning in their daily lives due to the physical symptoms that they experience. Seeing multiple doctors in an effort to find a physical cause for the reported symptoms is typical of people with this disorder. Undifferentiated somatoform disorder is also sometimes referred to as somatization syndrome.
Causes and symptoms
The symptoms of undifferentiated somatoform disorder vary widely from person to person. Some of the most common physical complaints are pain, fatigue, appetite loss, and various gastrointestinal problems. The physical complaints generally last for long periods. Patients with undifferentiated somatoform disorder tend to complain of many different physical problems over time.
No matter what symptoms a person complains about, the overarching characteristic of the complaints is that no physical reason can be found for them. Laboratory tests and thorough examinations by doctors will reveal no medical reason for the pains or problems the person is having. The physical problems, however, persist after the person has been told no explanation can be found.
The causes of undifferentiated somatoform disorder are not clear. Some experts believe that problems in the family when the affected person was a child may be related to the development of this disorder. Depression and stress are thought to be other possible causes. Other possible causes, especially in people who overreact to even minor medical conditions, include paying obsessive attention to any minor changes or sensations that their bodies experience. They give the feelings undue weight and worry unnecessarily about them.
Undifferentiated somatoform disorder is relatively common. It is estimated that between 4% and 11% of the population experience the disorder at some time in their lives. Women are more likely than men to have undifferentiated somatoform disorder, as are the elderly and people of lower socioeconomic backgrounds. Young women who have low socioeconomic status are the most likely group to have undifferentiated somatoform disorder. Fifty percent of the people with this disorder have other psychological or psychiatric disorders as well, such as anxiety or depression.
A person with undifferentiated somatoform disorder usually begins by visiting physicians looking for treatments for physical complaints. Later, he or she may be referred to a mental health professional. Referring physicians may continue to see the patient, however, so that a trusting relationship can be established, and the patient does not continue to bounce from doctor to doctor.
Mental health professionals use the handbook called the Diagnostic and Statistical Manual of Mental Disordersto diagnose mental disorders. The book lists diagnostic criteria, and requires that the following conditions be met in order for the clinician to diagnose this disorder:
- There must be no underlying medical cause evident that could explain the patient's physical complaints. If there is a medical condition that could be related to the complaints, the symptoms reported must be far worse than any that could be explained by the existing medical problems.
- The unexplained physical symptoms must persist for at least six months.
- The symptoms must cause problems in the patient's daily life or relationships or interfere with the patient achieving his or her goals.
- There cannot be another mental disorder that accounts for the complaints.
- The patient cannot knowingly make false complaints of physical distress.
Somatization disorderis very similar to undifferentiated somatoform disorder and the two can be easily confused. The symptoms are the same, but the diagnostic criteria are much more specific for somatization disorder. To be diagnosed with somatization disorder, the patient must have four different pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom. These symptoms can occur at different times. The symptoms must be present for several years and must have begun before the patient was thirty years old. Just as with undifferentiated somatoform disorder, the complaints must not be traceable to any medical cause.
Hypochondriasisis also similar in many ways to undifferentiated somatoform disorder. Patients with hypochondriasis are convinced that the physical symptoms they are experiencing are the signs of a major illness. Alternately, they may simply have an obsessive fear of contracting or developing a major illness. These patients often have a specific diagnosisin mind when they visit a doctor, unlike most patients with undifferentiated somatoform disorder who have complaints but do not have a cause in mind.
Most treatments of undifferentiated somatoform disorder focus on treating any underlying psychological problems or stresses that may be causing the disorder. When the disorder occurs in conjunction with another mental health problem such as depression, treating that problem often helps to resolve or lessen the symptoms of undifferentiated somatoform disorder. Some studies indicate that antidepressants are effective in treating this disorder. Patients also may benefit from programs intended to teach them how to manage stress and to understand the correlation between psychological stressors and physiological symptoms. These programs also teach people how to cope with criticism and how to stop negative behavior patterns.
For many people, undifferentiated somatoform disorder is a life-long disorder. Often, the physical complaints increase or decrease in relation to stressors in the affected person's life. Many people with this disorder are eventually diagnosed with another mental disorder or with a legitimate medical problem. For some people, treatment can be successful at lessening or completely resolving symptoms.
There are no known ways to prevent undifferentiated somatoform disorder; it is possible, however, for people who appear to be developing the disorder to enroll in programs designed to teach them coping strategies and about the relationship between psychological factors and physical symptoms.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th ed., text revised. Washington DC: American Psychiatric Association, 2000.
Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry.7th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.
Ford, Charles V., Wayne J. Katon, Mack Lipkin Jr. "Managing Somatization and Hypochondriasis." Patient Care27 no. 2 (January 30, 1993): 31-41.
"Illness Without Disease." Harvard Mental Health Letter16, no. 3 (September 1999).
Locke, Steven E. "Treating Somatzation: an Update." Behavioral Health Management17, no. 4 (July 1997): 22.
Tish Davidson, A.M.