In the early 1800s, the medical field began to consider
the various social and psychological factors that
influence illness. The term psychosomaticbegan
to be used to convey the connection between the
mind (psyche) and the body (soma) in states of health
and illness. Essentially the mind can cause the body
to create physical symptoms or to worsen physical
illnesses. Real symptoms can begin, continue, or be
worsened as a result of emotional factors. Examples
include diabetes, hypertension, and colitis, all of
which are medical illnesses influenced by stress and
emotions. When a person is under a lot of stress or
is not coping well with stress, symptoms of these
medical illnesses worsen. In addition, stress can cause
physical symptoms unrelated to a diagnosed med-
ical illness. After a stressful day at work, many peo-
ple experience “tension headaches” that can be quite
painful. The headaches are a manifestation of stress
rather than a symptom of an underlying medical
problem.
The term hysteriarefers to multiple physical
complaints with no organic basis; the complaints
are usually described dramatically. The concept of
hysteria probably originated in Egypt and is about
4000 years old. In the Middle Ages, hysteria was as-
sociated with witchcraft, demons, and sorcerers.
People with hysteria, usually women, were considered
evil or possessed by evil spirits (Goodwin & Guze,
1989). Paul Briquet and Jean Martin Charcot, both
French physicians, identified hysteria as a disorder
of the nervous system.
Sigmund Freud, working with Charcot, observed
that people with hysteria improved with hypnosis
and experienced relief from their physical symptoms
when they recalled memories and expressed emo-
tions. This development led Freud to propose that
people can convert unexpressed emotions into physi-
cal symptoms (Guggenheim, 2000), a process now re-
ferred to as somatization.This chapter discusses so-
matoform disorders, which are based on the concept
of somatization.
OVERVIEW OF SOMATOFORM
DISORDERS
Somatizationis defined as the transference of men-
tal experiences and states into bodily symptoms. So-
matoform disorderscan be characterized as the
presence of physical symptoms that suggest a med-
ical condition without a demonstrable organic basis
to account fully for them. The three central features
of somatoform disorders are as follows:- Physical complaints suggest major medical
illness but have no demonstrable organic
basis.
19 SOMATOFORMDISORDERS 461
- Psychological factors and conflicts seem
important in initiating, exacerbating, and
maintaining the symptoms. - Symptoms or magnified health concerns are
not under the client’s conscious control
(Guggenheim, 2000).
Clients are convinced that they harbor serious
physical problems despite negative results during
diagnostic testing. They actually experience these
physical symptoms as well as the accompanying pain,
distress, and functional limitations such symptoms
induce. Clients do not willfully control the physical
symptoms. While their illnesses are psychiatric in
nature, many clients do not seek help from mental
health professionals. Unfortunately, many health
care professionals who do not understand the nature
of somatoform disorders are not sympathetic to these
clients’ complaints (Servan-Schreiber, Kolb & Tabas,
2000). Nurses must remember that these clients really
experience the symptoms they describe and cannot
voluntarily control them.
The five specific somatoform disorders are as fol-
lows (American Psychiatric Association, [APA], 2000): - Somatization disorderis characterized
by multiple physical symptoms. It begins by
30 years of age, extends over several years,
and includes a combination of pain and
gastrointestinal, sexual, and pseudoneuro-
logic symptoms.
Somatoform disorders