Somatoform disorder
DESCRIPTION:
Somatoform disorder: psychological causes of physical complaints with unclear organic causes? Psychotherapy for chronic psychosomatic disorders: clarifying the diagnosis and alleviating symptoms.
Somatoform disorder: When chronic pain and psychological stress let the body speak
"You go first," said the soul to the body, "he won't listen to me. Maybe he'll listen to you." "I'll make myself sick, then he'll have time for you," said the body to the soul. – Ulrich Schaffer
These lines by the writer Ulrich Schaffer poetically summarise what millions of people experience: physical complaints that feel like a serious physical illness, but no doctor can find any organic evidence of disease. Somatoform disorder is one of the most common mental illnesses in the UK, but it often takes years to be correctly diagnosed. Those affected go through a marathon of visits to specialists, from operation to operation, and feel misunderstood. This article explains what lies behind the disorder, why the body becomes a mouthpiece for emotional distress, and which therapeutic approaches actually help.
What exactly is a somatoform disorder?
A somatoform disorder is a mental illness in which sufferers experience persistent physical symptoms for which no sufficient organic cause can be found despite careful medical examination. This does not mean that the symptoms are imaginary; on the contrary, the pain, the nausea, and the exhaustion are real. The only thing missing is the expected physical findings.
In the ICD-10 classification system, somatoform disorders are listed as a separate category (F45). The diagnosis requires that physical symptoms recur and persist for at least 2 years without being fully explained by a physical illness. It is also typical for those affected to remain convinced that they are suffering from physical diseases despite negative test results.
The disorder is widespread: according to estimates, around 10 to 15 per cent of the population suffer from somatoform disorders at some point in their lives. In general practice, patients with unclear physical complaints account for up to a third of all consultations. The severity of the disorder varies considerably, from mild, temporary symptoms to severely debilitating chronic conditions.
What forms of somatoform disorders are there?
Psychosomatic medicine distinguishes between several subtypes. Somatisation disorder is the most severe variant: those affected suffer from multiple, changing physical symptoms in various organ systems, such as abdominal pain, palpitations, sweating and headaches at the same time. The complaints have persisted for years and have often led to numerous visits to the doctor and sometimes to unnecessary operations.
In undifferentiated somatisation disorder, the symptoms are less pronounced or last for a shorter period of time, but do not meet all the criteria for full somatisation disorder. Hypochondriacal disorder, on the other hand, is primarily characterised by the fear of suffering from a serious illness, such as cancer or a neurological disorder. Here, the focus is less on the symptom itself and more on the conviction that one is seriously ill.
Another critical category is persistent pain disorder. Here, those affected suffer from chronic pain whose intensity and persistence cannot be explained by a physiological process or physical disorder. Psychological factors play a central role in its development and maintenance. Finally, there is somatoform autonomic dysfunction, in which symptoms affecting the autonomic nervous system occur, such as palpitations, diarrhoea or shortness of breath, without any detectable organic dysfunction of the affected organ.
What are the symptoms of somatoform disorder?
The symptoms of somatoform disorder can affect virtually any organ system. Pain symptoms are common: chronic headaches, back pain, abdominal pain or pain in the arms and legs. Gastrointestinal complaints such as nausea, flatulence or digestive problems are also typical. Cardiovascular symptoms include palpitations, chest pain or the feeling of being unable to breathe.
A characteristic feature is that the symptoms are not produced arbitrarily; they are involuntary reactions of the body. Unlike in cases of malingering, those affected genuinely believe that they are physically ill. The symptoms can be acute or chronic, mild or severe. They often change: as soon as one symptom subsides, another appears.
Many sufferers also show signs of depression and anxiety. They are often depressed or anxious, which further exacerbates the physical symptoms. A vicious circle develops: the physical symptoms lead to psychological stress, which in turn maintains or worsens the symptoms. The severity of the impairment can be so pronounced that sufferers are no longer able to work and become increasingly socially isolated.
Why can't doctors find an organic cause?
This question is central and is often misunderstood by those affected as a questioning of their symptoms. If, after a thorough diagnostic investigation, no organic findings are found, this does not mean that the symptoms are invented. It means that the physical cause of the symptoms does not lie in structural damage to the organ, but in a dysregulation of somatic and psychological processes.
The nervous system plays a key role in this process. Chronic stress can permanently alter pain perception. The brain "learns" to amplify or generate pain signals even in the absence of acute tissue damage. These neurobiological changes are now well documented and explain why the pain is real, even though imaging techniques show no pathology.
What's more, the distinction between "physical" and "psychological" is itself problematic. Every psychological process has a physical correlate. Anxiety increases heart rate, grief weighs on the stomach, and stress tenses the muscles. In somatoform disorders, these regular connections between the mind and body are merely intensified and chronic. The boundary between psychosomatic disorders and "purely physical" illnesses is fluid, which is what makes diagnosis so complex.
How do somatoform disorders develop?
The development of a somatoform disorder is multifactorial. Genetic factors play a role: studies show familial clustering, indicating genetic vulnerability. This genetic predisposition makes people more susceptible to reacting to stress with physical symptoms.
Childhood traumatic experiences are another significant risk factor. Neglect, abuse or emotional coldness can impair the ability to put emotional distress into words. When there is no language for feelings, the body speaks. This process, somatisation, is not a conscious decision, but an automatic reaction of the psychological system to unbearable stress.
Current stressful events can also trigger or exacerbate a somatoform disorder: separations, job loss, bereavements or ongoing conflicts. The stress does not always have to be obviously traumatic; sometimes, chronic everyday stress is enough to overwhelm the system. Psychological and social factors interact to create an environment in which the body becomes a means of expressing unprocessed emotions. The symptoms are then, in a sense, the body's attempt to draw attention to emotional distress, just as Schaffer's poem describes.
Why mentalisation is the key to understanding somatoform disorders
The concept of mentalisation, developed by Peter Fonagy and colleagues, provides a scientifically sound framework for understanding somatoform disorders. Mentalisation refers to the ability to understand one's own and others' behaviour as an expression of inner mental states, i.e. to recognise the feelings, desires, beliefs and intentions behind actions. This ability develops in early childhood within secure attachment relationships. When caregivers reliably mirror and name the child's emotional states, the child learns to represent their inner states as mental phenomena.
In people with somatoform disorders, this mentalisation ability is often limited, not generally, but specifically for stressful affects. The technical term alexithymia describes a related difficulty: the inability to identify and put feelings into words. When mental states cannot be recognised as psychological, they are experienced in the body. The pain, nausea and palpitations are then not symbols of something psychological; they are the psychological, only in physical form. The disorder lies not in the body and not in the psyche, but in the missing bridge between the two.
Therapeutically, this understanding has concrete consequences. Mentalisation-based therapy (MBT) aims to strengthen the ability to reflect on inner states. Instead of treating the body as defective or searching for psychological causes, the aim is to develop a new language for experiencing. The psychotherapeutic process helps those affected to gradually understand their physical symptoms as an expression of feelings, not through external interpretation, but through their own growing mentalisation skills. This approach has been well researched empirically and shows lasting effects in various mental illnesses, including psychosomatic disorders.
Why "The Body Keeps the Score" is pseudoscientific populism.
Bessel van der Kolk's bestseller "The Body Keeps the Score" has infected an entire generation of laypeople and, unfortunately, therapists with a fundamentally false idea of trauma and the body. The core thesis that trauma is literally "stored in the body" and must be "released" through body-based interventions is neurobiological nonsense, packaged in the aesthetics of scientific authority.
The body does not store memories. The brain does. What van der Kolk sells as "body memory" are altered neural processing patterns that naturally have physical correlates, as do every mental state. But the metaphor of trauma trapped in tissue that must be "released" through yoga, massage or theatre therapy serves esoteric fantasies, not science. It suggests that one can bypass the brain and heal directly on the body. This is about as plausible as claiming that one can repair software by stroking the hard drive.
Particularly problematic: van der Kolk promotes a smorgasbord of methods – EMDR, yoga, neurofeedback, theatre groups, martial arts – with an enthusiasm that grotesquely overstretches the actual evidence. EMDR is well documented for PTSD; for somatoform disorders, the data are thin. Yoga can be helpful as a supplement; as a primary trauma therapy, it is not evidence-based. But van der Kolk presents these methods as if they were all equally effective, the main point being that the body is "involved". This is not a differentiated clinical recommendation, but marketing for an ideology.
The distinction from the concept of mentalisation clarifies the difference. Fonagy asks: How can the patient learn to understand their physical sensations as an expression of mental states? Van der Kolk asks: How can we get the trauma out of the body? The first question leads to autonomy and self-understanding. The second leads to endless body therapies in which yet another trauma must be "resolved". Serious psychotherapy develops mentalisation skills. Van der Kolk-inspired bodywork replaces one dependency with another.
For those affected by somatoform disorders, this distinction is existential. Those who believe their body is a prison full of locked-up trauma become permanent consumers of esoteric offerings. Those who understand that the body sends signals that cannot yet be translated into psychological language have a path of development ahead of them. One path chronicles the disorder. The other leads out of it.
EMDR and Brainspotting: Body-oriented work in the service of mentalisation
If body-oriented methods are to be viewed so critically, is there any place for them at all in the treatment of somatoform disorders? The answer is yes, but with one crucial caveat: the method must promote mentalisation, not replace it. EMDR (Eye Movement Desensitisation and Reprocessing) is the best-studied body-based intervention that can do just that.
Francine Shapiro originally developed EMDR for the treatment of trauma-related disorders and is now one of the most evidence-based methods for PTSD. The method uses bilateral stimulation, usually through guided eye movements, to support the processing of stressful memories. What distinguishes EMDR from esoteric body therapies is that the physical component is not an end in itself, but a catalyst for psychological processing. The patient does not remain stuck in pure bodily experience but uses focused attention to establish connections among physical sensations, emotions, and meanings. This is mentalisation work with physical access.
Brainspotting, developed by David Grand, is a variation of EMDR that focuses more on the observation that certain eye positions correlate with the activation of emotional and physical states. The therapist helps the patient find a "brainspot," an eye position at which the connection to a traumatic experience is particularly intense. The evidence base for Brainspotting is significantly weaker than for EMDR; specific evidence of its effectiveness for somatoform disorders is largely lacking. This does not make Brainspotting worthless, but it should be used with appropriate caution: as a clinically interesting extension of the EMDR principle, not as a stand-alone miracle cure.
The crucial difference to esoteric body therapies lies in the therapeutic approach. Neither EMDR nor Brainspotting is self-running or a technique that can be used in isolation. They work within a sustainable therapeutic relationship in which the therapist serves as a model of mentalisation. The physical sensations that arise during the session are not mystified as "trauma release," but are used as material for joint reflection. What does the patient feel? What could that mean? What feelings, memories, thoughts arise? These questions translate bodily experience into psychological language; they promote precisely the mentalisation ability that is limited in somatoform disorders. Those who use EMDR or Brainspotting as part of an overall concept that promotes mentalisation can make a valuable contribution to treatment. Those who sell them as body techniques that make conversation superfluous are repeating the mistake that van der Kolk has turned into a business model.
How does psychological stress influence pain perception?
Psychological stress has been shown to alter the way the brain processes pain signals. Chronic stress weakens pain inhibition mechanisms and increases pain sensitivity. This explains why people under psychological stress perceive pain more intensely and why relaxation and psychological stabilisation can alleviate pain.
The feelings associated with pain also play a role. People who associate pain with fear, helplessness or catastrophic thinking experience it more intensely. Conversely, an accepting, calm attitude can reduce perceived pain. This is precisely where psychotherapeutic interventions come in: they do not primarily change the pain itself, but rather the relationship to pain.
Interestingly, imaging studies show that patients with chronic pain actually exhibit visible changes in brain regions responsible for pain processing. Pain disorders, therefore, leave measurable traces in the brain, further evidence that the separation between "physical" and "psychological" is artificial. Pain is neither purely physical nor purely psychological; it is both at once.
What role does psychotherapy play in somatoform disorders?
Psychotherapy is the treatment of choice for somatoform disorders. Psychotherapeutic methods have proven to be more effective than purely drug-based treatment or ongoing physical diagnostics. This does not mean that physical therapy is unimportant, but without psychotherapeutic treatment of the underlying psychological causes, lasting improvement is unlikely.
Cognitive behavioural therapy helps those affected to recognise and change unfavourable thought patterns that lead to their symptoms. Psychodynamic psychotherapy focuses more on unconscious conflicts and repressed feelings that are expressed physically. Both approaches have their merits; which one is more suitable depends on the person affected and their specific set of problems.
A central element of any therapeutic work is psychoeducation: those affected learn to understand the connection between mental stress and physical symptoms. This understanding alone often has a relieving effect. When the body is no longer experienced as defective, but as a means of communication for the psyche, the relationship to the symptoms changes fundamentally.
How is a somatoform disorder diagnosed?
The diagnosis is not simply a careful process of exclusion. Although doctors must rule out organic causes for the symptoms, they must do so without getting caught up in endless diagnostic loops. An experienced physician knows when further examinations are helpful and when they only reinforce the fixation on physical explanations.
The diagnostic challenge is, on the one hand, not to overlook any serious physical illness and, on the other hand, not to make the disorder chronic through overdiagnosis. Every additional operation, every additional examination can reinforce the conviction that "something must be found". This abnormal illness behaviour is itself part of the disorder and must be addressed therapeutically.
In addition to ruling out physical causes, the diagnosis also includes taking a psychological history. Have there been any traumatic experiences? Are there any current stressors? How does the affected person deal with stress? This information is crucial for diagnosis and treatment planning. The diagnosis should not be experienced as a stigma, but as an opportunity: finally, there is an explanation and thus a starting point for effective treatment.
What treatment options are available beyond psychotherapy?
In addition to psychotherapy, other treatment options can be helpful, but as a supplement, not a substitute. The effectiveness of mindfulness-based stress reduction (MBSR) is well documented. It trains attention regulation in a structured way and helps to perceive physical sensations without catastrophising. Regular physical exercise, whether endurance sports, strength training or swimming, has been proven to have antidepressant and anxiolytic effects without the need for esoteric theories. Biofeedback can also be helpful: patients learn to consciously perceive and influence vegetative reactions such as heart rate variability or muscle tension – a concrete, measurable approach to the body-mind connection.
In severe cases, inpatient treatment in a psychosomatic clinic may be advisable. Here, various therapeutic approaches are combined: individual and group therapy, relaxation techniques and, if necessary, medication. The advantage is that those affected are removed from their stressful everyday lives for a few weeks, allowing them to concentrate fully on their recovery.
On an outpatient basis, a combination of psychotherapy and accompanying GP care may be most appropriate. Good cooperation between the GP and psychotherapist is essential. The GP should not initiate new diagnostics for every new symptom, but should nevertheless respond to the complaints seriously and empathetically. This balance is challenging, but crucial for the success of the treatment. What all these complementary measures should have in common is that they serve to regulate stress and body awareness, not the mythical "liberation" of trauma stored in the tissue.
How can those affected deal with the condition?
The first step is to accept that physical symptoms can also have psychological causes, without this making the complaints any less real. Many sufferers resist this realisation for a long time because they fear being labelled as "imaginary sick". But the opposite is true: recognising the psychosomatic component is the first step towards healing.
It is also helpful to shift the focus away from the symptom. Those affected are often in a constant state of observation: How severe is the pain today? Is it getting worse? What does this new symptom mean? This hypervigilance exacerbates the symptoms. Distractions, enjoyable activities and social contact can break this vicious circle.
Finally, patience is essential. A somatoform disorder that has developed over the years will not disappear within a few weeks. Setbacks are part of the process. But with consistent psychotherapeutic treatment and an understanding environment, significant improvements are possible. The body, which has been sending warning signals for so long, can finally find peace when the soul is finally heard.
Summary: What you should know about somatoform disorders
· In a somatoform disorder, physical symptoms are real and distressing, even if no organic cause can be found.
· The condition is common, affecting up to 15 per cent of the population
· Forms include somatisation disorder, hypochondriacal disorder, persistent pain disorder and somatoform autonomic dysfunction
· Psychological stress, stress and unprocessed trauma can trigger and maintain symptoms
· Limited mentalisation ability, the inability to recognise feelings as psychological states, explains why emotional distress is experienced physically
· Mentalisation-based therapy strengthens the ability to understand physical symptoms as an expression of inner states
· Popular psychological concepts such as van der Kolk's "body memory" are scientifically untenable and promote esoteric rather than evidence-based treatment approaches
· EMDR is an evidence-based method that meaningfully combines body-related elements with mentalisation work; Brainspotting is a clinically interesting variation with less evidence
· The diagnosis requires careful exclusion of physical causes without overdiagnosis
· Psychotherapy is the most effective treatment
· Body-oriented methods and, if necessary, inpatient treatment complement the range of therapies
· Acceptance of psychosomatic connections is the first step towards recovery
· Chronic conditions can be positively influenced with patience and professional help
Frequently asked questions about somatisation and psychosomatic complaints
What is somatisation disorder in psychosomatics?
A somatisation disorder is a mental illness in which those affected suffer from a variety of changing physical symptoms for which no sufficient organic cause can be found despite thorough examination. The complaints are real, not imagined, but psychological factors significantly influence their development and persistence. In psychosomatics, somatisation disorder is understood as an expression of psychological stress that manifests itself in the body due to a lack of other means of expression.
What is the difference between "somatic" and "psychosomatic"?
"Somatic" means "relating to the body"; a somatic illness is a physical illness with a demonstrable organic cause, such as a broken bone or an infection. "Psychosomatic", on the other hand, refers to complaints in which psychological factors play a significant role in their development or progression. The body reacts to psychological stress with physical symptoms. Important: Psychosomatic does not mean "imaginary", but describes the close interaction between the mind and body.
What are psychosomatic complaints?
Psychosomatic complaints are physical symptoms that are triggered or exacerbated by psychological stress. These include headaches, back pain, gastrointestinal problems, palpitations, dizziness, shortness of breath or chronic fatigue. The complaints feel just as real to those affected as a purely physical illness, because they are real. The difference lies not in the intensity of the experience, but in the cause.
Which illnesses are considered psychosomatic?
Classic psychosomatic illnesses include somatisation disorder, hypochondriacal disorder, persistent somatoform pain disorder, functional heart problems, irritable bowel syndrome, tension headaches and fibromyalgia. Psychological factors can also have a significant influence on the course of illnesses such as neurodermatitis, asthma or high blood pressure. The boundaries are fluid; almost every physical disease also has a psychological component.
What are the seven psychosomatic illnesses?
The idea of exactly "seven psychosomatic illnesses" goes back to the historical concept of the "Holy Seven" formulated by Franz Alexander in the 1950s: stomach ulcer, ulcerative colitis, bronchial asthma, rheumatoid arthritis, neurodermatitis, high blood pressure and hyperthyroidism. This classification is now outdated. We now know that psychosomatic connections can play a role in practically all illnesses, and the strict separation into "psychosomatic" and "non-psychosomatic" no longer corresponds to the current state of research.
What types of somatisation disorders are there?
The ICD-10 distinguishes between several forms: somatisation disorder (F45.0) with numerous, changing symptoms over at least two years; undifferentiated somatisation disorder (F45.1) with less pronounced or shorter courses; hypochondriacal disorder (F45.2) with the conviction of being seriously ill; somatoform autonomic dysfunction (F45.3) with symptoms of the autonomic nervous system; and persistent somatoform pain disorder (F45.4) with chronic pain without sufficient physical explanation.
What causes somatisation disorders?
The causes are varied and interact. Genetic factors increase vulnerability. Early attachment experiences play a central role: those who did not learn to recognise and express feelings as children are more likely to experience emotional stress physically. Traumatic experiences, chronic tension and current life stresses can trigger a somatisation disorder. From a mentalisation theory perspective, those affected often cannot recognise physical sensations as expressions of psychological states.
How do psychosomatic disorders manifest themselves?
Psychosomatic disorders can manifest themselves in almost any organ system: pain (head, back, abdomen, joints), gastrointestinal complaints (nausea, diarrhoea, constipation), cardiovascular symptoms (palpitations, chest tightness, dizziness), breathing difficulties, skin problems, exhaustion or sleep disorders. It is often characteristic that the symptoms change, that examinations do not provide a sufficient physical explanation and that the complaints increase during times of stress.
What does psychosomatic pain feel like?
Psychosomatic pain feels just as real as pain with a clear physical cause because it is real. The brain produces the same pain signals, and the nerve pathways conduct the same impulses. Those affected often describe dull, diffuse pain that is difficult to localise, or wandering pain that occurs here today and there tomorrow. The intensity can range from mildly annoying to completely debilitating.
What triggers psychosomatic pain?
Triggers can be acute stress (conflicts, losses, excessive demands) or chronic stress without any identifiable single trigger. Often, there is a history of unprocessed emotional experiences, not necessarily dramatic traumas, but sometimes more subtle forms of emotional neglect. The body reacts to emotional distress that cannot be put into words. The pain is then, in a sense, the body's attempt to draw attention to something that could not be processed psychologically.
How does the body show that the soul is suffering?
The body has many languages: muscle tension when anger is pent up, stomach problems when conflicts are "undigested", palpitations when anxious, exhaustion when depressed, and skin issues when dealing with shame. These connections are not esoteric symbolism, but neurobiologically comprehensible. The autonomic nervous system reacts to psychological stress with measurable physical changes. In cases of chronic stress, these reactions can take on a life of their own and become permanent complaints.
How does physical overload manifest itself?
Physical signs of chronic overload include exhaustion despite sufficient sleep, concentration problems, headaches, neck and back tension, gastrointestinal problems, increased susceptibility to infections, sleep disorders and palpitations. Many sufferers report a feeling of inner tension that cannot be relieved. In the long term, chronic stress can lead to burnout or depression.
How can you tell that you are at the end of your tether?
Warning signs include persistent exhaustion that does not improve with rest; increasing irritability or emotional numbness; sleep disorders; physical complaints with no apparent cause; social withdrawal; concentration and memory problems; the feeling of no longer being able to cope with even simple tasks; and indifference towards things that used to bring joy. If several of these signs persist for weeks, professional help is recommended.
How does internal stress manifest itself?
Internal stress manifests itself on several levels: physically through tension, restlessness, palpitations or digestive problems; emotionally through irritability, anxiety or depression; cognitively through brooding, concentration problems or catastrophic thinking; and behaviourally through sleep problems, changes in eating habits or substance use. Those affected often do not notice the stress themselves; the body then signals it through complaints.
What are the body's warning signs?
The body sends warning signals when the system is overloaded: recurring infections, chronic fatigue, unexplained pain, digestive problems, skin changes, hair loss, weight changes, sleep disorders or sexual dysfunction. Taking these signals seriously does not mean panicking; instead, it means pausing and asking: What does my body need? What is stressing me out? Sometimes a physical symptom is the only indication that something is wrong psychologically.
What is a somatic stress response?
A somatic stress response is the physical response to psychological stress. In acute stress, the body activates the sympathetic nervous system: heart rate and blood pressure rise, muscles tense up, digestion is inhibited, and stress hormones are released. This response makes evolutionary sense; it prepares us for fight-or-flight. The problem arises when the stress is chronic, and the body cannot recover. Then the stress reactions can take on a life of their own and become permanent complaints.
What are some examples of somatic illnesses?
Somatic diseases in the narrow sense are physical illnesses with a demonstrable organic cause: infectious diseases, bone fractures, heart attacks, cancer, diabetes, thyroid disorders. The term is sometimes used confusingly. In psychiatry, "somatic disease" refers to a physical illness as opposed to a mental illness. In psychosomatics, a distinction is made between purely somatic diseases and those in which psychological factors play a significant role.
What problem frequently occurs in patients with somatisation disorder?
Those affected often find themselves in a vicious circle of doctor's visits, examinations and disappointments. They search for a physical explanation, find none, feel they are not being taken seriously and move on to the next doctor. This "doctor shopping" can lead to unnecessary interventions and make the disorder chronic. This is often accompanied by depression or an anxiety disorder. The biggest hurdle is usually accepting that the symptoms are real but have psychological causes.
How do I know if my symptoms are psychosomatic?
Indications of a psychosomatic component include: multiple examinations without clear findings; changing or migrating symptoms; a connection between complaints and stressful situations; improvement during relaxed phases; accompanying anxiety or depressive moods; conviction of being seriously ill despite unremarkable findings. Important: A psychosomatic diagnosis is not a diagnosis of exclusion in the sense of "we can't find anything, so it must be psychological". It requires positive criteria and a careful assessment of the patient's psychological history.
What effect does constant pain have on the psyche?
Chronic pain places a considerable strain on the psyche. It increases the risk of depression and anxiety disorders, leads to social withdrawal, impairs concentration and quality of life, and can change one's self-image. Those affected feel helpless and at the mercy of their illness. A vicious circle develops: pain leads to psychological stress, which intensifies the perception of pain. That is why psychotherapeutic treatment is always advisable for chronic pain.
How can I get rid of psychosomatic symptoms?
The most crucial step is to accept that physical symptoms can have psychological causes without making the symptoms seem any less real. Psychotherapy is the most effective treatment, especially cognitive behavioural therapy and psychodynamic methods. Stress management, mindfulness-based methods, regular exercise and relaxation techniques can also help. It is crucial to shift the focus from combating symptoms to the underlying emotional issues.
How can somatisation disorder be cured?
"Cure" in the sense of complete freedom from symptoms is not always realistic, but significant improvement is certainly possible. Psychotherapy helps to understand the connections between mental stress and physical symptoms and to develop new ways of dealing with them. The focus shifts from "getting rid of the symptom" to "dealing with the symptom differently". Many sufferers report that their symptoms decrease when they learn to recognise and express their feelings.
Are somatisation disorders curable?
Yes, with limitations. Complete freedom from symptoms cannot be achieved in all affected individuals, but quality of life can improve significantly. Studies show that psychotherapy reduces symptom intensity, increases functional ability and alleviates psychological distress. The willingness to accept psychological connections and actively participate in change is crucial for the success of therapy. The earlier treatment begins, the better the prognosis.
How long does it take for psychosomatic complaints to disappear?
That depends on the duration of the illness, its severity and the intensity of treatment. Complaints that have developed over the years do not disappear in weeks. Outpatient psychotherapy typically lasts 25 to 80 sessions, i.e. six months to two years. Initial improvements may occur earlier, but setbacks are part of the process. Patience is essential, but so is the confidence that change is possible.
What is the most common psychosomatic reaction?
Tension headaches and back pain are among the most common psychosomatic complaints. Gastrointestinal problems such as irritable stomach or irritable bowel syndrome are also widespread. In general practice, patients with functional and psychosomatic complaints account for a significant proportion of consultations, with estimates reaching up to a third.
How can you regain control of your psyche?
This formulation is understandable, but problematic. The psyche is not an enemy to be "controlled" but a part of the self that needs attention. A more helpful question is: What does my psyche need? Often, this means secure relationships, understanding of one's own feelings, relief from excessive stress and professional support through psychotherapy. The path to recovery is not through control, but through experience.
Can somatic symptoms be ignored?
This is not advisable. Ignoring symptoms does not make them disappear, nor does it make their cause disappear. In the case of somatoform disorders, ignoring the symptoms often exacerbates the complaints; the body "turns up the volume" when it is not heard. A middle ground is more sensible: take the symptoms seriously, but do not catastrophise; after appropriate medical clarification, accept and work on the psychological component.
Which doctor is responsible for psychosomatic complaints?
The family doctor is usually the first point of contact and should carry out an initial physical examination. Specialists in psychosomatic medicine and psychotherapy, or in psychiatry and psychotherapy, are responsible for further treatment. Medical and psychological psychotherapists also treat psychosomatic complaints. In severe cases, inpatient treatment in a psychosomatic clinic may be advisable.
Which medications help with psychosomatic complaints?
Medications are not the first choice for psychosomatic complaints, but they can be helpful as a supplement. Antidepressants can help with accompanying depression or anxiety disorders, and they also have a pain-modulating effect. Sedatives can be used for short-term relief of acute tension, but caution is advised due to the potential for dependency. Painkillers are usually not very effective for somatoform pain disorders and can worsen the symptoms when used long-term. The actual treatment remains psychotherapy.
Which medication stabilises the psyche?
No medication "stabilises the psyche" in a comprehensive sense. Antidepressants can alleviate depressive symptoms, anxiolytics can reduce anxiety, and mood stabilisers can dampen mood swings. But medication is no substitute for psychotherapy; at best, it can support it. The most lasting "stabilisation" comes from developing self-awareness, emotional regulation and sustainable relationships. These are not pills, but processes.
What medication is used to treat somatisation disorder?
There is no specific medication for somatisation disorders. SSRI (selective serotonin reuptake inhibitors) such as sertraline or citalopram are often used to treat accompanying depression. Tricyclic antidepressants such as amitriptyline can help with chronic pain. The evidence for drug therapy in pure somatisation disorders without psychiatric comorbidity is limited. Psychotherapy remains the treatment of choice.
How can you tell if you have a mental illness?
Persistent psychological distress and impairment in everyday life are the most critical indicators. If symptoms, whether mental or physical, persist for weeks, reduce quality of life and cannot be overcome on one's own, professional evaluation is advisable. Mental illnesses are not a weakness of character, but treatable health problems. Seeking help is not a sign of weakness, but of self-care.
Which mental illness has the highest suicide rate?
This question deviates from the topic of somatisation, but deserves an answer. The highest suicide rates are found in severe depression, bipolar disorder, schizophrenia and borderline personality disorder. Addiction also significantly increases the risk. In somatisation disorders, the risk of suicide is lower, but not negligible, especially when accompanied by depression. Suicidal thoughts should always be taken seriously and treated professionally.