somatoform pain disorder
Introduction
Introduction Somatoform pain disorder is also known as psychogenic pain. Sometimes chronic pains of unknown cause are collectively referred to as chronic pain syndrome. Mainly manifested as persistent pain in various parts, causing pain to the patient or affecting its social function, but medical examination can not find any organic lesions in the painful part, can not be reasonably explained by physiological processes or physical disorders, after medical treatment The examination revealed no persistent, severe pain symptoms of any organic disease. Pain can occur in any part of the body, but the typical pain areas are headache, atypical facial pain, low back pain and chronic pelvic pain; pain can be located on the body surface, deep tissue or internal organs; the nature can be blurred dull pain, swelling Pain, soreness or sharp pain. There is clinical evidence that psychological factors or emotional conflicts play an important role in the occurrence, aggravation, persistence and severity of such pain.
Cause
Cause
(1) Causes of the disease
The exact cause of the disorder in this group is unknown. Studies in recent years have suggested that such diseases are related to the following factors:
Genetic
Reports suggest that somatoform disorders are associated with genetic predisposition. A study of a group of chronic functional pain demonstrated a positive family history that was significantly higher than organic pain; multivariate analysis showed a positive correlation between family genetic history and pain.
2. Personality
The author's study found that both male and female patients have MMPI profiles of 1, 2, 3, and 7 types, and their two-point coding is basically consistent with the personality characteristics of neurosis. Patients with "nervous" personality focus more on their physical discomfort and related events, leading to a lower sensory threshold, increased sensitivity to body sensation, and a variety of physical discomfort and pain. Sterm's research found that patients with somatoform disorders often have certain personality disorders, and passive-dependent, performance-type, and sensitive attacks are more common.
3. Neurophysiological and neuropsychological research
It has been found that patients with somatoform disorders have changes in brainstem reticular attention and arousal function. Studies on brain function asymmetry link the feelings, attentions, and emotional changes of the transition disorder to the information processing process in the right hemisphere of the brain. Brain studies of somatoform disorders point to the second sensory zone (S11), which appears to be particularly well-suited to explain its neurophysiological and neuropsychological dynamics. Some people think that in the emotional conflict, neuroendocrine, autonomic nerve and blood biochemical changes in the body lead to changes in blood vessels, internal organs, muscle tension, etc. These physiological reactions are perceived by the patient as physical symptoms.
4. Psychosocial factors
(1) Subliminal benefit: The psychoanalytic school believes that such physical symptoms can provide patients with two benefits in the subconscious. One is to relieve emotional conflict through disguised venting; the other is to avoid the problem by presenting the sick character. Willing to take responsibility and get care and care.
(2) Cognitive role: the patient's personality characteristics and bad mood can affect the cognitive process, leading to sensitivity and enlargement of perception, making the person's feelings about the body information stronger, selectively paying attention to the body sensation and interpreting it with physical diseases. This tendency enhances the association and memory associated with the disease and the negative evaluation of one's own health.
(3) Alexithymia: Some people think that low-cultural people are not good at expressing their deep feelings in words, the so-called alexithymia. Lesser believes that alexithymia is a long-standing personality trait. Patients are not good at expressing their inner conflicts. It is easier to describe the body than emotional expression, and even to achieve indistinguishable inner feelings or physical sensations. Some people think that patients have serious defects in the self-perception and verbal expression of emotional experience. Their emotional experience is not transmitted to the cerebral cortex and expressed through linguistic symbols, but is released through the formation of so-called "organ language" by the nerves.
(4) Life events: Dantzer emphasizes the connection between life events and the body. Bacon found that life events were directly proportional to body complaints. The authors' study also found that the stimuli of negative events were higher in the study group than in the control group, and life events were positively correlated with the amount of pain. The total social support score of the study group was significantly lower than that of the control group and negatively correlated with the amount of pain. Long-term stress is the main cause of life.
(5) Social and cultural factors: Some studies have found that physical form disorders are particularly common in middle-aged and older women with lower culture. Studies have also shown that chronic functional pain is also more common in women with lower levels of education. Some people think that the expression of emotions is influenced by specific social culture. Whether in the Western society before the 20th century or the grassroots society in today's developing countries or developed regions, negative emotions are often seen as an expression of incompetence and shame. The direct expression of this kind of emotion, and the complaint of physical discomfort is a "legal" way. In this cultural context, patients will consciously or unconsciously conceal, deny, and even not feel their emotional experience, but pay attention to their physical discomfort. Although the onset and persistence of symptoms are closely related to unpleasant life events, difficulties, psychological factors or internal conflicts, patients often deny the existence of psychological factors and refuse to explore the possibility of psychological causes.
(two) pathogenesis
There have been many studies on the psychosocial mechanisms of somatization disorders, but there have been few reports on the biological basis of their occurrence. The role of somatization can be understood as social and emotional communication, and can also be interpreted as the result of psychodynamics.
Social exchange
It mainly refers to the patient's use of physical symptoms to achieve the purpose of controlling others (such as a young woman showing persistent abdominal pain, thus preventing his parents from going out on weekends).
2. Emotional communication
Sometimes patients can't express their emotions verbally, so they may use physical symptoms or physical complaints to express them. Some patients may also use physical complaints to deal with stress. Physical symptoms may also be a way to alleviate psychological conflicts. Psychological testing studies reported that MMPI-R scores in patients with somatization were significantly higher than those in the control group.
3. Psychodynamic factors
Classical theory of psychodynamics suggests that somatization disorders refer to the replacement of suppressed non-instinctive impulses with physical symptoms. Such physical symptoms of the patient can provide two benefits to the patient in the subconscious. One is that the disguised venting can alleviate the emotional psychological conflict; the other is that through the role of the somatization disorder, the unwilling responsibility can be avoided, and the family, The care and care of colleagues.
The patient's bad personality characteristics and bad mood can lead to sensitivity and enlargement of perception, selectively gradually pay attention to the body's feelings, and explain this tendency with physical diseases, and enhance the negative evaluation of their own health. Some patients are not good at expressing inner conflicts, describing physical discomfort is easier than emotional expression, and even reaching the difficulty of distinguishing between inner feelings and physical discomfort. Some people think that patients have serious defects in self-perception and verbal expression of emotional experience, and their emotional experience is good. Released by the so-called "organ language."
4. Biological factors
Neuropsychiatric examination confirmed that patients with somatization disorders were associated with functional deficits in the bilateral frontal lobe of the cerebral hemisphere and hypofunction in the non-dominant hemisphere. However, some studies have shown that patients with predominantly left side symptoms may suggest that the right hemisphere of the brain is more severely affected than the left side. Basic research has also confirmed that patients with somatization disorders are often associated with cortical dysfunction, and this result is also confirmed by auditory evoked potential examination. Compared with the control group, patients with somatization had similar responses to related and unrelated stimuli, suggesting that the patient's selective attention was reduced. Studies in pathophysiology have shown that increased physical complaints are related to the following factors: living alone, receiving less environmental stimuli, depression and anxiety. In addition, the personality threshold, the neurological allergy and the introversion personality have lower body somatosensory thresholds, which are also related to the occurrence of somatization disorders.
Examine
an examination
Related inspection
EEG examination blood routine
1, symptom standard
(1) Comply with the diagnostic criteria of neurosis.
(2) Mainly with physical symptoms, at least one of the following: 1 excessive care about physical symptoms (severity is not commensurate with the actual situation), but not delusion; 2 excessive care for physical health, such as the physiological phenomenon that usually occurs And abnormal feelings are too concerned, but not delusional.
(3) Repeated medical treatment or medical examination, but the negative results of the examination and the reasonable explanation of the doctor can not dispel their concerns.
2, serious standards
Impaired social function
3, the disease standard
Symptoms have been met for at least 3 months (somatic disorders require at least 2 years, undifferentiated somatoform disorders and somatoform pain disorders require at least half a year).
4, exclusion criteria
Exclude other neurotic disorders, depression, schizophrenia, and paranoid mental disorders.
Diagnosis
Differential diagnosis
Physical illness
Early detection of such diseases may not lead to objective medical evidence. But in the end, objective medical evidence can be found. Therefore, the diagnosis of various somatoform disorders requires at least half a year of disease. When the onset age is over 40 years old, the physical symptoms are single, the site is relatively fixed, and the trend is persistently aggravated. First, it may be considered that there may be organic lesions, and close observation, it is not appropriate to make a diagnosis of somatoform disorders. Clinical practice shows that: according to the onset of mental causes, the initial examination did not find positive signs, patients are easy to accept the suggestion of these points, the diagnosis of lower body form disorders, may lead to misdiagnosis, not careless.
2. Depressive disorder and anxiety disorder
Different degrees of depression and anxiety often appear in somatoform disorders, but to a lesser extent. The physical discomfort associated with it is not much, mainly based on the core symptoms of depression and anxiety. Depression and anxiety are more common in physical form disorders. Depressive patients often present a "depression triad" with a small number of physical symptoms and are mainly concentrated in the gastrointestinal system. ICD-10 points out that after 40 years of age, especially the physical symptoms of men, it is likely to be an early manifestation of primary depressive disorder.
3. fraud
It occurs in prisons, courts, work injuries and traffic accidents. The parties consciously create or exaggerate various physical symptoms; the symptoms of somatoform disorders are unconscious and involuntary.
4. Suspected delusions
The patient's physical illness beliefs are absurd and out of touch, and delusional or depressed patients may have weird physical beliefs such as "an organ or part of the body is rot." It can't be shaken with debates, explanations, etc., and often other psychotic symptoms exist at the same time. 5. Identify the disease and identify the following diseases
(1) Patients with depressive disorder may have a preconceived notion that they have a serious disease. However, depression may also be secondary to a suspected disorder. It is important to know which one first appears.
(2) Unexplained physical complaints or somatization disorders are concerned with symptoms rather than the presence of a disease and consequences.
(3) Beliefs related to suspected disorders are not as fixed as depression or schizophrenia with physical delusions. Patients with long-term suspected complaints should be classified as personality disorders. Because when they feel that medical staff can't handle their problems, they often become dissatisfied and even hostile.
(4) Anyone may have short-term concerns about health issues.
(5) Many anxiety disorders also have the characteristics of suspected complaints.
(6) One of the concerns of generalized anxiety disorder (GAD) is the concern about physical illnesses of oneself or family members. However, GAD's disease anxiety is only one of many concerns, not the only one.
(7) During the panic attack period, the concept of avoidance and preemption of physical or mental illness is prominent (ie fear of death, madness or loss of control), however, patients with panic disorder tend to misinterpret their acute anxiety response (as the anxiety increases) . Symptoms of distorted symptoms are more misinterpreted than anxiety (such as lumps and small spots). Secondly, the misunderstanding of panic tends to be acute, and at the same time there are symptoms of anxiety (such as heart attack), and the fear of suspected disease is mostly long-term (such as cancer).
(8) OCD patients are worried that they or their families have serious diseases like AIDS or cancer, and they have forced thinking about infection. They will perform forced posture movements (washing or checking) to avoid infection.
1, symptom standard
(1) Comply with the diagnostic criteria of neurosis.
(2) Mainly with physical symptoms, at least one of the following: 1 excessive care about physical symptoms (severity is not commensurate with the actual situation), but not delusion; 2 excessive care for physical health, such as the physiological phenomenon that usually occurs And abnormal feelings are too concerned, but not delusional.
(3) Repeated medical treatment or medical examination, but the negative results of the examination and the reasonable explanation of the doctor can not dispel their concerns.
2, serious standards
Impaired social function
3, the disease standard
Symptoms have been met for at least 3 months (somatic disorders require at least 2 years, undifferentiated somatoform disorders and somatoform pain disorders require at least half a year).
4, exclusion criteria
Exclude other neurotic disorders, depression, schizophrenia, and paranoid mental disorders.
