Why People with Somatoform Disorders behave the way they do?
Somatoform disorders are one of the main problems of any modern health system. These are patients who repeatedly come to seek medical advice and complain over (often changing) health problems (e.g., pains, breathing difficulties etc.). in a medical examination there will be no adequate physical findings, meaning that the complaint, even if the person really has a problem breathing of feels pain, comes primarily from emotional or mental background rather than of pure physical illness. The process of frequent visits to the doctor’s office without results is frustrating for both the physician and the patient, as well as costly to the healthcare system. Studies suggest that 15-30 percent of those who ask for medical advice have some kind of unexplained medical condition that falls into the somatoform category. Just to get the picture, a doctor who is visited by 50 patients a day will probably meet between 7-15 people like that until the end of his work day.
Let us try to look more closely into the reasons behind this phenomenon, which stands somewhere in the borderline between medicine and psychiatry. Indeed, there is very little pleasure in dealing over and over again with embarrassing medical examinations and bureaucracy, while knowing that a diagnosis will never be found.
For the sake of the discussion I would assume that these people actually believe that they have a problem and that they are not explicitly mentally ill. They do feel pain; their medical need is real, but the reason for the illness is emotional rather than physical.
I assume three main emotional backgrounds to this phenomenon. The first is unpleasant life events; death of a beloved person or loss of some other center of life (such as one’s job) are two classic examples. One would feel deep emotional pain that, in turn, can be screened in an organ.
The second reason is need for attention. A medical need is a perfect, often quite cheap, to be in the center of some other individuals’ concentration for a while. The medical processes, even if they are not pleasing, involve intense interaction with people, which provide an opportunity for those who do not receive enough attention.
A third and highly important reason has to do with cultural differences, mainly in concern with immigration. An immigrant who feels some emotional distress would find it hard to describe them, either due to cultural boundaries or insufficient abstract vocabulary to portray feelings. The result is approaching the doctor (mainly in primary care) with inaccurate report regarding one’s health conditions, or the real motive behind the visit.
Besides complaining about their health, those patients become often very demanding from the medical staff, commanding the latter to send them to complicated and expansive examinations, requesting second opinions and so on. Additional related character is unrealistic expectations from the medical personnel, resulting in disappointment and tension.
Other factors, such as socioeconomic status, gender and age can also be influential. It seems to me that people who are more aware of their health are more probable to have somatoform disorders than others. Generally speaking, women are more aware of themselves, therefore will tend to exaggerate their difficulties and ask for advice.
Reflecting on the issue, I find it necessary to define between two major groups within those who have some somatoform disorder. First are the “easy cases.” It is perfectly understandable that one’s temporary anxiety or distress would be channels to some physical symptoms. In a limited duration and on accordance with the right medical attention I am sure that those people (which can be any of us) come back to normative behavior in accordance with their genuine health conditions. It is imperative, though, that both the patient and the doctor will be open and try to find the underlying reason for this situation. On the other side stand those who have chronically somatoform behavior. Without admitting their problems they cannot be treated probably. The result is a vicious circle which creates even harder and more complicated health and emotional implications.
As always with social and behavioral phenomenon, the key issue here is awareness and common responsibility of both sides to find a sound solution to this multidimensional problem.
On the other hand, not every symptom without physical finding is necessary a somatoform disorder. Hence, it is the medical personnel’s obligation to perform a thorough investigation of patients’ complaints before jumping into false conclusions and referring a person in actual need to mental therapy.
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