What is Undifferentiated Somatoform Disorder?
Undifferentiated somatoform disorder. This category should be used in cases where somatic complaints are multiple, variable and long-lasting, but at the same time, a complete and typical clinical picture of a somatized disorder is not detected. For example, the assertive and dramatic nature of the complaint may be absent, the latter may be relatively small in number, or there may be no violation of social and family functioning. The grounds for the assumption of psychological conditioning may or may not be present, but there should be no somatic basis for a psychiatric diagnosis.
Symptoms of Undifferentiated Somatoform Disorder
Symptoms resembling somatic disease, however, constant complaints despite excessive detail, vague, inaccurate and inconsistent in time. Somatic is framed by emotional instability, anxiety, low mood, not reaching the level of depression, decay of physical and mental strength, besides, irritability, a feeling of internal tension and dissatisfaction are often present. An exacerbation of the disease is provoked not by physical exertion or by changing weather conditions, but by emotionally significant stressful situations.
Diagnosis of Undifferentiated Somatoform Disorder
Criteria:
- The presence of multiple, changing somatic symptoms in the absence of any somatic diseases that could explain these symptoms.
- Constant concern about the symptom leads to prolonged suffering and repeated (3 or more) consultations and examinations in the outpatient clinic, and if counseling is unavailable for any reason, repeated visits to representatives of paramedicine.
- Persistent refusal to accept a medical opinion on the absence of sufficient somatic causes of the existing symptoms or only a short-term agreement with it (up to several weeks).
Undifferentiated somatoform disorder can be diagnosed, when the minimum duration of symptoms is reduced to 6 months, criteria 1 and 3 are fully satisfied, criterion 2 can only be partially met
Important differentiation with the following disorders:
- Somatic disorders. It is most difficult to differentiate somatoform disorder from some somatic diseases, such as multiple sclerosis, systemic lupus erythematosus, etc., beginning with nonspecific, transient manifestations. Here, the doctor needs to distinguish from a variety of clinical symptoms those that are characteristic of these diseases. Thus, multiple sclerosis often begins with transient motor, sensory (paresthesia) and visual disturbances. Hyperparathyroidism can be manifested by osteoporosis (loosening and tooth loss), and systemic lupus erythematosus often begins with polyarthritis, which is gradually joined by polyserositis.
However, one should take into account the probability of the emergence of an independent somatic disorder in such patients, which is not lower than that of ordinary people at the same age. Particular attention in case of change of emphasis in the complaints of patients or their stability, when you need to continue surveys. - Affective (depressive) and anxiety disorders. Depression and anxiety of varying degrees are often accompanied by somatized disorders, but they should not be described separately unless they are sufficiently pronounced and stable to justify their own diagnosis. The appearance of multiple somatic symptoms after the age of 40 years may indicate a manifestation of primary depressive disorder.
- Hypochondriacal Disorder. With somatisation disorder, the focus is on the symptoms themselves and their individual manifestation, while in hypochondriacal disorder, attention is directed more to the presence of the intended progressive and serious disease process, as well as its disabling consequences. In hypochondriacal disorder, the patient more often asks for examination in order to confirm the nature of the alleged disease, while a patient with somatisation disorder asks for treatment in order to remove the existing symptoms. With somatisation disorder, there is usually excessive use of drugs, whereas patients with hypochondriacal disorder are afraid of drugs, their side effects, and seek support and relief from frequent visits to various doctors.
- Delusional disorders (such as schizophrenia with somatic delusions and depressive disorders with hypochondriacal ideas). Freakish features of ideas, combined with a smaller number of them and the more constant nature of somatic symptoms, are most typical of delusional disorders.
Longer (from 2 years) and more intense symptoms are diagnosed as somatoform disorder.
Treatment of Undifferentiated Somatoform Disorder
The main role in the treatment belongs to psychotherapy. Pharmacotherapy aims to create psychotherapy opportunities and is carried out to correct the accompanying symptoms. The choice of drugs in each case is determined by the characteristics of the symptoms and associated manifestations. The following groups of drugs are used for pharmacotherapy: drugs of the first choice are antidepressants (tricyclic and SSRI groups); second choice drugs are beta blockers and mood stabilizers; In the initial stages of treatment, a combination of antidepressant with benzodiazepine is possible; antipsychotics with sedative effect are also used as reserve medicines for severe anxiety, which can not be stopped by benzodiazepines. In addition, the treatment of somatoform disorders must be supplemented with vasoactive, nootropic drugs and vegetal stabilizers.