Aches and pains  may be problem in the mind and not in the system.Somatic disorders revisited.
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Aches and pains may be problem in the mind and not in the system.Somatic disorders revisited.

Contributed by 

Dr Arif Maghribi Khan

MBBS .MD 

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Mr Akbar (name changed) was  living happily with his family but unfortunately he had an extremely  stressful event in his life . A few months later.

He started feeling nasal blockade.   

Initially he visited some people commonly known as compounders in Kashmir, who gave him medicine ranging from inhalers to anti-allergic.

Then somebody advised him to visit a private hospital outside J&K and he was operated upon for DNS, Deviated Nasal Septum.

But his troubles were far from gone. 

 In addition, he felt like his stomach was burning, and after some months pain in legs and arms started.

With these complaints he presented to me . I am a psychiatrist.

After taking history I felt that he was suffering from somatic disorder .

I had a long conversation with him and started him on anti depressants .

He initially was reluctant to accept it but somehow he agreed to start the treatment.

He had gradual improvement and is following our clinic.

It was a somatic disorder. It was all in his mind.

Well this is one example , in many cases the predominant complaint is persistent and distressing pain, like backache or headache.

Often patient complains of self-diagnosed sexual weakness and by the time patient reaches a qualified counselor or psychiatrist, the patient would have spent lakhs of rupees on treatment from magical herbal syrups to pain -killers, that give no relief.

These unexplained stomach, bone and joint pain where investigations are normal are known as  SOMATIC DISORDERS!

Other examples are :

  • feeling of a lump in throat,
  • unexplained vomiting,
  • hyper-acidity,
  • unconsciousness and
  • neurological symptoms where investigations are normal

What causes Somatic disorders ?
The symptom remains dormant as  an unconscious mental conflict, an unacceptable painful thought is repressed and emotional energy is converted to a physical symptom. In the young, the symptoms often get the patient something they wanted.

Word of caution is that  all stomach or body aches should not  be called as somatic symptoms, a good clinical assessment often rules out physical illness.

Some patients with somatoform symptoms require a primary diagnosis of major depression or schizophrenia.

The symptom occurs abruptly and frequently follows acute stress.

The disorder usually is seen first during adolescence or in 20s.

The patients often have associated moderate anxiety and depression.

Treatment
Long term psychoanalysis appears to effect real change in many patients, crucial to any therapy is formation of a supportive therapeutic alliance with a mental health professional who helps the patient to ventilate.

The counselor should explore areas of stress in the patient’s life, and start working with other members of the family.

Need of the hour is orientation and awareness regarding somatoform disorders among masses, and health professionals.

Author can be mailed at arifmaghribi@yahoo.com

 

 

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