Somatización y trastornos funcionales

What is somatisation?

Somatisation is a word that means that the symptoms that you are experiencing are not due to a specific disease process but are caused by other biological, social or psychological factors.

Although the word somatisation still means the same thing as it always used to, the conditions that used to be referred to as somatoform are now more commonly referred to as functional.

There are a very wide range of symptoms that can be caused by somatisation or functional disorders. They include (but are not limited to):

• Dolor.

• Dolor de cabeza.

• Fatiga.

• Mareo.

• Náuseas.

• Vómitos.

• Fainting.

• Seizures or seizure-like activity.

These symptoms can all be caused by diseases - for example, anaemia can make you more likely to faint, arthritis can cause pain or epilepsy can cause seizures. However all these symptoms can also be caused by a complex interaction of biological, social and psychological factors - these are then referred to as functional symptoms.

Somatisation itself is extremely common and something that we all experience from time to time. We all recognise that sometimes when we feel stressed we feel more tired or get a headache. This physical symptom is caused by a condition that arises in the mind.

Somatoform or functional disorders are less common (though not uncommon). They are more complex than simple somatisation.

How can the mind cause physical symptoms?

The relationship between the mind and body is complex and not fully understood. However, we all recognise (even without noticing) the relationship between the mind and the body on a daily basis. For example, when we are feeling sad, our posture might change to be more droopy and our actions, such as walking, might become slower. We all recognise that the mind is used by both children and adults to learn new physical skills - for example, a toddler's mind helps it to learn to walk or to climb, an adult's mind helps it to learn to knit or ski. In a similar way, the mind can affect other aspects of our body. A mind can teach a person to develop unhelpful symptoms in just the same way as it can teach it useful physical skills.

How common is somatisation?

Es común. A veces podemos relacionar los síntomas físicos con un estrés reciente o un problema de salud mental. Por ejemplo, puedes darte cuenta de que un episodio de dolor de cuello o dolor de cabeza se debe al estrés. Ansiedad y depresión también son razones comunes para desarrollar síntomas físicos como un 'corazón palpitante' (palpitaciones) o dolores corporales. A menudo, los síntomas físicos desaparecen cuando los factores emocionales y mentales se alivian.

However, sometimes we may not realise the physical symptom is due to an emotional, psychological or social factor. We may think we have a physical disease and see a doctor about it.

Somatisation and functional symptoms

Un síntoma funcional significa que una función del cuerpo está defectuosa (por ejemplo, puede haber dolor o diarrea) pero la causa no se debe a una enfermedad que cause ese dolor o la diarrea. La causa puede deberse a factores psicológicos, sociales o biológicos.

What are functional disorders (previously known as somatoform)?

Los trastornos funcionales están en un extremo de la escala de somatización. Así, los síntomas físicos persisten a largo plazo, o son severos y causan una discapacidad significativa, pero no hay una enfermedad física presente que explique los síntomas.

They are classed as mental health disorders but this can be unhelpful. Psychological input can often help to treat functional disorders but they cannot be solely attributed to mental health conditions such as depression or anxiety. There is often a complex relationship between emotional, psychological, social and biological factors that lead to a functional disorder.

Puede ser difícil aceptar que los síntomas lo suficientemente graves como para afectar nuestra calidad de vida puedan deberse a un trastorno funcional. Cuando el dolor es muy severo, es completamente racional asumir inicialmente que ese dolor debe deberse a una causa física como la artritis, el cáncer o una lesión.

However one of the common misunderstandings about functional disorders is that they are less severe or less significant than symptoms that are caused by disease. This is not the case. However, understanding that the symptoms are caused by a functional disorder is key to being able to manage and treat those symptoms effectively.

Functional disorder

People with this disorder may have a variety of symptoms and signs. These include, but are not limited to:

• Dolores de cabeza.

• Sentirse enfermo (nauseabundo).

• Dolor abdominal.

• Bowel problems, particularly diarrhoea.

• Tiredness and fatigue.

• Fainting or seizures.

• Problemas sexuales.

• Mareo.

• Weakness of the limbs.

• Hoarse voice or "lost" voice.

No hay una única causa de los trastornos funcionales. A menudo hay una interacción compleja entre factores sociales, psicológicos y biológicos.

Our brains are constantly affected by sensations. For example, when you are sitting in a chair, many parts of your body are being touched by the different parts of the chair. When you have a minor injury to your leg, your leg will hurt as it is recovering. When you are working and there are children playing in the park outside, they are making noises that your ears can hear. However, our brains are good at filtering out some of these things. We are not usually aware of the feeling of the chair pressing on parts of our back and legs. We often can forget about the leg pain until something brings it to our attention. We can often block out noises so that we can concentrate on our work.

It is likely that, for some reason, functional disorders tend to start when the brain starts to notice certain normal biological symptoms but perceives them as abnormal or strange.

For example, many of us might feel nauseous or light-headed if we have not eaten for some hours. We all will experience tiredness and pains in our legs if we have been for a long walk. We may notice that our voice is weaker than normal when we have a sore throat or cold. Usually we recognise these symptoms as normal and can see that they will pass if we eat some food, have a rest or wait for the cold to pass.

Sin embargo, a veces nuestros cerebros dejan de tratar estas sensaciones o síntomas como normales y comenzamos a ser muy conscientes de ellos. Puede haber razones particulares para esto. Si un miembro de la familia ha sido diagnosticado recientemente con una afección cardíaca, entonces podríamos ser más conscientes de los latidos de nuestro corazón cuando nos sentimos un poco ansiosos y podríamos ser más propensos a pensar que estas "palpitaciones" son peligrosas. Si conocemos a alguien con diabetes, podríamos ser más conscientes de las sensaciones de náuseas o mareos cuando no hemos comido.

Sometimes there are no obvious reasons for the changes in the way our brain is reacting. This may be more common in situations where someone has very severe pain but where there is no underlying physical cause for that pain.

Trastorno neurológico funcional

Previously known as conversion disorder, functional neurological disorder (or FND) is a condition where a person has neurological symptoms, such as:

• Total loss of vision (severe sight impairment).

• Deafness.

• Weakness, paralysis or numbness of the arms or legs.

• Seizures or seizure-like activity.

These might normally suggest a disease of the brain or nerves (a neurological disease) but all the tests for disease are normal. The findings on examination tend to make it clear that a disease is not the cause because the examination findings tend to not make sense anatomically or biologically.

Pain disorder

Pain disorder is a condition where a person has a persistent pain that cannot be attributed to a physical disorder.

Who gets functional disorders and what causes them?

Los trastornos funcionales pueden afectar a cualquier persona de cualquier edad. Son más comunes en mujeres que en hombres y ligeramente más comunes en edades más jóvenes. El número exacto de personas afectadas es difícil de determinar.

It is not clear why some people develop functional disorders. Genetic makeup and environmental factors both probably play a part. Genetic makeup is the material inherited from your parents which controls various aspects of your body. This genetic makeup combined with factors such as how you were brought up, your parental and peer influences, etc, may all contribute. There are also social factors which can affect how likely someone is to develop a functional disorder - for example, they have been shown to be more common in some asylum-seeking populations in certain countries.

El abuso de alcohol y drogas es más común en personas con trastornos neurológicos funcionales. Sin embargo, no hay evidencia de que el uso de alcohol y drogas causes FND. Es más probable que algunas personas recurran al alcohol u otras drogas para aliviar el malestar de sus síntomas somáticos. Desafortunadamente, el exceso de alcohol o drogas ilícitas puede empeorar los síntomas.

What is the treatment for functional disorders?

It can be difficult for a doctor to diagnose functional disorders. This is because, even if the symptoms do not fit well with a disease process, it can be difficult to be absolutely sure of this without tests. People with functional disorders tend to be referred to various specialists, and have many tests and investigations before the diagnosis is made. Unfortunately, some of the tests that are done can be potentially harmful and increase the likelihood of disease in the future (for example, chest cancers from multiple CT scans or chest x-rays).

People with functional disorders can find it a difficult diagnosis to accept as people often misunderstand the diagnosis as meaning less severe, less significant or even that it is "made up". This is absolutely not the case - functional disorders can have symptoms just as severe or more severe than symptoms caused by disease, but it can be hard to understand. Media stories about functional disorders often talk about "mystery syndromes" as though there is an underlying disease process that we just haven't found yet. This can also make it hard to accept the diagnosis.

There is good evidence that psychological treatment works well to treat functional disorders. Cognitive behavioural therapy which tries to reframe the way that our brains react to symptoms or triggers has been shown to be effective at managing short-term and long-term symptoms.

La medicación no tiene un papel importante, pero a veces puede ayudar con la ansiedad o depresión subyacente. Algunas condiciones específicas, como el trastorno de dolor, han sido ayudadas por medicamentos llamados inhibidores selectivos de la recaptación de serotonina (ISRS). Normal painkillers are not of much benefit with a functional pain syndrome.

Books about functional disorders

There is a neurologist called Suzanne O'Sullivan who works with people with functional disorders and who has written books which can help explain functional disorders in much more detail.

These books are called "It's All in Your Head" and "The Sleeping Beauties" and are highly recommended as further reading.