Somatisation

Question 1

What is somatisation?

Answer 1

A subconscious process by which emotional stress is expressed as physical (somatic) symptoms.

Question 2

Chronic somatiser examples:

Answer 2

• IBS
• Chronic fatigue syndrome
• Fibromyalgia
• Non-cardiac chest pain

Question 3

Are symptoms real on somatisation?

Answer 3

Yes

In this the symptoms are “real” not made up or imagined.

It is common and is associated with excessive use of healthcare e.g. 30% of GP visits.

Question 4

Common somatised symptoms?

Answer 4

• Chest/back pain
• Fatigue
• Dizziness
• Headache
• Dysphonia
• Weakness
• Numbness/tingling

Question 5

Predisposing factors (factors putting patient at risk of problem)?

Answer 5

• Childhood illness coupled with lack of parental care.
• Physical illness in family member e.g. non-cardiac chest pain/family history of MI.
• Genetics

Question 6

Precipitating factors (factors that further trigger current events)?

Answer 6

• Stressful events
• Minor injury
• Psychiatric illness e.g. anxiety/depression

Question 7

Perpetuating factors (factors that maintain the problem once it’s started)?

Answer 7

• Inconsistent / ambiguous medical advice
• Family / spouse collusion
• Threat of withdrawal of social benefits
• Involvement in litigation
• Fear of disease

Question 8

Chronic somatisation consequences?

Answer 8

Over-investigation / iatrogenic illness, e.g. surgery.
Repeated hospitalisations.
Misuse of prescribed drugs, e.g. opioids.
Inability to work / invalidism / financial difficulties.
Family / relationship breakdown.
Deterioration in doctor / patient relationship, e.g. repeated requests for “second opinions”, “more tests”.

Question 9

What is functional neurological disorder (FMD)?

Answer 9

One or more neurological symptoms unexplained by any specific disease process affecting nervous system.

Question 10

Motor symptoms associated with FMD?

Answer 10

Weakness or paralysis

Tremor

Gait abnormalities

Abnormal limb posturing

Question 11

Sensory symptoms associated with FMD?

Answer 11

Altered/absent skin sensation

Double vision

Reduced or absent speech

Visual field abnormalities

Functional weakness of lower limb e.g. positive hoovers sign.

Question 12

What is a +ve hoover sign?

Answer 12

Patient unable to extend hip and press heel into bed on request.

Question 13

Treatment options for somatisation?

Answer 13

Screen for depressive / anxiety disorder

Consider antidepressants

Psychological treatment - explore illness beliefs
- manage emotional symptoms

Physiotherapy - Prevent deconditioning

www.neurosymptoms.org