Predisposing Factors for Somatoform Disorders

The patient with a somatoform disorder complains of physical signs and symptoms and typically travels from physician to physician in search of treatment. Physical examinations and laboratory tests can’t uncover an organic basis for the patient's signs and symptoms, nor are the somatic symptoms due to the effects of alcohol or recreational or prescription drugs. They're prevalent in 5% of the primary practice and include a variety of conditions that differ in symptoms and whether they're intentionally produced.

Predisposing Factors for Somatoform Disorders

Psychosocial

• Psychodynamic: Some psychodynamicists view hypochondriasis as an ego defense mechanism. They hypothesize that physical complaints are the expression of low self-esteem and feelings of worthlessness, and that the individual believes it is easier to feel something is wrong with the body than to feel something is wrong with the self. The psychodynamic theory of conversion disorder proposes that emotions associated with a traumatic event that the individual cannot express because of moral or ethical unacceptability are “converted” into physical symptoms. The unacceptable emotions are repressed and converted to a somatic hysterical symptom that is symbolic in some way of the original emotional trauma.
• Family Dynamics:  Some families have difficulty expressing emotions openly and resolving conflicts verbally. When this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child’s illness, leaving unresolved the underlying issues that the family cannot confront openly. Thus, somatization by the child brings some stability to the family, as harmony replaces discord and the child’s welfare becomes the common concern. The child in turn receives positive reinforcement for the illness.
• Sociocultural/Familial Factors:  Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it be within society or within the family. When the sick person is allowed to avoid stressful obligations and postpone unwelcome challenges, is excused from troublesome duties, or becomes the prominent focus of attention because of the illness, positive reinforcement virtually guarantees repetition of the response.
• Past Experience with Physical Illness: Personal experience, or the experience of close family members, with serious or lifethreatening illness can predispose an individual to hypochondriasis. Once an individual has experienced a threat to biological integrity, he or she may develop a fear of recurrence. The fear of recurring illness generates an exaggerated response to minor physical changes, leading to hypochondriacal behaviors.
• Cultural and Environmental Factors: Some cultures and religions carry implicit sanctions against verbalizing or directly expressing emotional states, thereby indirectly encouraging “more acceptable” somatic behaviors. Cross-cultural studies have shown that the somatization symptoms associated with depression are relatively similar, but the “cognitive” or emotional symptoms such as guilt are predominantly seen in Western societies.In Middle Eastern and Asian cultures, depression is almost exclusively manifested by somatic or vegetative symptoms. Environmental influences may be significant in the predisposition to somatization disorder. Some studies have suggested that a tendency toward somatization appears to be more common in individuals who have low socioeconomic, occupational, and educational status.

Physiological

• Genetic. Studies have shown an increased incidence of somatization disorder and hypochondriasis in first-degree relatives, implying a possible inheritable predisposition (Sadock & Sadock, 2003). Genetic or familial patterns are thought to play a contributing role in primary insomnia, primary hypersomnia, narcolepsy, sleep terror disorder, and sleepwalking.
• Biochemical. Decreased levels of serotonin and endorphins may play a role in the etiology of pain disorder.
• Medical Conditions. A number of medical conditions, including sleep apnea, endocrine or metabolic disorders, infectious or neoplastic disease, and CNS lesions, have been associated with insomnia and/or hypersomnia. Neurological abnormalities, particularly in the temporal lobe, may be related to precipitation of night terrors.