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Somatization and Bodily Distress Disorder

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Abstract

Somatization refers to the formation of bodily symptoms—including pain, vegetative symptoms, and others—that do not have an appropriate medical explanation.

From a psychodynamic perspective, somatization is caused by the repression of subjectively unbearable emotions, conflicts, and memories. A neurobiological correlate of this mechanism is the altered function of the brain regions that are involved in the processing of autobiographical memory.

If intensified pain perception is the leading symptom, subjectively experienced social separation can very often be identified as a trigger mechanism. From a neurobiological point of view, this phenomenon is caused by shared neural presentations for the processing of pain and social isolation.

Keywords

Somatization Bodily distress disorder DSM-V/ICD-11 Briquet’s syndrome Alexithymia Resomatization 
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References

  1. Alexander F. Psychosomatische Medizin. Grundlagen und Anwendungsgebiete. 3. unveränderte Auflage. Berlin: Walter de Gruyter; 1977.CrossRefGoogle Scholar
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  3. Bach M, Bach D. Alexithymia in somatoform disorder and somatic disease: a comparative study. Psychother Psychosom. 1996;65(3):150–2.CrossRefGoogle Scholar
  4. Bailey PE, Henry JD. Alexithymia, somatization and negative affect in a community sample. Psychiatry Res. 2007;150(1):13–20.CrossRefGoogle Scholar
  5. Bankier B, Aigner M, Bach M. Alexithymia in DSM-IV disorder: comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression. Psychosomatics. 2001;42(3):235–40.CrossRefGoogle Scholar
  6. Bond M, Gardner ST, Christian J, Sigal JJ. Empirical study of self-rated defense styles. Arch Gen Psychiatry. 1983;40(3):333–8.CrossRefGoogle Scholar
  7. Browning M, Fletcher P, Sharpe M. Can neuroimaging help us to understand and classify somatoform disorders? A systematic and critical review. Psychosom Med. 2011;73(2):173–84.CrossRefGoogle Scholar
  8. Burba B, Oswald R, Grigaliunien V, Neverauskiene S, Jankuviene O, Chue P. A controlled study of alexithymia in adolescent patients with persistent somatoform pain disorder. Can J Psychiatr. 2006;51(7):468–71.CrossRefGoogle Scholar
  9. Bushnell MC, Duncan GH, Hofbauer RK, Ha B, Chen JI, Carrier B. Pain perception: is there a role for primary somatosensory cortex? Proc Natl Acad Sci U S A. 1999;96(14):7705–9.CrossRefGoogle Scholar
  10. Casey KL. Forebrain mechanisms of nociception and pain: analysis through imaging. Proc Natl Acad Sci U S A. 1999;96(14):7668–74.CrossRefGoogle Scholar
  11. Coghill RC, McHaffie JG, Yen YF. Neural correlates of interindividual differences in the subjective experience of pain. Proc Natl Acad Sci U S A. 2003;100(14):8538–42.CrossRefGoogle Scholar
  12. Coghill RC, Sang CN, Maisog JM, Iadarola MJ. Pain intensity processing within the human brain: a bilateral, distributed mechanism. J Neurophysiol. 1999;82(4):1934–43.CrossRefGoogle Scholar
  13. Craig AD. Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci. 2003;26:1–30.CrossRefGoogle Scholar
  14. de Greck M, Bölter AF, Lehmann L, Ulrich C, Stockum E, Enzi B, Hoffmann T, Tempelmann C, Beutel M, Frommer J, Northoff G. Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy. Front Hum Neurosci. 2013;7:410.CrossRefGoogle Scholar
  15. de Greck M, Scheidt L, Bölter AF, Frommer J, Ulrich C, Stockum E, Enzi B, Tempelmann C, Hoffmann T, Han S, Northoff G. Altered brain activity during emotional empathy in somatoform disorder. Hum Brain Mapp. 2012;33(11):2666–85.CrossRefGoogle Scholar
  16. de Greck M, Scheidt L, Bölter AF, Frommer J, Ulrich C, Stockum E, Enzi B, Tempelmann C, Hoffmann T, Northoff G. Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder. World J Biol Psychiat. 2011;12(4):296–308.CrossRefGoogle Scholar
  17. Duddu V, Isaac MK, Chaturvedi SK. Alexithymia in somatoform and depressive disorders. J Psychosom Res. 2003;54(5):435–8.CrossRefGoogle Scholar
  18. Egloff N, Cámara RJ, von Känel R, Klingler N, Marti E, Ferrari ML. Hypersensitivity and hyperalgesia in somatoform pain disorders. Gen Hosp Psychiatry. 2014;36(3):284–90.CrossRefGoogle Scholar
  19. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An fMRI study of social exclusion. Science. 2003;302(5643):290–2.CrossRefGoogle Scholar
  20. Ermann M. Psychosomatische Medizin und Psychotherapie. 5. überarbeitete Auflage. Stuttgart: W. Kohlhammer GmbH; 2006.Google Scholar
  21. Gardini S, Cornoldi C, De Beni R, Venneri A. Left mediotemporal structures mediate the retrieval of episodic autobiographical mental images. NeuroImage. 2006;30(2):645–55.CrossRefGoogle Scholar
  22. Grabe HJ, Spitzer C, Freyberger HJ. Alexithymia and personality in relation to dimensions of psychopathology. Am J Psychiatry. 2004;161(7):1299–301.CrossRefGoogle Scholar
  23. Gupta A, McBeth J, Macfarlane GJ, Morriss R, Dickens C, Ray D, Chiu YH, Silman AJ. Pressure pain thresholds and tender point counts as predictors of new chronic widespread pain in somatising subjects. Ann Rheum Dis. 2007;66(4):517–21.CrossRefGoogle Scholar
  24. Hansell S, Mechanic D. Introspectiveness and adolescent symptom reporting. J Hum Stress. 1985;11(4):165–76.CrossRefGoogle Scholar
  25. Hiller W, Rief W. Why DSM-III was right to introduce the concept of somatoform disorders. Psychosomatics. 2005;46(2):105–8.CrossRefGoogle Scholar
  26. Landa A, Peterson BS, Fallon BA. Somatoform pain: a developmental theory and translational research review. Psychosom Med. 2012;74(7):717–27.CrossRefGoogle Scholar
  27. Landgrebe M, Barta W, Rosengarth K, Frick U, Hauser S, Langguth B, Rutschmann R, Greenlee MW, Hajak G, Eichhammer P. Neuronal correlates of symptom formation in functional somatic syndromes: a fMRI study. NeuroImage. 2008;41(4):1336–44.CrossRefGoogle Scholar
  28. Loughead JW, Luborsky L, Weingarten CP, Krause ED, German RE, Kirk D, Gur RC. Brain activation during autobiographical relationship episode narratives: a core conflictual relationship theme approach. Psychother Res. 2010;20(3):321–36.CrossRefGoogle Scholar
  29. Macdonald G, Leary MR. Why does social exclusion hurt? The relationship between social and physical pain. Psychol Bull. 2005;131(2):202–23.CrossRefGoogle Scholar
  30. Mai FM. The forgotten avant-garde. Trends Neurol Sci. 1982;5:67–8.CrossRefGoogle Scholar
  31. Martin JH. Neuroanatomy: text and atlas. 3rd ed. New York: McGraw-Hill Medical Publishing Division; 2003.Google Scholar
  32. Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, Joukamaa M. Alexithymia and somatization in general population. Psychosom Med. 2008;70(6):716–22.CrossRefGoogle Scholar
  33. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.CrossRefGoogle Scholar
  34. Mentzos S. Lehrbuch der Psychodynamik. Die Funktion der Dysfunktionalität psychischer Störungen. 2. Auflage. Göttingen: Vandenhock und Ruprecht; 2009.Google Scholar
  35. Morschitzky H. Somatoforme Störungen. Wien: Springer; 2007.Google Scholar
  36. Nakao M, Barsky AJ. Clinical application of somatosensory amplification in psychosomatic medicine. Biopsychosoc Med. 2007;1:17.CrossRefGoogle Scholar
  37. New York Times. Dr. Franz Alexander, 73, dies. New York Times; 1964.Google Scholar
  38. Nickel R, Egle UT. Psychological defense styles, childhood adversities and psychopathology in adulthood. Child Abuse Negl. 2006;30(2):157–70.CrossRefGoogle Scholar
  39. Panksepp J, Bishop P. An autoradiographic map of (3h)diprenorphine binding in rat brain: effects of social interaction. Brain Res Bull. 1981;7(4):405–10.CrossRefGoogle Scholar
  40. Price DD. Psychological and neural mechanisms of the affective dimension of pain. Science. 2000;288(5472):1769–72.CrossRefGoogle Scholar
  41. Rainville P. Brain mechanisms of pain affect and pain modulation. Curr Opin Neurobiol. 2002;12(2):195–204.CrossRefGoogle Scholar
  42. Schmeing JB, Kehyayan A, Kessler H, Do Lam AT, Fell J, Schmidt AC, Axmacher N. Can the neural basis of repression be studied in the MRI scanner? New insights from two free association paradigms. PLoS One. 2013;8(4):e62358.CrossRefGoogle Scholar
  43. Schuchart S. Berühmte Entdecker von Krankheiten. Jean-Martin Charcot begründete die moderne Neurologie. Dtsch Ärztebl Int. 2017;7:68.Google Scholar
  44. Schur M. Comments on the metapsychology of somatization. Psychoanal Study Child. 1955;10:119–64.CrossRefGoogle Scholar
  45. Shackman AJ, Salomons TV, Slagter HA, Fox AS, Winter JJ, Davidson RJ. The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat Rev Neurosci. 2011;12(3):154–67.CrossRefGoogle Scholar
  46. Svensson P, Minoshima S, Beydoun A, Morrow TJ, Casey KL. Cerebral processing of acute skin and muscle pain in humans. J Neurophysiol. 1997;78(1):450–60.CrossRefGoogle Scholar
  47. Taylor GJ. Alexithymia: concept, measurement, and implications for treatment. Am J Psychiatry. 1984;141(6):725–32.CrossRefGoogle Scholar
  48. Trepel M. Neuroanatomie. 5. Auflage. München: Elsevier Urban & Fischer; 2012.Google Scholar
  49. Vaillant GE. Adaptation to life. Boston, MA: Harvard University Press; 1977.Google Scholar
  50. Witthöft M, Hiller W. Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol. 2010;6:257–83.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Psychosomatic Medicine and PsychotherapyJohann Wolfgang Goethe University HospitalFrankfurt am MainGermany

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