Dr. Claudiu Ionescu, psychiatrist, doctor of medicine, university lecturer at the "Carol Davila" Faculty of Medicine and Pharmacy, Bucharest, continues to offer us in the second part of the article dedicated to somatization explanations regarding this medical problem, but especially available solutions to prevent and combat somatization.
Don't forget! If you have questions about somatization and feel the need to talk to a specialist, you can schedule an online consultation with one of the psychiatrists available on the Digital Clinics platform.
Psychiatrist Claudiu Ionescu says that a non-psychiatrist, who patients most often turn to when they choose to go for consultations, can realize that it is somatization by paying attention to the following things:
• The symptoms are atypical and cannot fit into a certain pattern;
• They are influenced by certain adverse life events;
• The doctor finds that he can make a correlation with the patient's emotional states that may maintain or precede somatization;
• And perhaps the most important signal – the patient's investigations and analyzes are within normal parameters.
If the doctor takes an anamnesis, a history of the person in question could thus find out some stressful episodes in his life and correlate them with the psycho-emotional causes that may underlie somatization. This is why non-psychiatrists need to look a little beyond the physical and organic causes of certain symptoms.
Before applying any kind of treatment, the psychiatrist will first make a classification of the type of somatization as accurately as possible, so that he can then proceed to the actual treatment. "If. for example. the symptoms are persistent as a result of a medical illness with detectable biomedical causes, then the first treatment is that specific to the underlying condition from which the somatic symptoms began. If the somatic symptoms coexist with anxiety-depressive disorders, the basic treatment is that of the comorbid anxiety-depressive disorders. There are also somatic disorders in their own right, in which case, the specific treatment for them, according to the guidelines in addressing physical symptoms, is the way in which we provide an explanation and a basic framework for patients. It seems that the explanatory model, that is, the fact that we validate the patient's subjective experience of pain or discomfort, represents the first step towards treatment. That is, we do not tell him – It's all in your head!, You need to relax. – such an approach invalidates a subjective experience, creates frustration and distances him from treatment. Therefore, communication must be centered on the patient's needs with reassurances and validations, appropriate explanations and the provision of a specific explanatory model. Basically everything I have listed must be personalized so that the patient understands a little how he came to present symptoms that seem to have no medical explanation. It must also be explained to him how individual perception modulates persistent physical symptoms in the long term and that the goal is not to slow down the progression of symptoms but to manage them, to control them with the possibility of changing the perception of them so as not to create dysfunctional expectations about what may happen later, if it will be a long-term condition, without treatment. The first step in treatment is therefore this delivery of a personalized biopsychosocial explanatory model”, says doctor Ionescu.
For cases in which it is a question of psychiatric comorbidities with somatization, in such cases their treatment involves supportive counseling, to which psychotropic medications, antidepressants to improve the symptoms or pain felt strongly by the patients are added. “Most of the time when they do not respond to treatment, an integrative treatment is applied, associations of psychotherapy, physical therapy, body-oriented therapy, cognitive behavioral therapy, etc.”
In short, patients should not expect to get rid of somatization forever and be completely cured, they must have realistic expectations and learn through personalized techniques, adapted to each patient, to manage these somatic symptoms so that their life is as good as possible and to integrate the symptoms as part of their experience, not as a disorder that they want to get rid of completely.
It is very difficult to prevent the appearance of somatization, but we can prevent the maintenance and worsening of somatic symptoms:
• We must learn to live with our emotions, not to hide them under the rug;
• Most of the time, somatic symptoms are subtle signals through which our mind or body tries to convey to us that they are under stress. That is why we must learn to manage stress, to make lifestyle changes – from nutrition, to sleep, interpersonal relationships, physical effort, in other words to give a "reset" to our lives.
• And there is something else! We must learn to say "no" in everyday life, that is, to shake off the savior syndrome, which is always attentive to the needs of others, not to our own needs.
