Somatoform Disorders

The Biological Perspective: Brain Dysfunction
 People with somatoform disorders tend to have family histories of somatic complaints
 A genetic study conducted by Guze and colleagues on somatization disorders revealed that:
o Women – increased frequency of somatization disorder
o Men – increased frequency of antisocial personality disorder which is the chronic indifference to the rights of others (Holder Perkins & Wise, 2001)
 Base on their study, Somatization Disorder and Antisocial Personality Disorder are seen together and observed more frequently in the same person
 These finding led to the hypothesis that Somatization Disorder and Antisocial Personality Disorder may be the product of similar genetic endowment and what determines whether a person with this endowment will develop Somatization Disorder or Antisocial Personality Disorder is his or her sex (Guze, Cloninger, Martin,
et.al.1986; Lilienfeld, 1992).
 In order to strengthen this hypothesis, a twin study (Torgersen, 1986) was conducted in Norway revealed the following:
 Monozygotic twin (identical twins) has higher concordance rate for somatoform disorder than Dizygotic twin (fraternal)
 MZ twins shared more similar genotypes and environments that DZ twins
o An adoption study in Sweden was made wherein researchers tracked down the medical and criminal histories of 859 women with somatization disorders
a) High frequency somatizer (frequent somatic complaints, few kinds of complaints)
b) Diversiform somatizer ( less frequent complaints, more diverse nature)
 Biological fathers of high frequency somatizers = high rates of alcoholism
 Biological fathers of diversiform somatizers = high rates of violent crime
(Bohman, Cloninger, von Knorring, et. al., 1984; Cloninger, Sigvardsso, von Knorring et. al. 1984)
 These supports and strengthen the suggestion that there is a genetic factor in somatization disorder and this factor is somehow linked to antisocial behaviour (Lilienfeld, 1992)

Brain Dysfunction and Somatoform Disorders
 Test of brain waves in people with conversion anaesthesias, blindness and deafness clearly indicate that these patients’ brains are receiving normal sensory input from their “disabled” organs
 “Imaging Shows Brain Changes in Conversion Disorder Patients “
 Dr. Selma Aybek of Geneva University in Switzerland studied 25 subjects (12 patients with conversion disorder and 13 control subjects) and made use functional MRI imaging to visualize the brains of the subjects while the subjects were asked to recall personally traumatic events. The researchers then compared the brain activity of the conversion disorder and control groups
 Results:
1. conversion-disorder subjects showed increased dorsolateral prefrontal cortex activity, decreased hippocampus activity, enhanced connectivity between the amygdala and the supplementary motor area (SMA), and increased supplementary motor area and temporoparietal activity (TPJ).
2. when the conversion-disorder subjects showed excess activity in the dorsolateral prefrontal cortex, it may have reflected the strong emotions that they felt about the traumatic events. At the same time, they showed little activity in the hippocampus, which may have reflected their efforts to repress memories of the traumatic event.
3. enhanced connectivity between the amygdala and motor areas suggested that subjects’ emotional pain was not completely repressed and continued to influence their motor areas. And finally, the excess activity in the supplementary motor area and temporo-parietal junction may have signaled conversion of their emotional pain into physical symptoms.
4. Also, the researchers noted, the temporo-parietal junction is known to influence bodily selflocation, self-consciousness, and self-person perspective, thus likely playing a key role in out-of body experiences.
 Presumably the problem lies in the processing of sensory signals in the cerebral cortex which will bring signals to conscious awareness
 Conversion patients suppress some cerebral processing (Marsden, 1986) and revealed high levels of inhibitory action in the cerebral cortex in response to sensory stimuli
 Hypoxia : oxygen deprivation and Hypoglycemia : low blood sugar can bring on

Conversion symptoms
 Whatever the processing problem is, it may be mimicked under Hypnosis.
 One functional imaging study found that the areas of the brain activated by paralysis induced by hypnosis were similar to those activated by paralysis in conversion disorder (Oakley, 1999; Halligan, Athwal, Oakley, et.al., 2000)
 Lateralization (difference between left and right hemisphere) also contributes in somatoform disorder.
 In a study of 61 patients with somatoform disorders, anxiety and depressive disorders, somatic symptoms and pain occurred more often on the left side of the body (Mim & Lee, 1997).
 Left side of the body is controlled by the right side of the brain (contralateral) which suggest that somatoform disorders may stem from dysfunction in the right cerebral hemisphere (Flot-Henry, Fromm-Auch, Tapper, et. al., 1981; James, Singer, Zurynski, et. al.,1987)

Drug treatment
 selective serotonin reuptake inhibitors (SSRI) such as Prozac and Zoloft show greater improvement than with norepinephrine reuptake inhibitor (Hollander, Allen, Kwon, et. al., 1999)
 SSRIs are effective with hypochondriacs and body dysmorphic while tricyclic antidepressants have been found effective in decreasing subjective ratings of pain for pain disorder (Wilson & Gil, 1996).

Source:
Alloy, L.B., Riskind, J.H., & Manos, M.J. (2005). Abnormal Psychology: current perspectives. 9th Edn. Tata McGraw-Hill: New Delhi, India

Aybek, S.,et.al. (2014). Neural Correlates of Recall of Life Events in Conversion. JAMA Psychiatry. January 2014, Vol 71, No.1.

Arehart-Treiche, Joan (Jan 2014). Imaging Shows Brain Changes in Conversion Disorder Patients. Retrieved from psychnews.psychiatryonline.org/doi/full/10.1176%2Fappi.pn.2014.1a2

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