Somatic symptom disorders

Somatic symptom disorders.

Somatic symptom disorders are characterized by physical symptoms that have insufficient medical explanation. They are often the result of unconscious psychic conflicts, maladaptive defenses and difficulties in processing emotions.

According to the psychoanalytic model, somatic symptoms can be interpreted as the result of somatic conversion of psychic conflicts. This dynamic is particularly evident in patients with a limited ability to mentalize, that is, to recognize and verbalize their emotions. In these cases, the body becomes the preferred site for expressing unprocessed internal tensions.

Defense mechanisms play a role in the genesis and maintenance of somatoform disorders. Among the most common are:

• Conversion: unconscious conflicts are transformed into physical symptoms, as occurs in conversion hysteria.
• Somatization: painful emotions are expressed through the body instead of through thought and language.
• Splitting and dissociation: in some cases, the patient may develop a split between mind and body, with a sense of estrangement from their symptoms.

Patients with somatic disorders have different characteristics depending on their level of personality functioning.

• Neurotic personality: despite somatic symptoms, tends to maintain good contact with reality.
• Borderline personality: may present somatic symptoms in a context of emotional dysregulation and relational instability.
• Psychotic personality: in severe cases, somatic symptoms may be part of a larger delusional construct.

Hypochondria

Hypochondria, also known as illness anxiety disorder, is one of the most common somatic disorders. It is a condition in which the patient manifests excessive and persistent concern for his or her health, interpreting normal bodily sensations as signs of serious illness. From a psychoanalytic perspective, this condition can be interpreted as:

• An expression of unprocessed anxiety shifted to the body to avoid deeper emotional conflict.
• A form of defense against feelings of vulnerability and fear of abandonment, with the symptom becoming a way of demanding attention and reassurance.
• A manifestation of unconscious anguish related to childhood experiences of illness or loss, with the body assuming the role of trauma repository.

In hypochondriac patients, the compulsive search for medical confirmation and the need for reassurance are central elements, but anxiety often does not subside even after negative medical examinations. Psychoanalytic treatment aims to explore the unconscious roots of fear of illness, helping the patient tolerate uncertainty and develop more adaptive ways of coping with anxiety.

The psychoanalytic treatment of somatic disorders

The psychoanalytic approach to the treatment of somatic symptom disorders is based on several strategies:

• Interpretation of symptoms: helping patients understand the unconscious meaning of their physical complaints.
• Mentalization and symbolization: fostering the patient’s ability to express emotional distress through language rather than through the body.
• Support for emotional regulation: especially in patients with borderline organization, the therapeutic focus may be on managing affectivity and the relationship with one’s body.

In conclusion, somatic symptom disorders pose a diagnostic and therapeutic challenge because they require an approach that integrates biological, psychological and relational aspects. It is important to set up therapeutic work that enables the patient to recognize, process, and express his or her emotional world without having to resort to the body as the only means of communication.

Lo Studio of Psychology, Psychotherapy Dr. Pedrazin is located in Milan, via Procaccini 11; the doctor receives in the office and online.