How to distinguish between psychosomatic disorders, somatoform disorders, malingering, and factitious disorders.
Were your school day memories filled with stomach aches? Have you suddenly fallen ill just before a big office presentation? Do you feel woozy whenever the big boss comes in your office for a peek? Before you dub these as just “all in your mind” and are only psychosomatic, let me tell you that you are only halfway correct – these symptoms are not necessarily figments of your imagination.
The Real Deal on Psychosomatic Illnesses
A psychosomatic illness consists of an actual and medically-measurable physical illness that is aggravated by psychological factors. For example, stress has been proven to lead to a dozen health problems including coronary heart disease and a weakened immune system (Nolen-Hoeksema, 2008). Sleep disorders also work the same way when they deprive the body of needed rest.
What this means is that a psychosomatic illness can be tested and can be documented via medical means. Psychosomatic illnesses are not imaginary and can be verified by a third party. Symptoms that are psychosomatic are not just “all in one’s mind”, illuminating its appropriate definition.
It is interesting to point out though that the means of evaluation is limited by medical convention. If there is no evaluative measure that can help corroborate your complaint, then a doctor might be more inclined to write it off as fictitiously psychological. This is not necessarily a problem of expertise but is a consequence of the sociology of health: doctors and patients just have different concepts of ill-health (Smithson, 2005). For patients, being ill is a subjective feeling of discomfort while doctors think in terms of giving a diagnostic label. If the ailment is not in a particular doctor’s repertoire then there is a probability that you need to get a second opinion.
A Quick Look at Somatoform Disorders
Of course, there are instances in which a set of symptoms is entirely subjective, hence the label somatoform disorder. It is a common misconception for people to dub something as psychosomatic when they actually mean that it’s somatoform. Somatoform disorders are a group of mental disorders in which people have subjective feelings of illness that are seemingly untestable by medical means. These disorders are deemed pathological in nature and exhibit symptoms that are not really expected of the average individual.
There are five types of somatoform disorders that we should be aware of: (1) conversion disorder; (2) somatization disorder; (3) pain disorder; (4) hypochondriasis; and (5) body dysmorphic disorder. Keep in mind that the diagnosis of each requires consultation from a professional clinician; self-diagnosis is not recommended. Conversion disorder happens when you feel that you’ve lost the use of a body part but no medical or physical reason can explain it. Somatization disorder is characterized by a history of medical complaints that have no organic reason. Pain disorder is similar to somatization disorder but is limited only to the subjective feeling of pain. Hypochondriasis is exhibited through a constant worry of physical that leads to frequent seeking of medical attention. Body dysmorphic disorder is an extreme preoccupation with a body part in which a person deems as lacking or defective.
Some Related Disorders
Although not necessarily pathological in nature, there are related disorders to somatoform illnesses that we should also take note of. Have you “faked a fever” so you didn’t have to go to school? When we deliberately fake physical symptoms of illness to avoid something unpleasant we call it malingering. On the other hand, faking physical illness to gain medical attention is called factitious disorder, or Munchhausen’s syndrome. This happens when a person, for subjective reasons, always wants to “feel sick” just to get attention. A more sinister version of this is called factitious disorder by proxy, in which a parent creates illnesses for their children so that they could get people’s attention.
Putting It All Together
How do we best remember the differences among the disorders that were discussed? To distinguish between psychosomatic and somatoform, just remember that the former depicts actual physical illness while the latter is only a subjective experience. When we say that something is psychosomatic, you feel woozy and a doctor can determine that you have a physical symptom from it, high-blood pressure for example.
To differentiate between malingering and factitious disorder, just remember that malingering is all about getting away from a situation while factitious disorder is about getting attention. Well-crafted stomachaches just to play hooky is malingering, while dramatizing an upset stomach so you feel cared-for is factitious.
Now that you’re armed with this knowledge, the next time you feel woozy about your boss or anxious about your big presentation, at least you already know what it all means.
Smithson, R. (2005). AQA AS Health and Social Care. Philip Allan Publishers, Ltd.
Nolen-Hoeksema, S. (2008). Abnormal Psychology: 4th Edition. McGraw-Hill College.
Saddock, B.J. & Saddock, V.A. (2003). Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry: 9th Edition. Philadelphia, USA: Lippincott Williams and Wilkins.