ETIOLOGY OF SOMATOFORM DISORDERS
A. ETIOLOGY OF SOMATIZATION DISORDER
Patients with somatization disorder are more sensitive to physical
sensations, pay excessive attention to these sensations, or interpret them as
harmful (Kirmayer et al., 1994; Rief et al., 1998). Various kinds of physical
complaints felt by patients with somatization disorder are a manifestation of
unrealistic anxiety in the body system. When normal functioning is disrupted,
maladaptive patterns will strengthen because they generate attention and reasons
to avoid things.
B. PSYCHOANALYTIC THEORY OF CONVERSION DISORDER
Conversion disorder provided a great opportunity for Freud to explore the
concept of the unconscious, which is one of the main concepts of psychoanalysis.
In Studies in Hysteria (1895/1982), Breuer and Freud argued that conversion
disorder occurs when a person experiences an event that creates a great
emotional tension, but his affection is not expressed, and the memory of the event
is separated from the experience of consciousness.
Conversion disorders in women according to Freud's hypothesis have
their roots in the unresolved early Electra Complex. Impulses – the initial
impulses will be suppressed if the parent responds to the feelings loudly and
disapproves. In the later period of life, when the person concerned encounters an
event that happens to generate these repressed impulses and related to sexual
satisfaction, it will cause anxiety. This anxiety is transformed or converted into
physical symptoms. The primary advantage of conversion disturbances is the
avoidance of unresolved Electra Complex and of previously suppressed id
impulses. Freud revealed that there could be a secondary advantage of
conversion disorder, namely that these symptoms can make the patient avoid
unpleasant current life situations or to get attention from others.
Motivation plays a role in whether individuals will isolate behavior from
consciousness. This is evidenced by the laboratory situation of Sackeim and his
colleagues. Participants who were highly motivated to maintain blindness gave
poor results when tested with visual discrimination tasks. Meanwhile,
participants who were less motivated gave very good results, even though they
said that they were blind. According to Sackeim and his colleagues, verbal and
behavioral speech seem to unconsciously differ. Where when a person who is
hysterically blind says that he cannot see, at the same time can be affected by
visual stimuli.
C. THERAPY FOR SOMATOFORM DISORDERS
1. . Therapy for somatization disorders
• Cognitive therapy, can be used to overcome fear. Reduced pain can
help reduce various somatic complaints. But more treatment will
likely be needed, as someone who has been suffering from "illness"
for a certain period of time is accustomed to being weak and
dependent, to avoid daily challenges rather than as an adult.
• Family therapy, can be used to help change the tissue of the family
with the aim of helping the business to become independent
• Assertion and social skills training is used to effectively practice
making social contacts such as approaching and initiating
conversations with others, maintaining eye contact, giving
compliments, receiving criticism, and making requests. This can be
beneficial to help him master different ways to relate to others and
overcome various challenges
• Doctors play a role in minimizing the use of various diagnostic tests
and administering medications, maintaining contact with patients
regardless of whether the patient complains of a disease or not. An
approach that can also be taken is to direct patients' attention to the
sources of anxiety and depression that may be underlying the
unexplained somatic symptoms and not to allow them to focus too
much on mild and harmless aches and pains.
• Biofeedback, which includes the control of physiological processes,
which effectively reduces destructive thoughts in patients suffering
from somatoform disorders. Biofeedback is that people can control
behaviors that are generally considered to be out of control, such as
heart rate and skin temperature, if they are invented to provide
feedback on the behavior. Thus in order to teach a person how to raise
their skin temperature, we must be able to tell them whether their skin
temperature is rising, or when a person with high blood pressure may
have to change his or her tense and ambitious lifestyle before he or
she can lower his blood pressure significantly
2. Therapy for Hypochondriasis
In general, the cognitive-behavioral approach has been proven to be
effective in reducing various hypochondriasis problems. Cognitive-
behavioral therapy can be aimed at restructuring pessimistic thinking. In
addition, management can include several strategies such as directing the
patient's selective attention to physical symptoms and not encouraging the
patient to seek medical certainty that he or she is not sick.
3. Therapy for pain
Effective management tends to consist of the following:
a. Validate that the pain is real, and not just in the patient's mind
b. Relaxation training
c. Rewarding the student for behaving in a way that is not compatible with
pain (enduring pain)
Psychodynamic body therapy, effective for reducing the pain experienced
by patients and maintaining favorable outcomes over a long period of time.
Low doses of some antidepressants, especially imipramine (Tofranil), have
higher benefits than placebo for reducing chronic pain and dysstress. In
general, patients need to be directed to shift their focus away from things that
patients cannot do due to their illness and even teach patients how to cope
with stress, encourage more activity, and improve self-control, regardless of
physical limitations or discomfort experienced by patients.
