Somatoform autonomic dysfunction. Somatoform dysfunction of the autonomic nervous system Somatoform disorder mcb 10

The main feature is the repeated presentation of somatic symptoms simultaneously with the insistent demands of medical examinations, despite their repeated negative results and the assurances of doctors that the symptoms are not of a somatic nature. If the patient has any physical illnesses, they do not explain the nature and severity of the symptoms or the suffering or complaints of the patient.

Excluded:

dissociative disorders (F44.-)
hair pulling (F98.4)
child form of speech [babbling] (F80.0)
lisping (F80.8)
nail biting (F98.8)
psychological and behavioral factors associated with disorders or diseases classified elsewhere (F54)
sexual dysfunction not due to organic disorder or disease (F52.-)
thumb sucking (F98.8)
tics (in childhood and adolescence) (F95.-)
de la Tourette syndrome (F95.2)
trichotillomania (F63.3)

Somatized disorder

The main features are numerous, recurring, frequently changing physical symptoms that persist for at least two years. Most patients have a long and complex history of contact with primary and specialized care services, during which many inconclusive studies and fruitless diagnostic manipulations may have been performed. Symptoms can refer to any part of the body or organ system. The course of the disorder is chronic and erratic and is often associated with impaired social, interpersonal, and familial behavior. Short-lived (less than two years) and less pronounced examples of symptoms should be classified as an undifferentiated somatoform disorder (F45.1).

Briquet's disease

Multiple psychosomatic disorder

Excludes: simulation [conscious simulation] (Z76.5)

last modified: January 1999

Undifferentiated somatoform disorder

The diagnosis of undifferentiated somatoform disorder should be made when the patient's complaints are numerous, variable and persistent, but do not satisfy the full and typical clinical picture of somatization disorder.

Undifferentiated psychosomatic disorder

hypochondriacal disorder

The most important feature is the patient's persistent concern about the possibility of having a severe, progressive disease or several diseases. The patient presents persistent somatic complaints or shows persistent concern about their occurrence. Normal, ordinary sensations and signs are often perceived by the patient as abnormal, disturbing; he usually focuses his attention only on one or two organs or systems of the body. Severe depression and anxiety are often present, which may explain additional diagnoses.

A disorder characterized by concern for one's own health

Dysmorphophobia (non-delusional)

Hypochondriacal neurosis

Hypochondria

Nosophobia

Excluded:

delusional dysmorphophobia (F22.8)
delusions fixated on the functioning or appearance of one's own body (F22.-)

Somatoform dysfunction of the autonomic nervous system

The symptomatology presented by the patient is similar to that which occurs when an organ or organ system is damaged, predominantly or completely innervated and controlled by the autonomic nervous system, i.e. cardiovascular, gastrointestinal, respiratory and genitourinary systems. Symptoms are usually of two types, neither of which indicates a disorder of a specific organ or system. The first type of symptoms are complaints based on objective signs of autonomic irritation, such as palpitations, sweating, redness, tremors, and expressions of fear and anxiety about a possible health problem. The second type of symptoms are subjective complaints of a non-specific or variable nature, such as fleeting pains throughout the body, a feeling of heat, heaviness, fatigue, or bloating, which the patient correlates with any organ or organ system.

cardinal neurosis

da Costa syndrome

gastroneurosis

Neurocirculatory asthenia

Psychogenic forms:

aerophagia
cough
diarrhea
dyspepsia
dysuria
flatulence
hiccups
deep and rapid breathing
frequent urination
irritable bowel syndrome
pylorospasm

Excludes: psychological and behavioral factors associated with disorders or diseases classified elsewhere (F54)

Persistent somatoform pain disorder

The main complaint is persistent, severe, excruciating pain that cannot be fully explained by a physiological disorder or physical illness, and which occurs in connection with emotional conflict or psychosocial problems, which allows them to be considered as the main etiological cause. The result is usually a marked increase in support and attention of a personal or medical nature. Pain of a psychogenic nature, arising in the course of a depressive disorder or schizophrenia, cannot be attributed to this rubric.

Most psychosomatic disorders are called somatoform and are considered in a separate section - F45. Somatoform disorders refers to the recurring occurrence of physical symptoms suggestive of a physical illness that is not supported by objective medical examination findings.

If physical disorders are present, they do not explain the nature and severity of the symptoms, as well as the suffering and concern of the patient. Even when the onset and persistence of symptoms is closely related to unpleasant life events, difficulties, or conflicts, the patient usually resists attempts to discuss the possibility of psychological conditioning; this may occur even in the presence of distinct depressive and anxiety symptoms. In these disorders, there is often some degree of demonstrative behavior aimed at attracting attention, as well as protest reactions associated with the inability of the patient to convince doctors of the predominantly physical nature of his disease and the need for further examinations and examinations.

^F45 Somatoform disorders

F45.0 Somatization disorder

F45.1 Undifferentiated somatoform disorder

Undifferentiated psychosomatic disorder

^ F45.2 Hypochondriacal disorders

The most important feature is the patient's persistent concern about the possibility of having a severe, progressive disease or several diseases. The patient presents with persistent somatic complaints or exhibits persistent

concern about their occurrence. Normal, ordinary sensations and signs are often perceived by the patient as abnormal, disturbing; he usually focuses his attention only on one or two organs or systems of the body.

Severe depression and anxiety are often present, which may explain additional diagnoses. A disorder characterized by concern for one's own health

Dysmorphophobia (non-delusional)

Hypochondriacal neurosis

Hypochondria

Nosophobia

F45.3 Somatoform dysfunction of the autonomic nervous system

Cardiac neurosis

da Costa syndrome

gastroneurosis

Neurocirculatory asthenia

Psychogenic forms:

Aerophagy

Dyspepsia

Dysuria

flatulence

Deep and frequent breathing

Frequent urination

irritable bowel syndrome

Pylorospasm

^ F45.30 Somatoform dysfunction of the autonomic nervous system of the heart and cardiovascular system

F45.31 Somatoform dysfunction of the autonomic nervous system of the upper gastrointestinal tract

F45.32 Somatoform dysfunction of the autonomic nervous system of the lower gastrointestinal tract

F45.33 Somatoform dysfunction of autonomic nervous system of respiratory organs

F45.34 Somatoform dysfunction of the autonomic nervous system of the urogenital organs

F45.38 Somatoform dysfunction of the autonomic nervous system of other organs

F45.4 Persistent somatoform pain disorder

Psychalgia

Psychogenic:

Backache

Headache

somatoform pain disorder

F45.8 Other somatoform disorders

Any other sensory, functional, or behavioral disturbances not due to a physical disorder. Disorders that are not mediated through the autonomic nervous system are limited to certain systems or areas of the body and have a close temporal association with traumatic events or problems.

Psychogenic (th):

Dysmenorrhea

Dysphagia, including "globus hystericus"

Torticollis

teeth grinding

^ F45.9 Somatoform disorder, unspecified

Psychosomatic disorder NOS

Psychosomatic disorders characteristic of children during the neonatal period, infancy and early childhood

(according to Isaev D.N., 2000)

infantile colic (attacks are sick in the abdomen with crying from several minutes to several hours in a child of 3-4 months);

Aerophagia (swallowing air during feeding, followed by belching in eagerly sucking children);

regurgitation (at 14-16 months, also associated with greedy ingestion of food);

anorexia (included in the structure of neuropathy, the factor of separation from the mother and other psychogenies is significant);

Perversion of appetite (usually at 2-3 years of age, consumption of coal, clay or paper, with psychosomatic genesis, great importance is attached to the rejection of the child with improper upbringing);

chewing gum, or mericism (repeated chewing of food after burping it; a symptom of neuropathy);

Changes in body weight (insufficient weight gain or obesity are characteristic of deprivation or other psychogenic factors);

constipation, or obstipation (a manifestation of depression, an obsessive fear of defecation due to its soreness or increased shyness and shyness of the child);

Encopresis (fecal incontinence due to loss or delay in the formation of control over the activity of the anal sphincter, due to neuropathic disorders following psychogenies).

Somatoform disorders- a group of mental disorders of a neurotic nature, the hallmark of which are numerous signs of somatic diseases that are not confirmed by objective clinical studies. Persons suffering from somatoform disorders tend to require more and more examinations. As a rule, they themselves try to study diseases that are accompanied by symptoms similar to those experienced by them and do not trust doctors. Often somatoform disorders are accompanied by anxiety and symptoms of depression. Traditionally, these conditions were seen as manifestations of hysteria (Bricke's syndrome, described in the 1850s); many patients are really prone to hysterical demonstration of their suffering in order to (often unconsciously) attract the attention of others.

These are physical symptoms that are not due to problems with the body, but due to stress and personal problems. A person suffers for a long time, but not a single somatic doctor (therapist, neurologist, surgeon) can make a diagnosis. The diagnosis and treatment of the disorder is carried out by a psychotherapist. With somatoform disorders, it is useless to be examined - the test results will be normal or with minor changes. The problem is in the psyche, so the psychotherapist should treat.

There is no single etiopathogenetic concept of somatoform disorders. This is partly due to the lack of strict scientific concepts that describe the process of somatization (i.e., in fact, “the process of involving somatic (vegetative, metabolic, neuroendocrine, immune, trophic) functions (dysfunctions) in one or another mental pathology and in mental reactions to verges of norm and pathology", and partly due to their clinical heterogeneity. Somatization, as a process, is limited, on the one hand, by affective states (somatic masks of depression, vegetative-somatic dysfunctions), and on the other hand, by somatic diseases closely associated with psychogenies and, in fact, psychosomatic disorders.

Symptoms

The disease manifests itself as pathological bodily sensations, which are quite difficult to differentiate. At first, such patients, most often, turn to a therapist for a consultation, but being dissatisfied with the result of the examination, they visit narrow specialists and undergo various expensive examinations. Somatic symptoms are complemented by emotional lability, anxiety, and chronically depressed mood.

During visits to specialists, such patients present many complaints, but they are inaccurate, vague and not coordinated with each other in time. It is impossible to convince such patients that all the complaints presented are not related to real diseases, but to mental factors.

A person visits various specialists trying to find a "good doctor", such patients are often hospitalized and endure many painful manipulations and even useless surgical interventions.

Behind all the patient's complaints is a mental disorder, which is revealed only during a thorough examination. In this case, the progression of the disease is not associated with heavy physical exertion and is provoked by stressful situations.

The main causes of somatoform neurosis

It is believed that somatoform disorders have a neuropsychological etiology, which is based on the fact that individuals with "somatic language" have a low threshold for tolerance of physical discomfort. In this regard, with somatoform disorders, tension is perceived by the patient as pain. This perception becomes a conditioned reflex reinforcement of pain, which, in addition to everything else, is confirmed by the patient's supposedly hypochondriacal forebodings.

The trigger in the development of the disease are some stressful situations that are of great importance for a person, such as divorce, trouble at work, and so on. Total:

Stress, conflicts, indifference of loved ones. For example, lonely old people can often suffer from the disorder. On a subconscious level, illness is a way for them to draw attention to themselves;
personality traits- the disease is more common in people who keep emotions in themselves. As a result, internal problems result in mental illness.

In people who have this disorder, medical examination results are either normal or do not explain the symptoms. However, these complaints cause excessive anxiety, and the person constantly makes appointments with doctors and takes tests. Anxious thoughts take away all the time and energy, interfere with work and life.

In somatoform disorders, symptoms include pain of any kind, interruptions in the heart, sensory disturbances, loss of strength. Manifestations are not related to a somatic disease (there is no infection or tumor in the body), but normal examination results do not reassure.

Classification

According to the International Classification of Diseases of the 10th revision (ICD-10), the disease is named in the section of mental disorders and has the code F45. At the same time, several variants of somatoform disorder are distinguished depending on the clinical manifestations:

F45.0- somatization disorder;
F45.1- undifferentiated somatoform disorder;
F45.2- hypochondriacal disorder;
F45.3- somatoform dysfunction of the autonomic nervous system;
F45.4- somatoform pain disorder.

The first three options have similar symptoms. It is based on numerous and varied complaints, often changing depending on the manifestations and localization. Vegetative symptoms are hardly noticeable because they are minimal and unstable.

There are two additional options:

F45.8 Other somatoform disorders;
F45.9 Somatoform disorder, unspecified.

1. Somatization disorder- a person has many symptoms that often change and last from two years or more. The presence of such a disorder is indicated by the patient's complaints about the loss and resumption of visual, auditory and tactile sensations, paralysis and impaired coordination. Patients can also assure the appearance of pain in the heart, shortness of breath, vomiting, bloating, diarrhea, disorders in the urogenital area. They embellish all descriptions of symptoms with fictitious metaphors and exaggerate the facts in order to give them importance. Such a disorder is most often a consequence of previously experienced stress and has a chronic form of expression.

2. Undifferentiated somatoform disorder- symptoms and complaints change, the picture of the disease is not clear enough to speak of a somatic disorder. About undifferentiated mental somatoform disorder experienced psychiatrist draws a conclusion on the basis of numerous stable and varied complaints of the patient, which in no way correspond to the full clinical picture characteristic of a somatized disorder.

3. Hypochondriacal somatoform disorder- a person is firmly convinced that he is seriously, mortally ill. The analyzes do not confirm this. Normal sensations are interpreted as signs of an illness, depression joins. With this disorder, patients complain of the presence of a dangerous and serious disease, which, in their opinion, cannot be cured. These are most often malignant tumors or serious cardiovascular problems. The disorder may be accompanied by a specific phobia. Hypochondriacal depression occurs.

4. Somatoform disorder of the ANS- symptoms of autonomic disorders (tremor, sweating, palpitations, increased pressure, redness of the skin).

First of all, vegetative symptoms speak of such a disorder:

excessive sweating;
nervous trembling of hands and feet;
skin rash or redness;
rapid pulse, etc.

Patients sometimes complain of pain in different parts of the body, fatigue, pain in the abdomen, constipation or diarrhea, frequent urination, choking cough. Examination usually does not confirm the severity of symptoms and the presence of a dangerous pathology.

5. Persistent somatoform pain disorder- persistent and excruciating pain that cannot be explained by physiological disorders. The only guiding symptom in the presence of this pathology can be considered a persistent manifestation of pain in a certain part of the body. But the study does not trace the relationship between pain sensation and a specific pathology, which has to be concluded only from the patient's statements. The duration of the disorder can range from two to three months to several years.

Treatment of somatoform disorders

The disease can remain undiagnosed for a long time due to the variety of complaints, especially when somatized and undifferentiated somatoform disorders.

Important.

If the patient did not come to the consultation of a psychotherapist in a timely manner, he can take painkillers, anti-inflammatory, antispasmodics, cardiotropic drugs for months, years in vain. These medicines do not relieve the condition because they do not address the underlying problem.

With somatoform disorder, treatment consists of two points:

1. Psychotherapeutic treatment- helps the patient relate to physical sensations and beliefs about health, learn to cope and work with stress and anxiety.

2. Medications(prescribed by a doctor).

Important.

Treatment of somatoform disorders should be carried out only under the close supervision of experienced doctors for a sufficiently long period from one month to a year or more. Medicines are prescribed by specialists, with a gradual decrease in dose until they are completely canceled. Short-term treatment and sudden withdrawal of drugs can be a catalyst for the resumption of negative symptoms of the disease.

A little about education to understand the process of appearance

There are six types of family education that provoke or reinforce certain character accentuations.

Hypoprotection (hypoprotection)- lack of necessary care for the child and lack of control. The child is left to himself, experiencing his abandonment. Dissatisfaction with the need for parental love, exclusion from family life can lead to antisocial behavior.
Dominant hyperprotection (hyperprotection)- obsessive care, excessive guardianship, petty control, prohibitions. The child's sense of responsibility is suppressed, lack of initiative develops, the inability to stand up for oneself; or there is a pronounced desire for emancipation.
Indulgent hyperprotection- the desire to satisfy all the desires and needs of the child, in excessive admiration for his minimal successes. The child is given the role of the idol of the family, his egoism is cultivated. As a result, the child develops an inadequate, overestimated level of claims that does not correspond to his capabilities, which contributes to the development of hysteroid accentuation.
Emotional rejection- rejection of the child in all its manifestations, its needs are completely ignored. Allocate explicit and hidden emotional rejection. This style of parenting has the most detrimental effect on the development of the child.
violent relationship- open in the form of violence, beatings; hidden in the form of emotional hostility and coldness.
Increased moral responsibility- the child is required to display high moral qualities: decency, a sense of duty not in accordance with the age of the child, make them responsible for the well-being of relatives and caring for them. With this parenting style, hyperthymic and epileptoid traits develop into leadership and the desire to dominate.

Chronic psychotraumatic experiences, emotional deprivation (loss, deprivation), improper, excessively strict upbringing with the use of physical punishment cause emotional stress, constant dissatisfaction, the child experiences conflicting feelings towards loved ones. In these situations, pathological habitual actions reduce, temporarily suppress negative emotional experiences, which, along with the feeling of pleasure accompanying some of these actions, contributes to their fixation.

Pathological habitual activities that combine body and head rocking (yactation), nail biting (onychophagia), hair pulling (trichotillomania), finger and tongue sucking, pre-pubertal masturbation, as well as a number of more elementary behavioral stereotypes constitute a group of specific disorders, characteristic of children and adolescents. They are rudimentary non-pathological prototypes of various forms of stereotypical motor behavior: eating, exploratory, play, comfort, cleansing (grooming) behavior. They provide calming, falling asleep, stimulation and stabilization of the basal emotional background, psychophysical tone, expression of innate social instincts. The prevalence of individual phenomena belonging to this group, or their combinations, is quite high.

One conspicuous pathological habitual activity is nail biting, which occurs in a third of children aged 3 to 10 years. Typical onychophagia - biting nails on the hands, less often on the legs; the habit of gnawing pencils, pens and other objects, biting the tongue, cheek mucosa, grinding teeth. There is also a non-phagic version of the phenomenon - the habit of breaking, tugging and picking nails, twisting and fingering fingers.

In the clinical picture, common features of pathological habitual actions are an arbitrary conscious nature, the ability to stop them for a while by an effort of will, an increase in the feeling of internal tension when they are suppressed, a child’s understanding of them (starting from the end of preschool age) as negative and even bad habits in the absence in most cases desire to overcome them and even active resistance to attempts by adults to eliminate habitual actions.

Over time, repetitive stereotypes, supplemented by conditioned reflex connections, acquire functional autonomy and persist due to the lack of sufficient incentives for alternative behavior and the acquisition of the quality of a stable pathological state (according to N. P. Bekhtereva). By the presence of the symptoms described above, one can judge the degree of neuroticism in a child suffering from somatoform disorders.

An additional key to understanding the development of the psychosomatic process is the model of two-phase repression:

Psychosocial level, on which the person (child) copes with the conflict with the help of exclusively mental means:
- conflict resolution by conventional means social interaction with a sufficiently mature personality (discussion of relevant problems and emotional experience) or through mature defense mechanisms (repression, sublimation);
- connection of neurotic (pathological) defense mechanisms(neurotic depression, obsessive thoughts and actions, fears, phobias, etc.) in cases where the use of normal (healthy) defense mechanisms is not enough, which determines the neurotic development of personality or character neurosis.
Psychosomatic level- somatization:
- if for some reason it is not possible to cope with a conflict threatening one's own existence by purely mental means, the protection of the second echelon is connected - at the psychosomatic level, somatization, which over time can lead to structural changes in a particular organ.

Modern psychoanalysts also distinguish a third level of protection - psychotic symptom formation.

Diagnostics

As a common feature of the group In somatoform disorders, it is customary to consider the occurrence of symptoms that resemble the clinical manifestations of physical ailment, for which it is not possible to identify a real somatic cause. Despite the apparent psychic nature of the symptoms, patients continue to persistently visit internists, resisting psychiatric and psychotherapeutic intervention.

1. F45.0 - somatization disorder

ICD-10 identifies the presence of multiple persistent, recurrent and 12 transforming somatic symptoms as the main feature, which mimic the symptoms of real somatic pathological conditions, for which patients seek help from internist doctors. As a result of long-term examinations, it is not possible to diagnose a somatic disease. At the same time, a number of data suggest that a significant number of patients with a clinic of somatic disorders receive medication and even surgical treatment that is not indicated for them at all. Often, a combination of somatic symptoms with anxiety and depression, a recurrent protracted course, much more pronounced than with real somatic suffering, a violation of social adaptation, dependence on medications, including those that, by their chemical nature, are not addictive, often speaks in favor of a somatic disorder. (particularly laxatives). Childhood makes it difficult to diagnose a somatization disorder.

Diagnostic criteria somatization disorder on ICD-10 include:

the presence for at least 2 years of multiple and variable somatic symptoms for which an adequate somatic explanation has not been found;
constant distrust of various doctors who tried to dissuade the patient of the existence of an organic cause of his symptoms and refusal to follow their advice;
some of the disruption to social and family functioning can be attributed to the nature of the symptoms and the behaviors they cause.

Somatized disorder manifested by multiple, long-term persistent or successive symptoms, to some extent (sometimes very reliably) resembling the symptoms of somatic pathology. As the patient's awareness of the symptoms of somatic diseases grows, their manifestations may change, more and more in line with his ideas. The most common disorders are from the cardiovascular system (chest pain with or without radiation, palpitations, shortness of breath, fluctuations in blood pressure) and the gastrointestinal tract (abdominal pain, nausea and vomiting, flatulence, diarrhea and constipation). In addition, there is an unclear origin and fuzzy localization of pain - in the legs and arms, in the back, in the neck. Traditionally, manifestations of conversion disorders were also attributed to somatization disorder, but today they are singled out in a special group.

2. F45.1 - undifferentiated somatoform disorder

Category undifferentiated somatoform disorder used in cases where the symptoms presented are of a long, unstable, multiple nature, however, a complete clinical picture of a somatized disorder is not formed.

3. F45.2 - hypochondriacal disorder

At hypochondriacal disorder as a leading symptom complex ICD-10 denotes behavior aimed at confirming one (rarely several) severe somatic disorders in oneself. Patients now and then complain, often as complaints they present the most ordinary sensations, which they perceive as painful, unpleasant, cause them to fear for their health.

Diagnostic criteria hypochondriacal disorder on ICD-10 include:

the presence of persistent ideas about the existence of one or more severe somatic diseases that cause the present symptom or symptoms, or fixation on the alleged deformity, and this idea persists despite the fact that an adequate somatic explanation for the corresponding complaints has not been found;
constant distrust of doctors of various specialties, trying to convince the patient that he does not have a somatic disease that causes the symptoms presented.

hypochondriacal disorder is less common than somatized. The main difference of this state is the belief in the presence of a certain disease. Patients willingly study medical literature, they can know the nuances of clinical and instrumental diagnostics. They are not so much concerned about the presence of symptoms as the very suspicion of the presence of a deadly or very dangerous disease.

4. F45.3 - somatoform dysfunction of the autonomic nervous system

Somatoform dysfunction of the autonomic nervous system- a group of conditions formerly united by the term "organ neuroses". Most of the complaints of patients come from the region of the heart, respiratory system, stomach and intestines. The symptoms are twofold: first, many of them are real, and their character clearly indicates a vegetative origin (palpitations, trembling, shortness of breath, sweating, blanching, hiccups); secondly, there are symptoms associated with non-specific and unstable sensations in one of the organs (not always in the area of its real localization) - pain, heaviness, swelling or stretching. At the same time, the presence of real symptoms (bloating, hiccups, aching chest pains, etc.) does not lead to a serious disruption of functioning. Attempts to find a psychotraumatic provoking factor of the disease are not always successful.

Diagnostic criteria somatoform dysfunction of the autonomic nervous system on ICD-10 include:

symptoms of autonomic arousal (palpitations, sweating, tremors, redness) that are chronic and cause anxiety;
the presence of additional subjective symptoms that relate to a particular organ or system;
the patient's concern about a possible serious, but usually indefinite, disease of this organ or system, and repeated explanations and reassurances of doctors remain fruitless;
there are no data for a significant structural or functional disorder of this organ or system.

All criteria must be met for diagnosis.

5. F45.4 - somatoform pain disorder

Persistent somatoform pain disorder- a condition accompanied by excruciating, prolonged, physically and mentally intolerable pain, which has no physiological explanation and is not a consequence of a somatic disease, but is often combined with psychosocial problems, conflicts, and allows the patient to receive a secondary benefit in the form of increased attention from relatives and doctors .

Other somatoform disorders (F45.8) - a mixed rubric, within which disorders are diagnosed, complaints in which are not associated with vegetative manifestations and are not limited to a specific organ or system. On the other hand, they are not multiple and easily transformable, as in somatization disorder. The disorders of this group traditionally include globulus hystericus, bruxism, psychogenic torticollis, psychogenic dysmenorrhea, and other similar conditions.

ICD-11

The classification of mental illnesses is constantly being revised.

AT ICD-11 a new categorization of somatization and somatoform disorders was developed, which combined all somatoform disorders into one register F45.0 and neurasthenia F48.0 in the classification ICD-10. The only category of conditions excluded from the new classification of somatic distress disorders is hypochondria. F45.2.

In the new classification, disorders of bodily sensations (somatic distress disorder) are defined as " characterized by the presence of bodily symptoms that are painful for a particular patient, excessively captivating his attention and aggravated by repeated communication with persons providing medical care. If the condition is caused or provoked by somatic symptoms, the level of attention to it is clearly excessive due to manifestations and progression. Increased attention is not reduced either by an appropriate clinical examination, or by research, or by adequate persuasion. The bodily symptoms and associated anxiety are persistent, present most days through at least several months, and are associated with significant impairment in personal, family, social, academic, professional, and other important areas of functioning. Usually the disorder includes many bodily symptoms that may change from time to time. Rarely, there is one symptom - usually pain or fatigue - that is associated with other manifestations of the disorder. ».

Prevention

Prevention of somatoform disorders is based on the timely treatment of depression and the correct assistance to a person who finds himself in a severe stressful situation.

Characteristic signs of ADHD are the abundance and non-specific nature of complaints. The patient may be disturbed by symptoms from several organs at the same time. The clinical picture consists of subjective sensations and disorders in the functioning of a particular organ, due to a violation of the activity of the autonomic nervous system. Symptoms and complaints resemble the clinical picture of any somatic disease, but differ from it in uncertainty, non-specificity and high variability.
The cardiovascular system. Patients with somatoform dysfunction of the autonomic nervous system often experience pain in the region of the heart. Such pains in their nature and time of occurrence differ from pain in angina pectoris and other heart diseases. There is no clear radiation. The pains can be stabbing, pressing, squeezing, aching, pulling, sharp. Sometimes they are accompanied by excitement, anxiety and fear. They usually occur at rest and resolve with exertion. They are provoked by psychotraumatic situations. They may disappear within a few minutes or persist for a day or more.
Along with pain, patients with somatoform dysfunction of the autonomic nervous system often complain of palpitations. Attacks appear both during movements and at rest, sometimes accompanied by arrhythmia. The resting heart rate can reach 100 or more beats per minute. An increase or decrease in blood pressure is possible. Changes in blood pressure can be quite stable or come to light in stressful situations. Sometimes the pathological manifestations of the cardiovascular system are so pronounced that the therapist or cardiologist may suspect that the patient has hypertension or myocardial infarction.
Respiratory system. A characteristic symptom of somatoform dysfunction of the autonomic nervous system is shortness of breath, aggravated by excitement and stress. Such shortness of breath is usually hardly noticeable from the outside, but gives the patient severe inconvenience. The patient may be disturbed by a feeling of lack of air, pressure in the chest, or difficulty in breathing. Often, pathological manifestations of the respiratory system are observed for many hours in a row or disappear only in a dream. Patients constantly feel discomfort due to lack of air, they ventilate the premises all the time, and they hardly endure stuffiness. Coughing, choking, and laryngospasm sometimes occur with ADHD. Children with somatoform dysfunction of the autonomic nervous system are more likely to suffer from respiratory infections, bronchitis and pseudoasthma attacks are possible.
Digestive system. Swallowing disorders, aerophagia, dysphagia, pylorospasm, abdominal discomfort, and pain in the stomach that are not associated with eating may be observed. Sometimes patients with somatoform dysfunction of the autonomic nervous system are disturbed by hiccups that occur in the presence of other people and are unusually loud. Another characteristic symptom of ADHD is "bear disease" - diarrhea during acute stress. Flatulence, irritable bowel syndrome and chronic stool disorders (tendency to constipation or diarrhea) are often detected.
urinary system. Patients with somatoform dysfunction of the autonomic nervous system complain of a variety of urination disorders: an acute need to urinate in the absence of a toilet, polyuria in psychotraumatic situations, urinary retention in the presence of a stranger or in a public toilet. Children may have enuresis or increased urination at night.

Psychopathological polymorphism of psychosomatic disorders is reflected in their position in modern classifications of mental illness. In the ICD-10, psychosomatic disorders can be classified in different sections: “Organic, including symptomatic, mental disorders” (headings F 04-F 07, corresponding to reactions of the exogenous type K. Bonhoffer), “Neurotic, stress-related and somatoform disorders” (headings F 44.4-F 44.7, corresponding to psychogenies, and F 45 - somatoform disorders), as well as "Behavioral syndromes associated with physiological disorders and physical factors" (headings F 50-F 53).

Despite such a variety of conditions under consideration, they are united by a common feature - a combination of mental and somatic disorders and related features of medical care for patients, which involves close interaction between psychiatrists and general practitioners, usually carried out either in general medical institutions or in specialized psychosomatic clinics.

Based on the structure of psychosomatic relationships, we consider it appropriate to distinguish 4 groups of states:

Somatized mental (somatoform) reactions, formed with neurotic or constitutional disorders (neurosis, neuropathy).

Psychogenic reactions (nosogeny), arising in connection with a somatic disease (the latter acts as a traumatic event) and related to the group of reactive states.

Reactions according to the type of symptomatic lability- psychogenically provoked manifestation or exacerbation of a somatic disease (psychosomatic diseases in their traditional sense).

Reactions of exogenous type (somatogeny), manifesting as a result of the impact of somatic harmfulness on the mental sphere and belonging to the category symptomatic psychoses, i.e., to the category of exogenous mental disorders.

In this chapter, for the reasons indicated above, we will confine ourselves to the consideration of disease states of the first three types.

www.psychiatry.ru

CLASSIFICATION ACCORDING TO ICD-10

"Classic" psychosomatic diseases, according to the new classification criteria, are diagnosed primarily as organic diseases. If psychological processes are given significant importance in the occurrence and maintenance of these diseases, then the code P54 (psychological and behavioral factors associated with disorders or diseases classified elsewhere) is used as an additional mental diagnosis in the ICD-10.

05M-1 For this, there is a code 316 (specific mental factors affecting a somatic disease).

Most assessment forms in healthcare settings require a diagnosis based on ICD-10. This is the largest classification system for "mental and behavioral disorders" used in many | countries. Many psychologists and psychotherapists find I \ ICD-10 limited for use in the analysis of I psychosomatic problems and planning

I psychotherapy. Nevertheless, the diagnosis disciplines | \ thinking of a specialist, protects against mistakes when prescribing psychotherapy methods. |

The purpose of classification is to streamline the diversity of individual phenomena and subordinate them to categories of a higher level. In medicine, it is important to classify not only signs, but also individuals according to the type of diagnosis.

Since Cullen's identification of neuroses, these disorders have been described within the framework of mental disorders occurring with autonomic stigmas. Later, a group of neuroses began to stand out, the terminological designation of which was different: vegetative, viscero-vegetative, systemic neuroses; neurocirculatory, vegetovascular dystonia. In the international classification of diseases (10th revision), adopted by WHO in 1992 and translated into Russian in 1994, these disorders are classified as "somatoform disorders".

In the discussion around the latest classification systems, there are several basic concepts that are suitable for the ICD and 08M. Below are variants of somatoform disorders of the two most leading classification systems in the world.

Somatoform disorders according to B8M-1U with coding according to ICD-10

Somatization disorder (F45.0)

Undifferentiated somatoform disorder (F45.1)

Conversion disorder (P44.xx)

Somatoform pain disorder (G45.4)

Body dysmorphic disorder (F45.2)

Somatoform disorder, unspecified (P45.9)

The ICD-10 classification system, in contrast to the American 08M-1U classification system, distinguishes between dissociative (conversion) (P44) and somatoform disorders. A sign of a dissociative (conversion) disorder, as in 08M-1U, is the presence of "pseudo-neurological symptoms".

Let's take a closer look at their characteristics.

psychosomatic disorders

Psychosomatic illnesses.

Psychosomatic diseases- violations of the functions of organs and systems of the body, in the emergence and development of which psychological causes play a decisive role, rather than physical factors. The term "psychosomatics" was first used at the beginning of the 19th century. J. Heinroth (1818) A century later, the concept of "psychosomatic medicine" was introduced into the medical lexicon.

Initially, seven nosological units were classified as psychosomatic diseases: essential hypertension, thyrotoxicosis, neurodermatitis, bronchial asthma, some forms of rheumatoid arthritis, ulcerative colitis and peptic ulcer disease. Currently, the list of psychosomatic disorders has been significantly expanded to include diseases of the cardiovascular system, a large number of skin and urogenital diseases, migraine, etc. Typical psychosomatic diseases in North America and Europe currently include anorexia nervosa and bulimia, some forms of psychogenic obesity, diabetes mellitus, cardiospasm, nervous vomiting, irritable bowel syndrome, impotence, constipation, cancer, etc.

Classification:

A. B. Smulevich identifies four groups of psychosomatic disorders:

1. Psychosomatic diseases in their traditional sense. This is a somatic pathology, the manifestation or exacerbation of which is associated with the body's lability in relation to the effects of psycho-traumatic social stress factors. Manifestations of somatic pathology in psychosomatic diseases are not only psychogenically provoked, but are exacerbated by disorders of the somatopsychic sphere - phenomena of somatic anxiety with vital fear, algic, vegetative and conversion disorders. This concept combines coronary artery disease, essential hypertension, peptic ulcer of the stomach and duodenum, psoriasis, some endocrine and allergic diseases.

2. Somatoform disorders and somatized mental reactions, formed with neurotic or constitutional pathologies (neurosis, neuropathy). Organ neuroses are psychogenic diseases, the structure of which is characterized by functional disorders of internal organs (systems) with the possible participation of borderline and subclinical somatic pathology. These include cardioneurosis (Da Costa syndrome), hyperventilation syndrome, irritable bowel syndrome, etc.

3. Nosogeny- psychogenic reactions arising in connection with a somatic disease (the latter acts as a traumatic event) and related to the group of reactive states. These disorders are associated with subjectively severe manifestations of somatic suffering, patients' perceptions of the danger of a diagnosis, and restrictions imposed by the disease on domestic and professional activities. Clinically, these psychogenic reactions can manifest themselves as neurotic, affective, pathological and even delusional disorders. The possibility of manifestation of nosogenies and their psychopathological features are largely determined by the clinical manifestations of somatic pathology (CHD, arterial hypertension, malignant tumors, surgical interventions, etc.).

4. Somatogeny(reactions of exogenous type or symptomatic psychoses). These disorders belong to the category of exogenous mental disorders and arise as a result of the impact on the mental sphere of massive somatic harm (infections, intoxications, non-communicable somatic diseases, AIDS, etc.) or are complications of some methods of treatment (for example, depression and mnestic disorders after coronary artery bypass grafting, affective and asthenic conditions in patients receiving hemodialysis, etc.). Among their clinical manifestations is a wide range of syndromes - from asthenic and depressive states to hallucinatory-delusional and psychoorganic syndromes.

A reflection of the polymorphism of psychosomatic disorders is the fact that in the modern classification of mental illness (ICD-10) there is no special section for these disorders. Thus, in the introduction to the ICD-10, it is indicated that SREP can be found in F45 (“somatoform disorders”), F50 (“eating disorders”), F52 (“sexual dysfunction”) and F54 (“psychological and behavioral factors associated with with disorders or diseases classified elsewhere). The least studied group are somatoform disorders.

There are many theories explaining the mechanism of occurrence and development of psychosomatic diseases. Generally speaking, the occurrence of psychosomatic disorders is associated with the suppression of one's emotions and desires. In ancient times, people reacted to an external stimulus with an action - they ran away from the enemy or attacked prey, which is facilitated by the production of adrenaline. And a modern person also produces adrenaline in response to stress, but more often, due to social norms and generally accepted forms of relationships, it is not realized in physical activity. Negative emotions, irritation, aggression do not find a direct way out to their cause, they are suppressed, driven inside. As a result, a person has nervous tics, constant muscle tension, hand trembling, spasms, pain, and dysfunction of organs. Of course, these changes do not happen quickly, so it is difficult for a person to grasp a clear relationship between their experiences and the disease. However, we all know that anxiety causes palpitations, difficulty breathing; anger, excitement contribute to an increase in blood pressure, etc. If these feelings become frequent, protracted, and the stereotype of a person’s response to them does not change, this helps to consolidate negative changes in the body. For example, a leader takes out his anger on a subordinate, yells at him. He is forced to endure this, to be silent. As a result, suppressed anger, internal protest contribute to the development of hypertension in a fairly young person.

From childhood, people are limited by family and social norms: “men don’t cry,” “you can’t be rude to your elders,” “you can’t be late for work,” “you have to do this and that,” etc. People with a pronounced personality suffer more. I think many will agree with me that changing your stereotype of responding to a stressor is easier than pushing the boundaries of social norms. Of course, the importance of the psychological factor in the occurrence of diseases cannot be exaggerated: there are other reasons for the occurrence of a headache, and heart rhythm disturbance often indicates an infectious lesion. But if, despite examinations and treatment by various specialists, for a long time there is no relief of the symptoms of the disease, or they are insignificant, it is worth connecting a psychotherapist to the treatment.

What is the psychotherapeutic help for psychosomatic diseases?

1. Learn to pay attention to your body. Realize that a symptom of a disease is an alarm that needs to be heeded. For example, by drowning out pain with painkillers, a person allows the development and progression of such diseases as arthritis, peptic ulcer, coronary artery disease, etc.

2. Learn to overcome stress in a new way, expand the scope of your perception of the world around you and ways to respond.

3. Individual selection of drug therapy if necessary (antidepressants, anxiolytics, sleeping pills).

The psychosomatic approach allows you to treat a sick person, not his illness. Of course, one should not expect a miracle, instant healing from diseases that have been formed over the years or even decades. But an integrated approach to the treatment of psychosomatic diseases, including psychotherapy, helps to quickly achieve remission, prevent further development of the disease, and in some cases completely get rid of the disease.

Somatoform disorders (F45)

dissociative disorders (F44.-)

hair pulling (F98.4)

child form of speech [babbling] (F80.0)

lisping (F80.8)

nail biting (F98.8)

psychological and behavioral factors associated with disorders or diseases classified elsewhere (F54)

sexual dysfunction not due to organic disorder or disease (F52.-)

thumb sucking (F98.8)

tics (in childhood and adolescence) (F95.-)

de la Tourette syndrome (F95.2)

trichotillomania (F63.3)

Multiple psychosomatic disorder

Excludes: simulation [conscious simulation] (Z76.5)

Undifferentiated psychosomatic disorder

A disorder characterized by concern for one's own health

Excluded:

delusional dysmorphophobia (F22.8)
delusions fixated on the functioning or appearance of one's own body (F22.-)

da Costa syndrome

Psychogenic forms:

aerophagia
cough
diarrhea
dyspepsia
dysuria
flatulence
hiccups
deep and rapid breathing
frequent urination
irritable bowel syndrome
pylorospasm

Excludes: psychological and behavioral factors associated with disorders or diseases classified elsewhere (F54)

Psychogenic:

backache
headache

somatoform pain disorder

back pain NOS (M54.9)
pain:
- NOS (R52.9)
- acute (R52.0)
- chronic (R52.2)
- fatal (R52.1)
tension headache (G44.2)

Any other sensory, functional, or behavioral disorders that are not due to physical disorders. Disorders that are not mediated through the autonomic nervous system are limited to certain systems or areas of the body and have a close temporal association with traumatic events or problems.

Psychogenic (th):

dysmenorrhea
dysphagia, including "globus hystericus" (globus hystericus)
torticollis

Classification of psychosomatic disorders

Deep study of psychosomatic disorders, early prevention and diagnosis require their substantiated classification. One example of such classifications can be the idea of I. Jochmus, G. M. Schmitt (1986) about the grouping of somatic disorders closely associated with psychological difficulties.

The first group includes psychosomatic functional disorders, that is, those somatic syndromes in which organic lesions of organs and systems are not detected. These syndromes include: psychogenic disorders in infants and young children; sleep disorders; enuresis; encopresis; constipation; conversion neuroses.

The second group includes psychosomatic diseases: bronchial asthma, neurodermatitis, ulcerative colitis, Crohn's disease, stomach ulcer, anorexia nervosa, bulimia, obesity.

The third group includes those chronic patients who have serious experiences. It includes patients with cystic fibrosis, diabetes mellitus, chronic renal failure, and malignant neoplasms.

Unfortunately, the classification is not based on a single approach, it includes a limited number of syndromes and diseases; a number of similar disorders remained outside of it. Nevertheless, it can be used in clinical and preventive work, as it involves fundamentally different approaches to diagnosis, treatment and prevention. If functional disorders can be corrected by means of influencing the relationship between sick children and their environment, then patients with psychosomatic diseases need psychotherapy and influence on the affected organs and systems.

Another example is the classification of psychosomatic disorders in children proposed by H. Zimprich (1984). Among these disorders, psychosomatic reactions, functional disorders, psychosomatic diseases with organic manifestations, specific psychosomatosis (colitis, stomach ulcer, etc.) have been identified. According to N. Zimprich, these diseases, despite their differences, are united by a common therapeutic approach that combines drug treatment and psychotherapy.

T. Stark, R. Blum (1986), studying psychosomatic states, warn against simplifying the understanding of pain syndromes and malaise as purely psychogenic or organic in nature. In their opinion, there are a number of limitations to such a "dichotomous" division: most physiological disorders have psychological consequences. The term "psychogenic" is erroneously regarded as never having a serious meaning; "dichotomy" erroneously implies homogeneity of psychogenic disorders. From the systematics of the types of psychosomatic disorders proposed by the authors, given below, it becomes clear that the syndromes classified as psychogenic are in fact different in their developmental mechanisms.

Conversion disorders are traditionally understood as the loss or impairment of physiological functions that lose their voluntary control due to psychological problems. Often these conditions resemble neurological symptoms, but they can affect any system or organ. In childhood, the combination of conversion and hysterical personality occurs in at least 50% of diagnosed disorders. Unlike other psychosomatic disorders, conversion disorders in children have the same prevalence among both sexes. The resulting pathological complex brings primary and secondary benefits to the individual, which forces him to keep the psychological conflict from awareness and thereby protect it from possible influences on it.

Pain syndrome. Its main feature is complaints of pain in the absence of physical disturbances, or complaints of pain that is much more severe than the physical condition would suggest. Often the environmental stressor is found to precede the pain. Like conversion responses, complaints of pain can free the individual from certain responsibilities and entitle them to emotional support that cannot otherwise be acquired.

Somatization is often presented as multiple somatic complaints that cannot be explained by any physical cause. It is a way of coping with psychological stress, tends to appear during puberty and often runs chronically, with paroxysmal remissions throughout life.

Hypochondria has its own characteristics: conviction in the presence of the disease, focus on one's health, fear of illness, persistent abuse of medical care. Due to the rapid and drastic physical changes during puberty, focusing on them is common in adolescents. Although a complex of somatic symptoms is not uncommon at this age, the onset of a hypochondriacal state may be associated with neglect of one's duties.

Simulation can be defined as feigning or using illness to avoid an unwanted situation, job or other responsibilities. The stereotypical view of the malingerer - the adult - is that of an individual who invents a disease in order to evade responsibility. In the pediatric population, such a label can be used with considerable caution. Usually in children, the purpose of creating symptoms is easily detected and easily understood by analyzing the circumstances of life. It is important to remember that for children, for example, schooling is work and thus school avoidance is a serious symptom that should be carefully studied.

An artificially produced disorder of health is understood as a disease that is caused by the deliberate actions of the patient, regardless of whether the disease is desired or not. As a rule, there is no clear indication of a secondary benefit derived from the symptoms caused. More often, relatively unusual clinical syndromes are found, such as hematuria and spontaneous hemorrhages.

Chronic artificial disorder (Munchausen's syndrome) is characterized by repeated hospitalizations due to a feigned illness, often leading to surgery. In its most pronounced form, this condition can be called "mania operativa": patients endure up to 30 or more surgeries. Although this disorder is extremely rare in pediatrics, there are reports of artificially induced health problems in children by their mothers - Polle syndrome.

The above classification does not so much systematize various types of "psychosomatic disorders" as it reflects the range of disorders that require a differential diagnosis. This is what, from our point of view, it can be useful to a pediatrician and a psychiatrist.

In the international classification of diseases (10th revision), adopted by WHO in 1992 and translated into Russian in 1994, there are sections in which psychosomatic disorders are rubricated. So, in the section "Neurotic, stress-related and somatoform disorders" (F4) there is a subsection "Somatoform disorders" (F45), which includes the corresponding headings. In the introduction to the section, it is said that neurotic stress-related and somatoform disorders are combined into one large group due to their historical connection with the concept of neurosis and the conditionality of the main (though not precisely established) part of these disorders by psychological causes. As noted in the general introduction to ICD-10, the concept of neurosis was not retained as a fundamental principle, but in order to facilitate the identification of those disorders that some professionals may still consider neurotic in their own understanding of the term. The definition of somatoform disorders is given as follows: “The main feature of somatoform disorders is the recurring occurrence of physical symptoms along with constant demands for medical examinations despite confirmed negative results and medical assurances that there is no physical basis for symptoms. If physical disorders are present, they do not explain the nature and severity of the symptoms or the patient's distress and preoccupation."

Most doctors group psychosomatic disorders according to age.

In infancy, these disorders include colic in the third month of life, flatulence, chewing gum, regurgitation, functional megacolon, anorexia of infancy, developmental arrest, obesity, respiratory attacks, neurodermatitis, lactation, spastic crying, sleep disturbances, early bronchial asthma, sudden death baby.

At preschool age, such psychosomatic disorders as constipation, diarrhea, "irritable bowel", abdominal pain, cyclic vomiting, refusal to chew, anorexia and bulimia, encopresis, enuresis, obesity, sleep disturbance, fever, etc. are observed.

In school-age children and adolescents, psychosomatic disorders include migraine, "growth pains", recurrent pains of changing localization, sleep disturbances, hyperventilation attacks, fainting, vegetovascular dystonia, bronchial asthma, anorexia nervosa, bulimia, obesity, gastric ulcer and duodenal ulcer, ulcerative colitis, enuresis, encopresis, neurodermatitis, menstrual disorders, etc.

Different authors give a different number of such symptoms and syndromes. The etiology of these disorders is not equally interpreted. However, it is obvious that, regardless of a more or less successful name, psycho-emotional factors take a significant part in their pathogenesis. Some of the disorders listed in this taxonomy are given in other chapters in accordance with the affected system.

home > Food production

Somatoform autonomic dysfunction. Somatoform dysfunction of the autonomic nervous system Somatoform disorder mcb 10

Symptoms

The main causes of somatoform neurosis

Classification

Treatment of somatoform disorders

A little about education to understand the process of appearance

Diagnostics

1. F45.0 - somatization disorder

2. F45.1 - undifferentiated somatoform disorder

3. F45.2 - hypochondriacal disorder

4. F45.3 - somatoform dysfunction of the autonomic nervous system

5. F45.4 - somatoform pain disorder

ICD-11

Prevention

CLASSIFICATION ACCORDING TO ICD-10

psychosomatic disorders

Somatoform disorders (F45)

Classification of psychosomatic disorders

We also recommend