Multi-Disciplinary Approach

The most beneficial of all treatments is a multidisciplinary approach, involving a neurologist, physiotherapy, occupational therapy and perhaps a psychologist to handle any psychological issues, if there are any, either as a cause or a result of a Somatoform disorder.

In-hospital programs such as those held at the Lishman Unit in the Maudsley Hospital in London, and other programs like it in the UK, have been found to be the most effective way of breaking the cycle of symptoms and triggers of these disorders. There are now several specifically designed programs like this in Australia, e.g. Dr Alexander Lehn at the Mater Hospital in Brisbane.

Medical Treatment

One of the biggest mistakes made with patients with apparent Somatoform disorders is to forget to treat ALL symptoms medically. Unfortunately the result of this is often a delay of 5 to 7 years with unnecessary suffering before proper medical diagnoses are made and proper medical treatment is given. This can and has resulted in death, e.g. from undiagnosed brain tumours.

There are positive tests that can be done to check whether a symptom is medical or functional. 

The Hoover's Sign is one such test. http://pn.bmj.com/content/1/1/50.full.pdf+html?sid=e208757c-e96b-4d32-9445-75cecba0950b

Blood tests - There are numerous imbalances and deficiencies that can be identified through blood tests to look for medical reasons for seizures, for example. Magnesium deficiency is one that is regularly overlooked. Due to the extra load on the muscles, the body's requirements for Magnesium are often significantly elevated, to the point that the patient may not be able to take sufficient Magnesium orally without causing diarrhoea. Magnesium lotions, oils and Epsom Salts baths can help when a patient needs very high doses of Magnesium to prevent muscle damage.

Vitamin B12 deficiency is relatively common with somatoform patients. According to one researcher, neurological damage can be done with levels of B12 that are within the lower end of the reference range. Sufferers of Somatoform Disorders regularly show normal blood test levels of Vitamin B12 but supplementation with injections of Vitamin B12 have subsequently been shown to be of significant benefit.

Other blood tests that have been helpful include testing for cortisol levels, adrenal hormone levels, Folate and Iron.

There are many medical conditions that have been initially diagnosed as Conversion Disorders, including Mitochondrial Disease, Ehlers Danross, Fibromyalgia and other metabolic disorders.

Cognitive Behaviour Therapy

 

Cognitive Behaviour Therapy appears from traditional literature to be the most effective form of treatment for Somatoform Disorders, however Dialectical Behaviour Therapy (DBT) and Acceptance and Commitment Therapy (ACT) have also been found to be very helpful for many patients. 

Psychotherapy

Psychotherapy is aimed at helping the person to express their feelings more appropriately by exploring the links between the symptoms and emotional factors. 

This is turn helps to re-route the electrical impulses going through the brain. More recent advances in this area of neurology have found that many patients have messages being highjacked from their correct path and ending up in inappropriate areas of the brain, e.g. messages to move a muscle often end up in the emotional centres of the brain, and emotional messages can end up in the movement centres of the brain.

While it hasn't been shown to decrease pain levels, for example, it has been shown to reduce health care costs during the first year after treatment. It helps reduce stress in the patient's life, and any method of reducing stress helps to reduce symptoms in most patients.

Pain Management Clinics

Pain Management Clinics have been found to be very beneficial for many patients. It helps them to make the adjustment to living with a chronic disabling condition. There is a lot of cross-over in the information that is taught in these clinics, especially as many patients also suffer from pain issues, especially from damage to muscles and tendons.

Relaxation Training

Psychophysiologists have described several mechanisms that produce somatic symptoms where there is no organic pathology or real cause. These mechanisms include overactivity or dysregulation of the autonomic nervous system, smooth muscles contractions, endocrine overactivity and hyperventilation.

There are various techniques for reducing the physiological arousal and discomfit associated with Somatoform symptoms and some have been shown to have some positive effects, eg biofeedback, guided imagery, progressive muscle relaxation exercises and hypnotherapy.

Regular Family Doctor Visits

This has been found to be very effective in reducing the patient's levels of stress in relation to their symptoms. Visits should be scheduled every 4 to 6 weeks, instead of 'as needed'

Physical Therapy

Something as simple as regular, scheduled physiotherapy may reduce the severity and frequency of symptoms, and reduce the overall cost of management for the patient.

Self Help Options

There doesn't appear to be any readily available information on self help options that have been successfully used to treat Somatoform symptoms, although I personally have been able to interrupt or reduce the severity of my pseudo-seizures using a combination of EFT (Emotional Freedom Technique) and Reiki. Each technique on its own is not sufficiently strong enough to achieve the same results, however the combination appears to work well with a significant number of episodes of severe symptoms.

I have experienced variable levels of success and failure with other self help techniques.

Behaviour Modification

Behaviour modification can be used, especially to help the person overcome learned helplessness. Frequent rewards for small goals can help, along with family not rewarding any maladaptive behaviours.

The patient may need to learn that their spouse or parent is not their nurse!

Drug Treatments

It appears from traditional literature that there is only limited benefit from drug therapies, with the following exceptions:

St John's wort for somatization, amitriptyline and duloxetine for fibromyalgia, and teaserod and alosetron for IBS.

In recent times a wide range of medications have been anecdotally found to be useful in the treatment of functional issues. These include medications for the management of pain, nerve pain, autonomic dysfunction, hormonal imbalances, muscle spasms and dystonia, and epileptic medications such as Epilim. 

Other psychotropic, anti-depressant, SSRI and SNRI medications have been very useful for some people with treating the symptoms that result from the severely disabling effects of having this range of disorders, while others have found these medications make their symptoms significantly worse and actually be a cause or perhaps a trigger for symptoms.

As with all medications, always talk to your doctor first before starting any of these medications. Do not self medicate with any of these medications, other than with normal doses of over the counter pain medications. Never exceed the stated dose for Panadol/Paracetamol/Tylenol as even slight overdoses of this medication can cause serious liver damage.

Other Options

If you become aware of any other successful treatment options and would like to see them included here, please send an email to vivienne@somatoformaustralia.org