Somatik Belirti Bozukluğu: Tarihsel Süreç ve Biyopsikososyal Yaklaşım

Öz

Somatizasyon zihin-beden ilişkisinin derinden hissedildiği bir kavramdır. Ortaya çıkmasında biyolojik, bilişsel, psikodinamik ve kültürel etmenlerin katkısı bulunmaktadır. Bir ruhsal bozukluğun belirtisi olarak somatizasyonun tanımı, oluş nedenleri, sürdürücü etkenleri ve tedavisi çok yönlü ve karmaşıktır. Bu bozukluk tarihsel süreçte üzerinde en çok tartışılan konulardan biridir. DSM’nin son baskısı ile birlikte “Somatik Belirti Bozuklukları ve İlişkili Bozukluklar” başlığıyla sınıflandırmada yer almıştır. Somatik belirti bozukluğu yaşam kalitesinin azalmasına, yeti kaybına ve sağlık hizmetlerinde yüksek maliyete yol açmaktadır. Bu haliyle hastalıkla ilgili belirtileri biyopsikososyal bütünlük içinde ele almak kaçınılmaz olmaktadır. Bu çalışmada somatik belirti bozukluğunun tarihsel sürecinin özetlenmesi, oluş nedenlerinin ve temel tedavi yaklaşımının biyopsikososyal bütünlük içinde sunulması amaçlanmıştır.

Anahtar Kelimeler

• Somatoform Bozukluklar
• Sınıflandırma
• Psikosomatik Tıp

Somatic Symptom Disorder: Historical Process and Biopsychosocial Approach

Abstract

Somatization is a concept in which the mind-body relationship is deeply felt. Biological, cognitive, psychodynamic and cultural factors contribute to its emergence. The definition of somatization as a symptom of a mental disorder, its etiopathogenesis, maintenance factors and treatment are multifaceted and complex. This is one of the most discussed mental disorders in the historical process. It was included in the classification with the title of “Somatic Symptom Disorders and Related Disorders” with the last edition of DSM. Somatic symptom disorder causes a decrease in the quality of life, loss of disability and high costs in health services. Therefore, it is necessary to consider the symptoms of the disease in a biopsychosocial integrity.In this study, it is aimed to summarize the historical process of somatic symptom disorder, to present its causes and basic treatment approach in biopsychosocial integrity.

Keywords

• Somatoform Disorders
• Psychosomatic Medicine
• Classification

References

1. Abbey SE, Wulsin L, Levenson JL (2005) Somatization and somatoform disorders, Textbook of Psychosomatic Medicine,1st ed (Eds Levenson JL): 261. Washington DC, American Psychiatric Publishing.
2. Algul A, Tutuncu R (2013) Pain as a form of somatization: psychiatric evaluation and treatment. Update in Psychiatry, 3 (1): 52-59 (in Turkish).
3. Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM (2006) Cognitive-Behavioral therapy for Somatizaton Disorder: A Randomized Controlled Trial. Arch Intern Med, 166: 1512-1518.
4. American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd ed). APA.
5. Amerikan Psikiyatri Birliği (2000) Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması Elkitabı, Yeniden Gözden Geçirilmiş Dördüncü Baskı (DSM-IV-TR) (Çeviri Ed. E Köroğlu). Ankara, Hekimler Yayın Birliği.
6. Amerikan Psikiyatri Birliği (2013) Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5) Tanı Ölçütleri Başvuru Elkitabı (Çeviri Ed. E Köroğlu). Ankara, Hekimler Yayın Birliği.
7. Anderson G, Maes M, Berk M (2012) Biological underpinnings of the commonalities in depression somatization and chronic fatigue syndrome. Med Hypotheses, 78(6): 752-756.
8. Atmaca M, Sirlier B, Yildirim H, Kayali A (2011) Hippocampus and amygdalar volumes in patiens with somatization disorder. Prog Neuropsychopharmacol Biol Psychiatry, 35(7): 1699-1703.

9. Atmaca M (2012) Neuro-imaging in somatoform disorders: A review. Turkish Journal of Psychiatry, 23 (4): 264-273 (in Turkish)
10. Ball SG, Desaiah D, Spann ME, Zhang Q, Russell JM, Robinson MJ et al. (2011) Efficacy of duloxetine on painful physical symptoms in major depressive disorder for patients with clinically signifizant painful physical symptoms at baseline: A meta-analysisi of 11 double-blind, placebo-controlled clinical trials. Prim Care Companion CNS Disord, 13 (6): PCC. 11r01181.
11. Barsky AJ (1992) Amplification, somatization and the somatoform disorders. Psychosomatics, 33: 28-34.
12. Barsky AJ, Wool C, Barnett MC, Cleary PD (1994) Histories of childhood trauma in adult hypochondriacal patients. Am J Psychiatry, 151: 397-401.
13. Barsky AJ (2016) Assesing the New DSM-5 Diagnosis of Somatic Symptom Disorder (Editorial Comment). Psychosom Med, 78: 2-4.
14. Berry DS, Pennebaker JW (1993) Nonverbal and verbal emotional expression and health. Psychother Psychosom, 59: 11-19.
15. Beyazyuz M, Goka E (2013) Culture and somatization. Update in Psychiatry, 3 (1): 17-26 (in Turkish)
16. Boeckle M, Schrimpf M, Liegl G, Pieh C (2016) Neural correlates of somatoform disorders from a meta-analytic perspective on neuroimaging studies. Neuroimage Clin, 11: 606-613.
17. Bourke JH, Langford RM, White PD (2015) The common link between functional somatic syndromes may be central sensitisation. J Psychosom. Res, 78: 228–236.
18. Choi E, Chentsova-Dutton Y, Parrott WG (2016) The Effectiveness of Somatization in Communicating Distress in Korean and American Cultural Contexts. Front Psychol, 7: 383.
19. Craig TK, Boardman AP, Mılls K, Daly-Jones O, Drake H (1993) The south London somatization study. I: longitudinal course and the influence of early life experiences. Br J Psychiatry, 163: 579-588.
20. Craig TK, Drake H, Mills K, Boardman P (1994) The South London Somatisation Study. II. Influence of stressful life events, and secondary gain. Br J Psychiatry, 165: 248–258.
21. Dannlowski U, Stuhrmann A, Beutelmann V, Zwanzger P, Lenzen T, Grotegerd D et al (2012) Limbic scars: long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biol Psychiatry, 71: 286–293.
22. de Waal MW, Arnold IA, Eekhof JA, van Hemert AM (2004) Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. British Journal of Psychiatry, 184: 470–476.
23. Dinan T (2001) Novel approaches to the treatment of depression by modulating the hypothalamic pituitary adrenal axis. Hum Psychopharmacol, 16(1): 89-93.
24. Escobar JI, Canino G (1989) Unexplained physical complaints: psychopathology and epidemiological correlates. Br J Psychiatry, 154 (Suppl 4): 24–27.
25. Espiridion E D, Kerbel S A (2020) A Systematic Literature Review of the Association Between Somatic Symptom Disorder and Antisocial Personality Disorder. Cureus, 12(7): e9318.
26. Ford CV (2000) Somatoform Disorders. In: Ebert MH, Loosen PT, Nurcombe B (ed.). Current Diagnosis and Treatment Psychiatry. Lange Medical Books/McGraw-Hill Companies, New York, 366-377.
27. Frances A (2013) The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. BMJ, 346: f1580.
28. Gorard DA, Libby GW, Farthing MJ (1994) Influence of antidepressants on whole gut and orocecal transit times in health and irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 8:159–166.
29. Hahn SR (2001) Physical symptoms and physician-experienced difficulty in the physician-patient relationship. Ann Intern Med, 134:897–904.
30. Hakala M, Karlsson H, Kurki T, Aalto S, Koponen S, Vahlberg et al (2004) Volumes of the caudate nuclei in women with somatization disorder and health women. Psychiatry Res, 131(1): 71-78.
31. Hakala M, Vahlberg T, Niemi PM, Karlsson H (2006) Brain glucose metabolism and temperament in relation to severe somatization. Psychiatry Clin Neurosci, 60 (6): 669–675.
32. Harrison NA, Brydon L, Walker C, Gray MA, Steptoe A, Critchley HD (2009) Inflammation causes mood changes through alterations in subgenual cingulate activity and mesolimbic connectivity. Biol Psychiatry, 66(5): 407-414.
33. Heim C, Ehlert U, Hellhammer DH (2000) The potential role of hypocortisolism in the pathophysiology of stres related bodiliy disorders. Psychoneuroendocrinology, 25(1): 1-35.
34. Hollfield MA (2005) Somatoform Bozukluklar. In Kaplan&Sadock’s Comprehensive Textbook of Psychiatry, 8. Baskı (Ed. Sadock BJ, Sadock VA) (Çeviri Ed. H Aydın, A Bozkurt): 1800-1828, Ankara, Güneş Kitabevi.
35. Kırpınar İ (2013) Somatization and somatoform disorders: ambiguity reflected to practice. Update in Psychiatry, 3 (1): 1-16 (in Turkish)
36. Kırpınar İ (2019) Somatizasyon ve Bedensel belirti bozuklukları. Konsültasyon Liyezon Psikiyatrisi Cilt 1, (Ed. H.Elbi, C. Cimilli, Ö. Önen Sertöz, Ç.Karşıdağ, G. Sözeri-Varma). Ankara, Türkiye Psikiyatri Derneği Yayınları.
37. Kidd BL, Urban LA (2001) Mechanisms of inflammatory pain. Br J Anaesth, 87: 3–11.
38. Kirmayer LJ, Robbins JM (1991) Three forms of somatization in primary care: Prevalance, co-occurence, and sociodemographic characteristics. J Nerv Ment Dis, 179: 647-655.
39. Kirmayer LJ, Young A (1998) Culture and somatization: clinical, epidemiological and ethnographic perspectives. Psychosom Med, 60: 420–430.
40. Kleinstauber M, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ (2014) Pharmacological interventions for somatoform disorders in adults. Cochrane Database Syst Rev, (11): CD010628.
41. Kroenke K (2007) Efficacy of treatment for somatoform disor¬ders: a review of randomized controlled trials. Psycho¬som Med, 69(9):881-888.
42. Kubera N, Lin AH, Kenis G, Bosmans E, van Bockstaele D, Maes M (2001) Anti-inflammatory effects of antidepressants through suppression of the interferon-gamma/interleukin-10 production ratio. Journal of Clinical Psychopharmacology, 21:199–206.
43. Mai F (2004) Somatization Disorder: A Practical Review. Can J Psychiatry, 49 (10): 652-662.
44. Maunder RG, Hunter JJ, Atkinson L, Steiner M, Wazana A, Fleming AS et al. (2017) An attachment-based model of the relationship between childhood adversity and somatization in children and adults, Psychosomatic Medicine, 79(5):506-513.
45. Mayou R (2014) Is the DSM-5 chapter on somatic symptom disorder any better than DSM-IV somatoform disorder? Br. J. Psychiatry, 204 (6): 418–419.
46. Mechanic D (1972) The concept of illness behaviour. J Chronic Dis, 15:189–94.
47. Öztürk O, Uluşahin A (2016) Disosiyatif Bozukluklar ve Somatoform Bozukluklar. Ruh Sağlığı ve Bozuklukları, 14.Baskı: 391-420. Ankara: Nobel Tıp Kitabevleri.
48. Paras ML, Murad MH, Chen LP, Goranson EN, Sattler AL, Colbenson KM et al (2009) Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA, 302: 550–561.
49. Pennebaker JW, Watson D (1991) The Psychology of Somatic Symptoms. In Progress in psychiatry, No. 31. Current concepts of somatization: Research and clinical perspectives (Eds. LJ Kirmayer, JM Robbins): 21-36. Washington, American Psychiatric Press.
50. Pukhalsky AL, Shmarina GV, Alioshkin VA, Sabelnikov A (2008) HPA axis exhaustion and regulatory T cell accumulation in patients with a functional somatic syndrome: recent view on the problem of Gulf War veterans. J Neuroimmunol, 196(1-2): 133-138.
51. Rief W, Hennings A, Riemer S, Euteneuer F (2010) Psychobiological differences between depression and somatization. J Psychosom Res, 68 (5): 495-502.
52. Şafak Y, Türkçapar H (2013) Cognitive behavioral therapy in somatoform disorders. Update in Psychiatry, 3 (1): 84-94 (in Turkish)
53. Schwarz MJ, Spath M, Müller-Bardoff H, Pongrtz DE, Nondy B, Ackenheil M (1999) Relationship of substance P, 5-hydroxyindole acetic acid and tryptophan in serum of fibromyalgia patients. Neurosci Lett, 259(3): 196-198.
54. Sharpe M, Mayou R, Seagroatt V, Surawy C, Warwick H, Bulstrode C et al (1994) Why do doctors find some patients difficult to help? Q J Med, 87: 187–193.
55. Smith JK, Józefowicz RF (2012) Diagnosis and treatment of somatoform disorders. Neurol Clin Pract, 2 (2): 94-102.
56. Stahl SM (2002) The psychopharmacology of painful physical symptoms in depression. Journal of Clinical Psychiatry, 63:382–383.
57. Taycan O, Sar V, Celik C, Erdogan-Taycan S (2014) Trauma-related psychiatric comorbidity of somatization disorder among women in eastern Turkey. Compr Psychiatry, 55:1837–1846.
58. Ünal S (2002) Bir anlatım tarzı olarak bedenselleştirme. Anadolu Psikiyatri Dergisi, 3(1):52-55.
59. Van Dessel N, den Boeft M, van der Wouden JC, Kleinstauber M, Leone SS, Terluin B et al (2014) Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev, 1 (11): CD011142.
60. Vangeel E, Van Den Eede F, Hompes T, Izzi B, Del Favero J, Moorkens G et al (2015) Chronic Fatigue Syndrome and DNA Hypomethylation of the Glucocorticoid Receptor Gene Promoter 1F Region: Associations With HPA Axis Hypofunction and Childhood Trauma. Psychosom Med, 77(8): 853-62.
61. Vangeel EB, Kempke S, Bakusic J, Godderis L, Luyten P, Van Heddegem L et al (2018) Glucocorticoid receptor DNA methylation and childhood trauma in chronic fatigue syndrome patients. J Psychosom Res, 104:55-60.
62. Waller E, Scheidt CE, Hartmann A (2004) Attachment representation and illness behavior in somatoform disorders. J Nerv Ment Dis, 192: 200–209.