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Could these symptoms be part of somatoform disorder?
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Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Could these symptoms be part of somatoform disorder?

by Rody, Nov 29, 2003 12:00AM
Dear Sir,



I am a 35 year old man from Holland



I suffer from several neurological symptoms that started 6 years ago after a body building exercise. It started with tingling in both hands. A few weeks later, I woke up with what I call a kind of double vision. This has nothing to do with my eyes. They have been examined by an opthalmologist and are OK. It's like two indentical images overlap eachother not correctly and everything seems to be too bright.



Even when I close one eye, I still have the disturbed vision. It also seems that my peripheral vision has become stronger causing me to notice things around me that I didn't notice before. I am sure it's because my brain isn't processing the visual info correctly.



I also suffer from strong after images and trails. Also, unstable gait, burning feet, deterioration of motor control and dizziness.



The first episode of weird vision took 6 months 24/7 non-stop. It subsided after 6 months but reappeared after exercise again. Then again it took many months to subside. This has been going up and down during the years, a down always preceded by physical exercise.



In Summer 2002, a neurologist diagnosed Somatoform Disorder since MS and other neuro disorders have been ruled out. I took psychotherapy but couldn't find any unconcious conflicts. Also, I can't relate how I feel mentally with the symptoms.



This Summer, I felt great but everything reappeared after a two hour bike trip 7 weeks ago. Strange thing is that since then it is getting worse day by day. Of course I had moments of anxiety but I feel OK now.



I use Clomipramine to make the nervous system less sensitive. I also used Zoloft in the past but it didn't help. I can't say the Clomipramine is really helping me. I stopped it gradually and maybe it's because of this that it got worse but I am back on 150mg/day again since 3 weeks without any improvement.



Through the years, more and more neuro symptoms were added to the list.



I still can't imagine this is a conversion disorder because there are so many symptoms involved and because I really am an open person who discussed everything with his psychologist.



Could this be a conversion disorder or not?



Thanking in advance for your help,



Rody Mulder
Doctor's Answer

by Roger Gould, M.D., Nov 30, 2003 12:00AM
yes, it could be, but before concluding that I would ask your neurologist for a consultation or work up of your brain vascular system just to make sure that these exertion related onsets are not because of some vascular abnormality.
Member Comments (16)

by nurse12hr, Nov 29, 2003 12:00AM
http://www.ninds.nih.gov/health_and_medical/pubs/myasthenia_gravis.htm



The double vision is quite common, your other symptoms less so.  Worth a read, in any event.  Especially since your symptoms seem to come on after exercise.

by rodymu, Nov 29, 2003 12:00AM
To: Christie
Dear Christie,



Some doctors who I consulted via the internet also suggested MG based on the fact that my symptoms flare up after exercise.



But, the symptoms do not subside with rest in my case. The symptoms last for months even with rest. I talked to some MG sufferers and they told me their symptoms are stronger after exercise but subside within a couple of days.



Also, my double vision isn't caused by misalignment between the eyes. Even when I close one eye, I still experience the same vision. MG could cause double vision because of problem with the eye's tracking muscles what's not the case with me.



I am sure that all of my symptoms origin from the brain.



Thanks for your reply Christie.



Rody

by Try_to_be_social, Nov 30, 2003 12:00AM
To: rodymu
Your condition has been 6 year in duration. There is a long list of neurological symptoms one or all of which cannot be ascribed by your neurologist and ophthalmologist to one or a number of physical diseases even after exhaustive examinations and investigations (I supposed). If you had an organic illness that could cause all your symptoms, it would most likely progress into an easily recognizable physical disease after 5 to 6 years. All the psychological and psychiatric conditions are diagnosed after exclusion of physical ailments and this is particular important in your condition which consists almost entirely of physical symptoms. And your neurologist who reviewed you condition of 5 to 6 years was the best person to say all the relevant physical disorders were excluded. The fact that your condition “did not respond to” psychotherapy, Anafranil and Zoloft does not automatically mean that it is not psychological. For somatoform disorder please read http://www.hsc.wvu.edu/aap/aap-car/slides/somatoform/somatoform-disorders.ppt and  http://homepage.psy.utexas.edu/homepage/class/Psy352/Hawkins/PowerpointLectures/Chap7_Dissoc/Hawkins7.ppt.

by Try_to_be_social, Nov 30, 2003 12:00AM
To: rodymu
Your condition has been 6 year in duration. There is a long list of neurological symptoms one or all of which cannot be ascribed by your neurologist and ophthalmologist to one or a number of physical diseases even after exhaustive examinations and investigations (I supposed). If you had an organic illness that could cause all your symptoms, it would most likely progress into an easily recognizable physical disease after 5 to 6 years. All the psychological and psychiatric conditions are diagnosed after exclusion of physical ailments and this is particular important in your condition which consists almost entirely of physical symptoms. And your neurologist who reviewed you condition of 5 to 6 years was the best person to say all the relevant physical disorders were excluded. The fact that your condition “did not respond to” psychotherapy, Anafranil and Zoloft does not automatically mean that it is not psychological. For somatoform disorder please read http://www.hsc.wvu.edu/aap/aap-car/slides/somatoform/somatoform-disorders.ppt and  http://homepage.psy.utexas.edu/homepage/class/Psy352/Hawkins/PowerpointLectures/Chap7_Dissoc/Hawkins7.ppt.

by rodymu, Dec 01, 2003 12:00AM
To: Try-to-be-social
Dear social person,



Thanks for your comment. This weekend, I researched a lot on Conversion Disorder. That and your comment helped to understand the background.



I agree with you that if those symptoms were caused by an organic illness, the illness would have presented itself by now. Also, I can't find anyone who experiences the same kind of visual disturbance.



This is all very scary because more and more symptoms were added to the list during the years. It seems to live a life on its own.



Probably I haven't found the right psychologist yet. How to find out which unconcious conflicts are represented by these physical symptoms?



Even more scary is the fact there's no full recovery. The past years have been a hell for me, except the last year. Unfortunately, my vision turned bad two months ago after a biketrip. A major aggrevation always happened after a peak physical exercise. This is something I can't recognise in the conversion stories I've read.



Rody

by Try_to_be_social, Dec 02, 2003 12:00AM
To: Rody
Dear Rody,



From your first post, you are not convinced at all that your have somatoform disorder. The first and foremost requirement for therapy is to accept whole-heartedly the diagnosis made by a psychiatrist. Then you are presented with several options of therapy. Please refer to http://www.hendrickhealth.org/healthy/001277.htm. If brief insight-oriented psychotherapy did not work you select another approach or school such as CBT. If Anafranil and Zoloft failed you, you select another class of antidepressant such as Effexor XL or Wellbutrin the dose of which should be stepped up gradually until you obtain the effect or the maximum therapeutic dose is reached. Never give up.



Best wishes

by Try_to_be_social, Dec 02, 2003 12:00AM
To: Rody
Dear Rody,



From your first post, you are not convinced at all that your have somatoform disorder. The first and foremost requirement for therapy is to accept whole-heartedly the diagnosis made by a psychiatrist. Then you are presented with several options of therapy. Please refer to http://www.hendrickhealth.org/healthy/001277.htm. If brief insight-oriented psychotherapy did not work you select another approach or school such as CBT. If Anafranil and Zoloft failed you, you select another class of antidepressant such as Effexor XL or Wellbutrin the dose of which should be stepped up gradually until you obtain the effect or the maximum therapeutic dose is reached. Never give up.



Best wishes

by rodymu, Dec 02, 2003 12:00AM
To: Try-to-be-social
Thanks again for your reply, I really appreciate it.



I am a rational person and that may be the reason why it's difficult to believe it's a conversion disorder