Could these symptoms be part of somatoform disorder?

[Rody]

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

[Roger Gould, M.D.]

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.

[nurse12hr]

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.

[rodymu]

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

[Try_to_be_social]

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 <a href=http://www.hsc.wvu.edu/aap/aap-car/slides/somatoform/somatoform-disorders.ppt>http://www.hsc.wvu.edu/aap/aap-car/slides/somatoform/somatoform-disorders.ppt</a> and  <a href=http://homepage.psy.utexas.edu/homepage/class/Psy352/Hawkins/PowerpointLectures/Chap7_Dissoc/Hawkins7.ppt>http://homepage.psy.utexas.edu/homepage/class/Psy352/Hawkins/PowerpointLectures/Chap7_Dissoc/Hawkins7.ppt</a>.

[Try_to_be_social]

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 <a href=http://www.hsc.wvu.edu/aap/aap-car/slides/somatoform/somatoform-disorders.ppt>http://www.hsc.wvu.edu/aap/aap-car/slides/somatoform/somatoform-disorders.ppt</a> and  <a href=http://homepage.psy.utexas.edu/homepage/class/Psy352/Hawkins/PowerpointLectures/Chap7_Dissoc/Hawkins7.ppt>http://homepage.psy.utexas.edu/homepage/class/Psy352/Hawkins/PowerpointLectures/Chap7_Dissoc/Hawkins7.ppt</a>.

[rodymu]

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

[Try_to_be_social]

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 <a href= http://www.hendrickhealth.org/healthy/001277.htm> http://www.hendrickhealth.org/healthy/001277.htm</a>. 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

[Try_to_be_social]

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 <a href= http://www.hendrickhealth.org/healthy/001277.htm> http://www.hendrickhealth.org/healthy/001277.htm</a>. 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

[rodymu]

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.

I have read the information you suggested. Maybe my brain is selective and just willing to pick up the information that supports my denial but I read that symptoms of a conversion disorder usually only last for a couple of months while mine are non-stop.

I have many symptoms indeed but I wonder whether most of them could be conversion related while only a few or one may be due to a real organic illness. Everything started with the weird visual disturbance and this is the symptom that is so much related with a physical exertion trigger. All other symptoms could just be caused by anxiety and not knowing what's going on. What do you think?

Thanks for your advice on anti-depressants. I forgot to mention that I also tried Seroxat but without success. I have heard about Efexor and I will suggest it to my shrink.

What's your own life experience or illness?

Looking forward to your reply,

Rody

[Try_to_be_social]

Dear Rody,

Essentially it is somatoform disorder with secondary anxiety. And the symptoms are NOT classical. I would not spend too much time in analyzing the symptoms and see if they fit into the classical DSM IV criteria. The focus is to find ways to solve the problems and to learn more about your problems by reading and searching.
I have social phobia according to Dr Gould of this forum. I was brought up in a dysfunctional family. I have tried most of the antidepressants and anxiolytics. I was on Mianserin 60mg and Luvox 50mg and Klonopin 2mg all before bed for 10 years. Since I join this forum in August 2003, I discontinue Luvox and cut down Klonopin very slowly to 1mg. I will be an IT graduate this month.

Kindest regards

[rodymu]

How you are doing now?

Good luck with your graduation!

Take care,

Rody

[Try_to_be_social]

Dear Rody,

Thanks for your concern.
I had my psychiatric disorder treated in remission with the three medicines before I know in fact I had social phobia. Thanks to antidepressants that treat anxiety and depressive symptoms at the same time. That is why I propose finding the solution is sometimes more important than full understanding of the symptoms and diagnosis. I am very happy that I am doing equally well with nearly half of my medication reduced since August 2003. I had a good job. I furthered my study with good results. I am divorced and still looking for a partner. Recently I have lost a large sum of money in foreign exchange margin but I can still taper my medicine. I had life-long asthma and allergic rhinitis. In the last few months I has an exacerbation of my asthma due to change of weather and is resistant to all possible medications but is improved as the weather turns better. My chronic physical illness was one of the causes of my social phobia.

Best regards

[pager1]

Hi, Ive had some of the same visual disturbances youve had, and other problems. I dont beleive its a Somatoform disorder.

[rodymu]

Dear Pager,

Did your symptoms disappear?

I just returned from a neurologist in Germany. He diagnosed me with somatoform disorder one year ago. This time, he explained to me that since he doesn't know any illness with which aggrevation of vision disturbance is caused by physical exertion and since none of the examinations reveiled any organic illness, he had to conclude that the symptoms are caused by a conversion disorder.

It's a diagnosis of exclusion.

He also said that it's very hard for both the patient and the therapist to relate between the onset or aggrevation of symptoms and the way how the patient feels preceding this.

It seems one just has to be patient since it normally subsides. But, it may take many years.

Asking me whether I believe in conversion diagnosis is like asking me whether I believe in God or not. The fact is I can't just answer yes or no!

Rody

[pager1]

The symptoms went away after about 5-6 months. It has happened to me three times in my life Im 30. Do you have any other symptoms or just the visual? How many times has it happened?

[pager1]

Ive been to regular doctors and they have no idea.Ive tried antidepressants and risperdal and zyprexa with no benefit. The meds dont help me either. My symptoms get stronger every time this happens. Do you have any headaches or burning in your head?