Skip to main content
SpringerLink
Log in

Why Does My Body Hurt? Somatoform Disorders and Pain

  • Chapter
  • First Online:
Mental Health and Pain

Abstract

Somatoform disorders are characterized by the presence of a number of somatic symptoms without an organic cause that completely explains the symptoms. The following chapter will focus on the pathogenesis of somatoform pain disorder, which is still far from clear. Early biographical stress experiences (childhood adversities) seem to modulate the symptomatology of somatoform pain disorder. In this patient group several studies show a dysfunctional central stress regulation and stress response, an altered autonomic response with impaired interoceptive sensitivity, as well as abnormalities of brain structure and function, with an increased activity of a number of brain regions believed to be involved in the emotional appraisal, namely anterior cingulated cortex and insula. These findings are of great importance due to the fact that the extent of an individual’s sensitivity to external (environment) and internal (bodily) signals is considered to be an essential variable in social interaction. This might contribute to deficits in interpersonal relationships and emotional and social functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Adler RH, Zlot S, Hurny C, Minder C (1989) Engel’s “Psychogenic Pain and the Pain-Prone Patient:” a retrospective, controlled clinical study. Psychosom Med 51:87–101

    Article  CAS  PubMed  Google Scholar 

  2. Anderzén I, Arnetz BB, Söderström T, Söderman E (1997) Stress and sensitization in children: a controlled prospective psychophysiological study of children exposed to international relocation. J Psychosom Res 43:259–269

    Article  PubMed  Google Scholar 

  3. APA (1994) Diagnostic and statistical manual of mental disorders (DSM IV), 4th edn. APA Press, Washington, DC

    Google Scholar 

  4. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK (2005) Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 9:463–484

    Article  PubMed  Google Scholar 

  5. Barsky AJ (1992) Amplification, somatization, and the somatoform disorders. Psychosomatics 33:28–34

    Article  CAS  PubMed  Google Scholar 

  6. Bechara A, Damasio AR (2005) The somatic marker hypothesis: a neural theory of economic decision. Games Econ Behav 52:336–372

    Article  Google Scholar 

  7. Benjet C, Borges G, Medina-Mora ME (2010) Chronic childhood adversity and onset of psychopathology during three life stages: childhood, adolescence and adulthood. J Psychiatr Res 44:732–740

    Article  PubMed  Google Scholar 

  8. Bingel U, Lorenz J, Schoell E et al (2006) Mechanisms of placebo analgesia: rACC recruitment of a subcortical antinociceptive network. Pain 120:8–15

    Article  CAS  PubMed  Google Scholar 

  9. Bowlby J (1988) The secure base. Clinical applications of attachment theory. Tavistock/Routledge, London

    Google Scholar 

  10. Bremner JD (2005) Effects of traumatic stress on brain structure and function: relevance to early responses to trauma. J Trauma Dissociation 6:51–68

    Article  PubMed  Google Scholar 

  11. Browning M, Fletcher P, Sharpe M (2011) Can neuroimaging help us to understand and classify somatoform disorders? A systematic and critical review. Psychosom Med 73:173–184

    Article  PubMed Central  PubMed  Google Scholar 

  12. Champagne F, Meaney MJ (2001) Like mother, like daughter: evidence for non-genomic transmission of parental behavior and stress responsivity. Prog Brain Res 133:287–302

    Article  CAS  PubMed  Google Scholar 

  13. Chrousos GP (1998) Stressors, stress, and neuroendocrine integration of the adaptive response. The 1997 Hans Selye Memorial Lecture. Ann N Y Acad Sci 851:311–335

    Article  CAS  PubMed  Google Scholar 

  14. Chrousos GP, Gold PW (1992) The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 267:1244–1252

    Article  CAS  PubMed  Google Scholar 

  15. Coghill RC, McHaffie JG, Yen YF (2003) Neural correlates of interindividual differences in the subjective experience of pain. Proc Natl Acad Sci U S A 100:8538–8542

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Creed F, Barsky A (2004) A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 56:391–408

    Article  PubMed  Google Scholar 

  17. Damasio AR (2000) The fabric of the mind: a neurobiological perspective. In: Uylings HBM, Van Eden CG, De Bruin JPC et al (eds) Progress in brain research, vol 126. Elsevier, Amsterdam, pp 457–467

    Google Scholar 

  18. Dantzer R (2005) Somatization: a psychoneuroimmune perspective. Psychoneuroendocrinology 30:947–952

    Article  PubMed  Google Scholar 

  19. De Waal MWM, Arnold IA, Eekhof JAH, van Hemert AM (2004) Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. Br J Psychiatry 1846:470–476

    Article  Google Scholar 

  20. Dimsdale JE, Dantzer R (2007) A biological substrate for somatoform disorders: importance of pathophysiology. Psychosom Med 69:850–854

    Article  PubMed Central  PubMed  Google Scholar 

  21. Drossman DA, Talley NJ, Leserman J et al (1995) Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med 123:782–794

    Article  CAS  PubMed  Google Scholar 

  22. Egle UT, Hoffmann SO, Steffens M (1997) Psychosoziale Risiko- und Schutzfaktoren in Kindheit und Jugend als Prädisposition für psychische Störungen im Erwachsenenalter (Psychosocial risk and protective factors in childhood and adolescence as predisposition for psychiatric disorders in adulthood). Nervenarzt 68:683–695

    Article  CAS  PubMed  Google Scholar 

  23. Fink P, Hansen MS, Oxhoj ML (2004) The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 56:413–418

    Article  PubMed  Google Scholar 

  24. Garralda E (2005) Somatization and somatoform disorders. Psychiatry 4:97–100

    Article  Google Scholar 

  25. Geisser ME, Casey KL, Brucksch CB et al (2003) Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing. Pain 102:243–250

    Article  PubMed  Google Scholar 

  26. Gianaros PJ, Jennings JR, Sheu LK et al (2007) Prospective reports of chronic life stress predict decreased grey matter volume in the hippocampus. Neuroimage 35:795–803

    Article  PubMed Central  PubMed  Google Scholar 

  27. Gracely RH, Geisser ME, Giesecke GT et al (2004) Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain 127:835–843

    Article  CAS  PubMed  Google Scholar 

  28. Gündel H, Valet M, Sorg C et al (2008) Altered cerebral response to noxious heat stimulation in patients with somatoform pain disorder. Pain 137:413–421

    Article  PubMed  Google Scholar 

  29. Gunnar MR (1998) Quality of early care and buffering of neuroendocrine stress reactions: potential effects on the developing human brain. Prev Med 27:208–211

    Article  CAS  PubMed  Google Scholar 

  30. Hamann SB, Ely TD, Grafton ST, Kilts CD (1999) Amygdala activity related to enhanced memory for pleasant and aversive stimuli. Nat Neurosci 2:289–293

    Article  CAS  PubMed  Google Scholar 

  31. Hansen GR, Streltzer J (2005) The psychology of pain. Emerg Med Clin North Am 23:339–348

    Article  PubMed  Google Scholar 

  32. Houtveen JH, van Doornen LJ (2007) Medically unexplained symptoms and between-group differences in 24-h ambulatory recording of stress physiology. Biol Psychol 76:239–249

    Article  PubMed  Google Scholar 

  33. Imbierowicz K, Egle UT (2003) Childhood adversities in patients with fibromyalgia and somatoform pain disorder. Eur J Pain 7:113–119

    Article  PubMed  Google Scholar 

  34. James W (1884) What is an emotion? Mind 9:188–205

    Article  Google Scholar 

  35. Klossika I, Flor H, Kamping S et al (2006) Emotional modulation of pain: a clinical perspective. Pain 124:264–268

    Article  PubMed  Google Scholar 

  36. Laederach-Hofmann K, Ruddel H, Mussgay L (2008) Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms? Biol Psychol 79:243–249

    Article  PubMed  Google Scholar 

  37. Lee MC, Ploner M, Wiech K et al (2013) Amygdala activity contributes to the dissociative effect of cannabis on pain perception. Pain 154:124–134

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. McLaughlin KA, Breslau J, Green JG et al (2011) Childhood socio-economic status and the onset, persistence, and severity of DSM-IV mental disorders in a US national sample. Soc Sci Med 73:1088–1096

    Article  PubMed Central  PubMed  Google Scholar 

  39. Melin B, Lundberg U (1997) A biopsychosocial approach to work-stress and musculosketal disorders. J Psychophysiol 11:238–247

    Google Scholar 

  40. Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150:971–979

    Article  CAS  PubMed  Google Scholar 

  41. Meredith P, Ownsworth T, Strong J (2008) A review of the evidence linking adult attachment theory and chronic pain: presenting a conceptual model. Clin Psychol Rev 28:407–429

    Article  PubMed  Google Scholar 

  42. Oztan O, Aydin C, Isgor C (2011) Chronic variable physical stress during the peripubertal-juvenile period causes differential depressive and anxiogenic effects in the novelty-seeking phenotype: functional implications for hippocampal and amygdalar brain-derived neurotrophic factor and the mossy fibre plasticity. Neuroscience 192:334–344

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Paskitti ME, McCreary BJ, Herman JP (2000) Stress regulation of adrenocorticosteroid receptor gene transcription and mRNA expression in rat hippocampus: time-course analysis. Mol Brain Res 80:142–152

    Article  CAS  PubMed  Google Scholar 

  44. Pine DS, Charney DS (2002) Children, stress, and sensitization: an integration of basic and clinical research on emotion? Biol Psychiatry 52:773–775

    Article  PubMed  Google Scholar 

  45. Pollatos O, Herbert BM, Wankner S et al (2011) Autonomic imbalance is associated with reduced facial recognition in somatoform disorders. J Psychosom Res 71:232–239

    Article  PubMed  Google Scholar 

  46. Posada G (2008) Attachment. In: Marshall MH, Benson JB (eds) Encyclopedia of infant and early childhood development. Academic, San Diego, pp 96–106

    Chapter  Google Scholar 

  47. Richter-Levin G (2004) The amygdala, the hippocampus, and emotional modulation of memory. Neuroscientist 10:31–39

    Article  PubMed  Google Scholar 

  48. Rief W, Auer C (2001) Is somatization a habituation disorder? Physiological reactivity in somatization syndrome. Psychiatry Res 101:63–74

    Article  CAS  PubMed  Google Scholar 

  49. Rief W, Hessel A, Braehler E (2000) Somatization symptoms and hypochondriacal features in the general population. Psychosom Med 63:595–602

    Article  Google Scholar 

  50. Rief W, Shaw R, Fichter MM (1998) Elevated levels of psychophysiological arousal and cortisol in patients with somatization syndrome. Psychosom Med 60:198–203

    Article  CAS  PubMed  Google Scholar 

  51. Schachter S, Singer J (1962) Cognitive, social, and physiological determinants of emotional state. Psychol Rev 69:379–399

    Article  CAS  PubMed  Google Scholar 

  52. Schaefer M, Egloff B, Witthöft M (2012) Is interoceptive awareness really altered in somatoform disorders? Testing competing theories with two paradigms of heartbeat perception. J Abnorm Psychol 121:719–724

    Article  PubMed  Google Scholar 

  53. Seminowicz DA, Davis KD (2006) Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain 120:297–306

    Article  PubMed  Google Scholar 

  54. Sensky T, MacLeod AK, Rigby MF (1996) Causal attributions about common somatic sensations among frequent general practice attenders. Psychol Med 26:641–646

    Article  CAS  PubMed  Google Scholar 

  55. Stoeter P, Bauermann T, Nickel R et al (2007) Cerebral activation in patients with somatoform pain disorder exposed to pain and stress: an fMRI study. Neuroimage 36:418–430

    Article  CAS  PubMed  Google Scholar 

  56. Tak LM, van Roon AM, Rosmalen JG (2009) Is baroreflex sensitivity really pathological in patients with somatization disorder? Comment on: Laederach-Hofmann et al. (2008). Biol Psychol 82:97–98

    Article  PubMed  Google Scholar 

  57. Thayer JF, Brosschot JF (2005) Psychosomatics and psychopathology: looking up and down from the brain. Psychoneuroendocrinology 30:1050–1058

    Article  PubMed  Google Scholar 

  58. Tracey I, Becerra L, Chang I et al (2000) Noxious hot and cold stimulation produce common patterns of brain activation in humans: a functional magnetic resonance imaging study. Neurosci Lett 288:159–162

    Article  CAS  PubMed  Google Scholar 

  59. Van Houdenhove B, Egle UT (2004) Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom 73:267–275

    Article  PubMed  Google Scholar 

  60. Van Houdenhove B, Neerinckx E, Lysens R et al (2001) Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics. Psychosomatics 42:21–28

    Article  PubMed  Google Scholar 

  61. Weaver ICG, La Plante P, Weaver S et al (2001) Early environmental regulation of hippocampal glucocorticoid receptor gene expression: characterization of intracellular mediators and potential genomic target sites. Mol Cell Endocrinol 185:205–218

    Article  CAS  PubMed  Google Scholar 

  62. Wiech K, Ploner M, Tracey I (2008) Neurocognitive aspects of pain perception. Trends Cogn Sci 12:306–313

    Article  PubMed  Google Scholar 

  63. Williams DT, Harding KJ (2010) Somatoform disorders. In: Kompoliti K, Verhagen LM (eds) Encyclopedia of movement disorders. Academic, Oxford, pp 121–127

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Albert-Einstein-Allee 41, 89073, Ulm, Germany

    Ellen Matthias & Olga Pollatos

Authors
  1. Ellen Matthias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olga Pollatos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellen Matthias .

Editor information

Editors and Affiliations

  1. Centre de Recherche Clinique Etienne Le Bel, Sherbrooke, Canada

    Serge Marchand

  2. EPS Barthélémy Durand, Etampes, France

    Djéa Saravane

  3. Faculté de médecine et CRCELB, Sherbrooke, Canada

    Isabelle Gaumond

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag France

About this chapter

Cite this chapter

Matthias, E., Pollatos, O. (2014). Why Does My Body Hurt? Somatoform Disorders and Pain. In: Marchand, S., Saravane, D., Gaumond, I. (eds) Mental Health and Pain. Springer, Paris. https://doi.org/10.1007/978-2-8178-0414-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-2-8178-0414-9_10

  • Published:

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-8178-0413-2

  • Online ISBN: 978-2-8178-0414-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation