A kind of somatoforme disorder

[gil_galad]

In my search for answers regarding this syndrome I have found many hints and evidence that (at least in my case) we are talking about a somatoforme disorder:

"Somatization Disorder has multiple unexplained somatic (physical) complaints that occur in multiple areas of the body. The minimum number of separate complaints that have to occur in order to qualify for this disorder is 8, including 4 pain symptoms, 2 gastrointestinal symptoms, 1 sexual symptom, and 1 pseudoneurological symptom. Generally, when people with this disorder present with a problem, they do so very dramatically, explaining the symptom as "the worst ever" or "I was bleeding like a stuck pig."
"Symptoms
Symptoms begin in adolescence or early adulthood with many vague physical complaints. Any part of the body may be affected, and specific symptoms and their frequency vary among different cultures. In the USA, typical symptoms include headaches, nausea and vomiting, bloating, abdominal pain, diarrhea or constipation, dysmenorrhea, fatigue, fainting, dyspareunia, loss of sexual desire, and dysuria. Men frequently complain of erectile or ejaculatory dysfunction. A wide variety of neurologic symptoms are common. Although symptoms are primarily physical, anxiety and depression also occur. Typically, patients are dramatic and emotional when recounting their symptoms, often referring to them as "unbearable," "beyond description," or "the worst imaginable."


My believe is that chronic prostatitis / chronic pelvic pain syndrome is in many cases a kind of psychiatric disorder (even AHIP as causes in many cases gives psychiatric traumas and the solution it suggests is has physical and phsycological parts)

[webslave]

... typical symptoms include headaches, nausea and vomiting, bloating, abdominal pain, diarrhoea or constipation, dysmenorrhea, fatigue, fainting, dyspareunia, loss of sexual desire, and dysuria. Men frequently complain of erectile or ejaculatory dysfunction...

Doesn't sound like CP/CPPS/IC/Pelvic Myoneuropathy to me. I've never heard of many of these symptoms on this forum.

However, IC has been linked genetically to panic disorder and stress
viewtopic.php?t=1602

[gil_galad]

Those symptoms aren't related directly to chronic prostatitis / chronic pelvic pain syndrome but I'm sure that almost anyone in this forum has,had troubles with headaches (1)

"bloating, abdominal pain, diarrhoea or constipation" those are symptoms of IBS and I have read many posts complaining aboy it (2).

"fatigue" I've also read many times about CFS (3),


"loss of sexual desire", when you are in pain you don't want sex (4),

"dysuria" aka "burning during peeing" many posts with that too (5),

"Men frequently complain of erectile or ejaculatory dysfunction..." I rest my case in this sentence (6)!

What I'm trying to say is that each part of medicine has a different name (and approach) for basically the same condition.And there it is Biofeedback is talking about anilevator syndrome, urologists about CPPS,psychologists about "somatoform disorder".That gives a good explanation why S.Protocol works.It's because it addresses the problem both physically and mentally!
And there lies the reason for the failures too.If you fail to correctly "fix" one the 2 parts the problem will stay.

[webslave]

Those symptoms aren't related directly to chronic prostatitis / chronic pelvic pain syndrome but I'm sure that almost anyone in this forum has,had troubles with headaches (1)

I only get headaches when I eat certain foods, and most forum posters do not mention headaches.

"bloating, abdominal pain, diarrhoea or constipation" those are symptoms of IBS and I have read many posts complaining about it (2).

IBS is related to CPPS, but many people have chronic prostatitis / chronic pelvic pain syndrome or pelvic myoneuropathy without having IBS. Bloating is also a feature of food sensitivity, and again, in my case I get it when I eat particular foods only (plants from the nightshade family -- tomato, potato, eggplant).

"fatigue" I've also read many times about CFS (3),

CFS is a whole area of concern on its own. To bundle CFS and chronic prostatitis / chronic pelvic pain syndrome together as "somatoform disorder" would be over-simplifying things drastically, IMO.

"loss of sexual desire", when you are in pain you don't want sex (4),

There are many things that cause a drop in libido, and many men with our condition who have very strong libidos, & some who have sexual intercourse daily.

"dysuria" aka "burning during peeing" many posts with that too (5),

A common symptom of our condition, but also with ordinary cystitis in females (and this description of somatoform disorders does seem to be aimed at females for the most part).

"Men frequently complain of erectile or ejaculatory dysfunction..." I rest my case in this sentence (6)!

Vague. ED and PE are common complaints in men with and without CPPS.

What I'm trying to say is that each part of medicine has a different name (and approach) for basically the same condition.

I'll agree with you tentatively on that one.

And there it is Biofeedback is talking about anilevator syndrome, urologists about CPPS,psychologists about "somatoform disorder".That gives a good explanation why S.Protocol works. It's because it addresses the problem both physically and mentally! And there lies the reason for the failures too.If you fail to correctly "fix" one the 2 parts the problem will stay.

Now, be careful here. One of the features of somatization disorder is that it is related to hypochondriasis and the psychologists mention this as a key feature: "Symptoms are unfounded or exaggerated". People with chronic prostatitis / chronic pelvic pain syndrome and CFS are very likely to go red with rage if you start telling them that their symptoms are unfounded and exaggerated! It's only recently that we were able to get the medical profession to acknowledge that CFS is a real disease with an organic basis. Are you not aware that all through time the medical profession has tended to label untreatable diseases as "psychological" and "somatoform" in a dismissive way, right up until the time that an organic basis and/or effective treatment is finally found, and then, like magic, lo and behold the disease gets official recognition and moves into the respectable camp? As long as doctors cannot effectively treat something, they tend to blame the patient for the condition. It's a form of psychological self-defence on their part.

Look more closely at the theories behind the somatization disorders you'll see that the behaviourists see it as a form of "malingering" and something learned from social reinforcement. They see us "acting" sick for some sort of "secondary gain". Are you sure you want to support this errant nonsense here?

The psychoanalytic theorists see somatoform disorders as a form of repressed sexuality, which is patently absurd when applied to our patient group.

The other key thing they mention is that symptoms are "described in dramatic ways". That is NOT something I have ever noticed on this forum.

I do not see the Stanford/Wise-Anderson Protocol as supporting your view that this is a somatoform disorder. To say that we are an unusually tense and anxious group with a proclivity to tense up our pelvic muscles is one thing, but to say that we exaggerate our symptoms and are malingerers who do this for some sort of social advantage is quite another.

[gil_galad]

"The psychoanalytic theorists see somatoform disorders as a form of repressed sexuality, which is patently absurd when applied to our patient group." I can not comend on that because we have to examine each sufferer individualy.Although I do think that phsycological pressure (subcounsiously or external factors) do explain the onset and the cousre of the syndrome.

"The other key thing they mention is that symptoms are "described in dramatic ways". That is NOT something I have ever noticed on this forum."
You are wrong in this just view the suicide posts!

"I do not see the Stanford/Wise-Anderson Protocol as supporting your view that this is a somatoform disorder. To say that we are an unusually tense and anxious group with a proclivity to tense up our pelvic muscles is one thing, but to say that we exaggerate our symptoms and are malingerers who do this for some sort of social advantage is quite another."
Page 37 of the 3d edition of AHIP "Factors associated with onset (may include one or more of the following)"
1.high periods of stress
2. Anxiety-producing sexual encounter
3.Compulsive sexual activity or masturbation

along with the "mechanical" factors

Page 250 of the 3d edition of AHIP "The usefulness of cathastic psycotherapy"

Page 252 of the 3d edition of AHIP "Sexual shame ang guilt"

Page 249 of the 3d edition of AHIP "EMDR" in the second paragraph writes"A small but not insignifigant number of patients have tightted their pelvic muscles chronically as a reaction to physical or sexual abuse"

ALL I'M saying is that in many cases the phsycological factor is the key to solve this problem!

[webslave]

"The psychoanalytic theorists see somatoform disorders as a form of repressed sexuality, which is patently absurd when applied to our patient group." I can not comment on that because we have to examine each sufferer individualy.Although I do think that phsycological pressure (subcounsiously or external factors) do explain the onset and the course of the syndrome.

Psychological pressure is not the same as repressed sexuality. Apples and Oranges.

"The other key thing they mention is that symptoms are "described in dramatic ways". That is NOT something I have ever noticed on this forum."
You are wrong in this just view the suicide posts!

We have a few suicide threats, and it is quite reasonable for some men to talk about suicide given their unrelenting pain. Just yesterday I had someone tell me about a case where a man did actually commit suicide because of pelvic pain. You need to differentiate between melodramatic statements made by attention-seeking "malingerers" and actual descriptions of real pain.

"I do not see the Stanford/Wise-Anderson Protocol as supporting your view that this is a somatoform disorder. To say that we are an unusually tense and anxious group with a proclivity to tense up our pelvic muscles is one thing, but to say that we exaggerate our symptoms and are malingerers who do this for some sort of social advantage is quite another."
Page 37 of the 3d edition of AHIP "Factors associated with onset (may include one or more of the following)"
1.high periods of stress
2. Anxiety-producing sexual encounter
3.Compulsive sexual activity or masturbation

along with the "mechanical" factors

Page 250 of the 3d edition of AHIP "The usefulness of cathastic psychotherapy"

Page 252 of the 3d edition of AHIP "Sexual shame ang guilt"

Page 249 of the 3d edition of AHIP "EMDR" in the second paragraph writes"A small but not insignificant number of patients have tightted their pelvic muscles chronically as a reaction to physical or sexual abuse"

ALL I'M saying is that in many cases the phsycological factor is the key to solve this problem!

I agree that of course there is a psychological factor, but it is not somatoform disorder. That is where we disagree.

[gil_galad]

"I agree that of course there is a psychological factor, but it is not somatoform disorder. That is where we disagree."

Can you please give me your personal understanting of the definition of a somatoform disorder.Because I believe that our disagreement lies in the words not in the essense of our writings!

[webslave]

Somatoform disorders are psychiatric illnesses in which people have complaints, concerns and pain out of proportion to the actual physical findings.

"You say you have intense pelvic pain, but all I can find is a few white blood cells!"

In my opinion, this new diagnostic category was invented to describe many of the sick people for whom modern medicine does not yet have good treatments.

[gil_galad]

For me real somatoform disorders (not diseases like Fibromyalgia), are the physical expresion that something is wrong in your life (problems at home etc,or personal like PE).The mental pressure (with the "help" of physical pressure,like sitting too much at work) is too much for the body that starts to produces real symptoms.

[LightningTree]

Gil,

My twin brother and I both have this condition. Before I had this condition, my parents told me my twin brother had a 'back problem.' Yet when I developed this problem it appeared in my pelvis, and only then did my parents inform me that my brother had the same problem.

Therefore, it seems unlikely that I was seeking attention by mimicking his symptoms alone. As a twin, I can assure you that a hypochondrial or attention seeking reaction would have definitely mimicked my twin's symptoms through my perception of where his symptoms were at the time. As I perceived them in his back, that is where they would have been.

That means that the only remaining likely way that I could have developed similar (but not exactly the same) actual symptoms through a psychological process for attention would be if my body and my twin's body had predispositions to develop pain in the particular region. But that predisposition either suggests a physiological basis, or a behavioral basis as suggested by Dr. Wise.

Such a disease causation, lying on the mind-body border is both psychological and physical. And I agree with Webslave that the three of us agree on this concept.

But where I agree with Webslave, and disagree with you, Gil, is where this mind-body connection lies.

I would like to turn your attention to the very early stages of this syndrome as evidence against the sematophoric theory. Many of us experience weird numbness and afferent sensations, and finally, minor testicular ache and reduced urine stream at least a few weeks to a few months prior to developing significant pain. We often consider these conditions to merely be the effects of aging and could care less about them.

Only later does the pain rapidly progress. This rapid progression of pain is a physiological manifestation of continued pathological process hinted at by the earlier sensations that we (1) disregarded as unimportant and (2) as a result of them, sought no change in our behavior or the behavior of others. No avoidance was practiced. No attention was received. No emotions were diverted.

Why would a somatophoric illness begin with a common set of symptoms shared by the community that have no psychological feedback relationship?

If it were because of a physiological causation, such as sitting too much, would this not a causal relationship between symptoms that cannot be explained without neuromuscular disorder and a physiological cause, that arises prior to the potential for a somatophoric feedback effect?
Would not then suggesting that the feedback is a result of somatophoria not introduce an extra, unneeded concept into the theory of causation, which would do most to help calm doctors and do little to explain the causation of symptoms in patients?

[ddt1974]

I don't believe in somatoforme disorders. They are yet undiscovered illnesses of some type, IMO. They labeled Multiple Sclerosis a somatoforme disorder back in the stone ages before they knew what it was.

[robertpagen]

I have to compliment all of you on the high level of the discussion here, whatever your point of view. I called up a uro yesterday who had been of no use in Nov 2001 and asked if he had read AHIP yet. He said no! It just shows you where the medical urologists still are! I suspect that the average young man who goes to the average uro now days is still doomed to suffer. First he will be treated inappropriately the he will be labeled as crazy.

Amd to think it is August 2005

Any optomists out there?

[LightningTree]

My brother saw a urologist who forwarded him to a pain management clinic, after antibiotics were unsuccesful. The pain management clinic then suggested physical therapy. I guess that is some progress over 'go home, calm down, and take a bath.'