Somatoform Disorders: What They Are and How to Recognize Them

Somatoform disorders are neither imaginary nor a sign of weakness. Dr. Saulitis is clear: psychosomatics is an absolute reality. Understanding it begins with one core concept — homeostasis.

The underlying mechanism

The body is constantly seeking equilibrium: blood markers, hormones, organ function — all of it continuously returns to balance. When stressors — biological, psychological, or environmental — disturb that balance and the body can no longer restore itself, disorders emerge. This inability to return to baseline is the central mechanism of psychosomatic illness.

What it looks like in practice

A person feels genuinely unwell: fatigue, pain, persistent physical discomfort. They visit doctors, run tests — and no organic pathology is found. This is a critical point: the symptoms are not imaginary. But their source is not tissue damage; it is a disruption in the neuroendocrine regulatory system — the interplay of the nervous and hormonal systems that governs the body's equilibrium.

How to recognize it: what must be ruled out first

Before a somatoform disorder can be identified, two other categories of cause must be systematically excluded:

• Psychiatric disorders — clinical depression, psychotic-spectrum conditions, and similar diagnoses that independently produce physical symptoms.
• Somatic diseases — disorders of the thyroid, liver, pancreas, and other organs that can secondarily generate psychosomatic complaints.

Only after these two layers have been ruled out through proper investigation (blood and urine tests, biochemistry, and where indicated, neuroimaging) does the picture become clear enough to work with.

An important distinction: the "depression" confusion

The word "depression" means different things in everyday speech and in psychiatry. When people say they are depressed, they often describe fatigue, low mood, and bodily discomfort — symptoms that can fall within the somatoform spectrum. Clinical depressive disorder is an entirely different entity, treated differently. This confusion frequently delays recognition of the somatoform nature of a person's complaints.