Somatic delusion: definition, causes, symptoms, and treatments
Table of content
- What is somatic delusion?
- What are the causes of somatic delusion?
- What are the symptoms of somatic delusion?
- What are the treatments for somatic delusion?
Somatic delusion is a type of delusion that makes a person believe there is something wrong with their body, either internally or externally. Delusions are false beliefs that people adopt despite the evidence to the contrary. So, in this case, a person may believe they have parasites or bugs under the skin or that they have health problems even when the doctor says otherwise. It’s a type of delusional disorder, but many other mental illnesses can cause it too.
The causes of somatic delusions are a combination of genetics, biological factors, and the environment. Somatic delusions may stem from other conditions such as schizophrenia, schizoaffective disorder, schizophreniform disorder, shared psychotic disorder, brief psychotic disorder, substance-induced psychotic disorder, bipolar disorder, major depression with psychotic features, and dementia.
Symptoms of somatic delusion usually revolve around believing in the presence of some abnormality in internal or external functioning. A person may spend a lot of time checking their body, or they may change doctors in an attempt to get a confirmation for their beliefs. Other symptoms include developing anxiety due to delusions or feeling like physical exams, and medical tests that doctors perform aren’t adequate. People also tend to consider normal physical sensations as serious problems that confirm their delusional beliefs.
Treatment of somatic delusion usually requires psychotherapy, which is the first-line approach, and medications. Drugs such as antipsychotics and antidepressants are only complementary therapy, not the only treatment option for people with somatic delusions. Treatment of somatic delusions can be complicated, but patients can recover and improve their quality of life.
What is somatic delusion?
Somatic delusion is a false belief of having abnormal internal or external bodily functions. People with somatic delusions are convinced they have serious health problems even when doctors say they are fine.
Also known as monosymptomatic hypochondriacal psychosis, somatic delusions are rare but tend to be among the most persistent delusions. They may appear as a type of delusional disorder, but other mental illnesses can cause them as well.
People with somatic delusions generally believe their bodies are infested by parasites. These delusions can also occur in the form of body dysmorphia and persistent mouth odor.
Somatic delusion is not the same thing as hypochondriasis (or illness anxiety disorder). Hypochondriacs can leave room for the possibility their feared illness isn’t present. On the flip side, people with somatic delusions are strongly convinced of the presence of some type of body abnormality or a health problem.
Since somatic delusion is not a standalone mental illness, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association classifies it in the form of a symptom or a subtype of a specific mental illness such as a delusional disorder. For example, they are present in the chapter Schizophrenia and Other Psychotic Disorders. Many conditions involve delusions, which is why this type can appear as a delusional disorder, somatic subtype.
Not much is known about the history of somatic delusion. Generally speaking, delusions have been present for centuries. Back in ancient history, people experienced delusions of being one of the gods. Other examples of delusions include people firmly believing that they are objects, animals, speakers, or something else. There were also cases of delusions that included parasitic infestations.
The first description of delusional parasitosis or a somatic type of delusional disorder, can be traced back to 1894. At that point, French physician George Thibierge reported the cases of patients who were convinced they were infected with mites. During the following years, many physicians and psychiatrists reported similar cases.
For example, Swedish neurologist Karl-Axel Ekbom described a similar clinical picture in 1938. He called it a presenile dermatozoic delusion, which was later referred to as Ekbom’s syndrome. Ekbom theorized that patients experienced abnormal sensations that led to delusions that parasites were present in their bodies.
The term delusional parasitosis was introduced in 1946 by Wilson and Miller, who described 45 previously reported cases in addition to six cases of their own.
Over the years, the understanding of delusional parasitosis was widely discussed and some psychologists compared it to tactile hallucinations. Today, the strong belief of having parasites in the body or some other form of external and internal abnormalities is referred to as somatic delusion. This type of delusion requires further research since it’s still widely misunderstood.
How common is somatic delusion?
Somatic delusion is not common. It’s one of the rarest types of delusions. The actual prevalence of somatic delusion is unknown. According to the paper by A. Reich et al from Poland, published in the December 2019 issue of the journal Dermatology and Therapy states that delusional parasitosis occurs in 5% to 15% of cases.
A paper by C. H. Bailey et al. from the May 2014 issue of the British Journal of Dermatology reports the incidence of delusional parasitosis is 1.9 per 100,000 person-years. The term person-year is used by scientists, and it refers to the number of new cases of disease during a period of time divided by the person-time-at-risk.
The actual prevalence of somatic delusion in children and adolescents is unknown, but it’s useful to keep in mind delusions in this population are extremely rare. These delusions are more prevalent in women, according to the abovementioned study by A. Reich et al. from the December 2019 issue of Dermatology and Therapy.
Although the prevalence of somatic delusion in the elderly is known, a delusional disorder, in general, affects around 0.03% of this population, R. R. Tampi et al. wrote in their paper from the October 2019 issue of Therapeutic Advances in Psychopharmacology reports.
What are the causes of somatic delusion?
The causes of somatic delusion include a combination of environmental, genetic, neurological, biological, and psychological causes. For example, excessively high levels of the neurotransmitter dopamine may contribute to the development of these delusions alongside low cerebral blood flow. This type of delusion is also produced by various mental or neurological illnesses. The causes of somatic delusion are listed below:
- Schizophrenia (delusions are a core symptom)
- Schizoaffective disorder
- Schizophreniform disorder
- Shared psychotic disorder
- Brief psychotic disorder
- Substance-induced psychotic disorder
- Bipolar disorder (usually during manic states)
- Major depression with psychotic features
1. Schizophrenia (delusions are a core symptom)
Schizophrenia is a mental disorder indicated by the abnormal perception of reality. This long-term, severe mental illness affects cognition, emotions, and behavior. The most prominent symptom of schizophrenia is psychosis, indicated by hallucinations, delusions, and disorganized thinking or speaking. While the actual symptoms may vary from one patient to another, delusions affect almost everyone with schizophrenia, Mayo Clinic explains.
Risk factors associated with the development of schizophrenia include a family history of schizophrenia and other psychotic disorders, taking mind-altering substances, and pregnancy and birth complications. These include malnutrition, low birth weight, and exposure to viruses and toxins in the womb.
Schizophrenia contributes to the development of somatic delusions through changes in brain regions and neurotransmitters. People with schizophrenia display abnormalities in brain regions that regulate perceptions and thinking. Levels of neurotransmitters such as dopamine and serotonin and their receptors are also impaired. This affects the way a person perceives reality and may pave the way to false beliefs.
2. Schizoaffective disorder
Schizoaffective disorder is a type of psychotic disorder characterized by a combination of symptoms of psychosis (delusions and hallucinations) and mood disorder symptoms such as mania or depression. There are two types of schizoaffective disorder. First is bipolar type, which includes psychotic symptoms as well as mania (sometimes major depression). Second is the depressive type, which includes psychosis and symptoms of depression.
The main risk factors linked to the schizoaffective disorder are stressful life events and trauma, psychoactive drugs, and having a blood relative (parent or sibling) with schizoaffective disorder, bipolar disorder, or schizophrenia.
Schizoaffective disorder may cause somatic delusions the same way schizophrenia does. A comparative study by B.L. Amann et al. published in the January 2016 issue of Acta Psychiatrica Scandinavica showed that in terms of grey matter abnormalities, schizoaffective disorder is more similar to schizophrenia than to bipolar disorder. Participants with this disorder experienced reductions in grey matter volume. The main function of grey matter is to help us control movement, memory, and emotions. Additionally, an imbalance of dopamine, glutamate, serotonin, and norepinephrine is also associated with schizoaffective disorder. Impaired levels of neurotransmitters disrupt the way people process information and stimuli from the environment. This could lead to somatic delusions.
3. Schizophreniform disorder
Schizophreniform disorder is a type of psychotic disorder where a person experiences symptoms of schizophrenia for one to six months. The main symptoms include delusions, hallucinations, disorganized speech, strange behaviors, lack of energy, loss of interest, and limited emotional expression.
Risk factors for schizophreniform disorder include a family history of psychotic disorders, trauma, postpartum psychosis from a recent birth, and personal history of mental illnesses and psychotic episodes.
Schizophreniform disorder may cause somatic delusions because it changes the way people relate to others, perceive reality, express emotions, act, and think. A person with this temporary psychotic disorder can’t distinguish what’s real or not. Together with brain abnormalities and imbalances of neurotransmitters, schizophreniform disorder could make a person feel like there is something wrong with internal or external health and wellbeing.
4. Shared psychotic disorder
Shared psychotic disorder, also known as folie a deux, is a rare mental illness indicated by sharing a delusion among at least two people in a close relationship. One person (primary) has a psychotic disorder with delusions, but they transfer their delusional belief onto the other person (secondary) or more people.
Risk factors associated with the shared psychotic disorder include family and personal history of psychotic disorders, extreme social isolation, traumatic or stressful life events, cognitive impairment, challenges with communication, and a history of personality disorders. The duration of a relationship also contributes to the risk of developing this disorder. Being dependent, physically or mentally, on someone can also increase the risk of developing this mental illness.
The shared psychotic disorder causes somatic delusions because one person develops psychosis due to a specific mental illness, trauma, or brain abnormalities. The main psychotic symptom is delusion. The other person may adopt delusional beliefs due to extreme isolation from a society where it becomes impossible to differentiate fact from fiction. The secondary individual may attempt to avoid conflicts and aims to keep the peace, but eventually, they come to believe the same delusion as the primary.
5. Brief psychotic disorder
A brief psychotic disorder is defined as a sudden and short-term psychotic behavior that occurs with stressful events. Symptoms, mainly delusions and hallucinations last less than a month. A patient usually achieves complete recovery but may be at risk of developing the same symptoms in the future.
The main risk factors for brief psychotic disorder include significant life stress or trauma, history of personality disorders, family history of psychotic disorder, pregnancy or four weeks postpartum, previous psychiatric symptoms, being a single mother, and 35 to 45 years of age.
The brief psychotic disorder causes somatic delusions due to high levels of stress and trauma. This disorder is mainly caused by traumatic and significantly stressful experiences with which people can’t cope properly. This leads to biased threat beliefs and the development of negative beliefs about oneself, other people, and the surroundings. As a person doesn’t process their trauma adequately, their perception of reality and their body becomes abnormal. In turn, somatic delusions may occur. The relationship between brief psychotic disorder and somatic delusion could be multifactorial and involve changes in neurotransmitter levels as well.
6. Substance-induced psychotic disorder
The substance-induced psychotic disorder is a type of mental illness whose symptoms are associated with starting or stopping the use of alcohol or certain drugs. People may develop symptoms of psychosis when using drugs, especially hallucinogens and cannabis, and may also have delusions and hallucinations during withdrawal from addiction.
Risk factors for substance-induced psychotic disorder include traumatic brain injury or stroke, family or personal history of schizophrenia, psychotic disorders, mood disorders, dementia, brain tumors, genetic abnormalities, and substance abuse. Medications may also increase the risk of this disorder due to its side effects.
A substance-induced psychotic disorder may cause somatic delusions because substances (alcohol or drugs) act directly on the brain. They influence the transmission of messages and change the way people perceive and process information. That way, their understanding of reality may change, which could lead to the formation of delusional beliefs.
7. Bipolar disorder (usually during manic states)
Bipolar disorder is a mental health condition characterized by extreme mood swings that include extreme highs and lows i.e., mania and depression. People with bipolar disorder may experience these episodes rarely or several times during the year. Highs and lows of bipolar disorder affect more than mood; they also influence a person’s behavior, energy, and activity levels.
Risk factors for bipolar disorder include a family history of bipolar disorder or depression, drug or alcohol abuse, and periods of high life stress (e.g., trauma or death of a loved one).
Bipolar disorder can cause somatic delusions or other types of delusions. The presence of delusions is more common in a manic state. The exact reason behind delusions in people with bipolar disorder is unclear. They are usually in line with a person’s mental state. Mania is characterized by symptoms such as racing thoughts, distractibility, poor decision-making, and euphoria or high energy levels. These symptoms may act on the mind to the point it starts “generating theories” about parasites in the body or some other type of abnormality. As a result, a person may develop somatic delusions.
8. Major depression with psychotic features
Major depression is a severe mood disorder characterized by a persistent feeling of sadness, helplessness, and loss of interest. People with major depression experience a wide range of physical and psychological symptoms, including suicidal thoughts and tendencies. A person with major depression can’t simply “snap out of it” as their symptoms can be so strong they affect daily functioning. In major depression with psychotic features, a person experiences depressive symptoms as well as psychosis i.e., delusions and hallucinations.
Risk factors for major depression with psychotic features include family or personal history of depression or psychotic illnesses, traumatic or stressful events, alcohol or drug abuse, taking certain medications (antihypertensive drugs or sleeping pills), and having a serious chronic illness such as cancer, stroke, heart disease, and chronic pain. Additionally, people with certain personality traits are at a higher risk of major depression, such as being pessimistic, self-critical, and too dependent. Men and women who are homosexual, transgender, or have some other variations in development may be more likely to develop major depression when living in an unsupportive environment.
It is unclear how major depression with psychotic features causes somatic delusions. It is highly likely that imbalances in dopamine and serotonin, as well as the stress hormone cortisol play a role. These chemicals help regulate mood, memory, reward, motivation, sexual desire, and perception. Impaired levels of neurotransmitters may work in combination with hormonal imbalances to affect the way a person perceives reality and thereby pave the way to somatic delusions.
Dementia is defined as the loss of cognitive functioning. There are many types of dementia, but the most common is Alzheimer’s disease. Dementia is progressive, meaning symptoms worsen over time, and the impact on daily functioning worsens. Besides cognitive changes, people with dementia also tend to experience personality changes, anxiety, depression, inappropriate behavior, agitation, paranoia, and psychosis.
Risk factors for dementia include older age, having Down syndrome, a family history of dementia, a sedentary lifestyle, an unhealthy diet, excessive alcohol use, depression, smoking, head trauma, sleep disturbances, air pollution, and medications such as anticholinergic drugs, benzodiazepines, and proton pump inhibitors.
Dementia causes somatic delusions through changes in the brain. A person with dementia goes through a loss of cognitive abilities, which is why it may be difficult for them to understand their surroundings. They become confused and disoriented. As a result, they may believe things that aren’t true. Developing delusions usually happens when a patient tries to fill in the blanks of their memory and understanding using their own conclusions. This can lead to paranoia, hallucinations, and the onset of delusions, somatic delusions included.
What are the symptoms of somatic delusion?
Symptoms of somatic delusion are different from one person to another. Signs and symptoms vary because delusions are not based on reality, which is why they can take any shape and form. People with somatic delusion experience specific physical sensations. The most common symptoms of somatic delusion are listed below:
- Oral somatic delusions (oral cenesthopathy) or complaining of unusual oral sensations e.g., excess mucus production, presence of a foreign body, or slimy mouth
- The nagging feeling of wires and coils in the mouth
- Strong beliefs of having bad breath, despite being assured it’s not true
- Spending hours examining mouth or body
- Believing the body is infected by parasites that have taken over the internal organs
- Being convinced tiny insects have laid eggs under the skin
- Unrealistic beliefs about physical appearance e.g. becoming convinced the body is deformed, misshapen, or unattractive
- Spending a lot of time visiting one doctor after another in an attempt to get a confirmation for delusional beliefs
- Feeling like medical exams and tests aren’t adequate
- High level of anxiety about symptoms or health
- Considering normal physical sensations as a sign of severe illness or believing they are harmful and threatening
- Fearing symptoms are severe, even when there is no evidence or they don’t exist
- Being unresponsive to medical treatment or unusually sensitive to the side effects of medications such as benzodiazepines
- The presence of a more severe impairment is expected with an underlying medical condition
Who is affected by somatic delusion?
Middle-aged individuals are usually affected by somatic delusion. The symptoms tend to appear in persons who are in their 40s, which is the average age of onset of delusional disorders, according to Cleveland Clinic. Somatic delusions affect women more than they affect men. Additionally, persons with a history of psychotic disorders could also be affected by somatic delusions.
What are the risk factors for somatic delusion?
Risk factors for somatic delusion are similar to those of other forms of delusions. They can be biological, psychological, and environmental. Keep in mind that having one or more risk factors doesn’t immediately mean a person is bound to develop somatic delusions. These delusions are rare, but the factors indicate a person could be more susceptible to them than someone else. Common risk factors for somatic delusion are listed below:
- Personal or family history of psychotic disorders and other mental illnesses
- Being a woman
- Being middle-aged
- The lower level of education and socioeconomic status
- History of trauma, especially in childhood
- Major life stress
- Having a medical condition or recovering from one
- Being at a high risk of developing a health problem e.g. having a family history of a heart disease
- Social isolation
- Sensitive personality
- Substance abuse
How is somatic delusion diagnosed?
Somatic delusion is diagnosed upon thorough physical exam and psychiatric evaluation. Physical exam shows whether somatic delusions result from a specific health problem. For this purpose, the doctor may order blood tests, urine tests, imaging tests such as CT or MRI, and X-rays.
The patient also undergoes psychiatric evaluation, whose main objective is to assess delusions and other symptoms, concerns, fears, family and personal history, and relationship problems. The psychiatrist strives to get a deeper insight into a patient’s thoughts, emotions, and behaviors. To get more information about the patient’s condition, the psychiatrist may interview their family members.
In order to diagnose the problem, the psychiatrist will use DSM-5 to compare the patient’s symptoms and results of the psychiatric evaluation to diagnostic criteria for different mental illnesses. For example, if a person experiences one or more somatic delusions for at least one month and their symptoms can’t be explained by other conditions, a psychiatrist will diagnose delusional disorder somatic type.
How to prevent somatic delusion?
It’s not possible to prevent somatic delusion, especially when it is linked to a delusional disorder. Delusions are complex, and their development still puzzles psychiatrists and psychologists. However, processing trauma and major life stress in a healthy manner could lower the risk or lessen the impact of somatic delusion. It may also help to adopt healthy lifestyle habits that protect mental health. Persons who are at risk of a health problem or recovering from a serious medical condition may want to consider counseling. Mental health support is incredibly important for the recovery process, and it may help develop healthier coping mechanisms.
What are the treatments for somatic delusion?
Treatments for somatic delusion are listed below:
- Psychotherapy: the first-line treatment for somatic delusion and other types of delusions. The primary objective of talk therapy is to teach patients how to manage their symptoms and improve their overall functioning. There are different types of psychotherapy, but cognitive-behavioral therapy (CBT) is the main approach for persons with somatic delusions. Cognitive-behavioral therapy works by enabling patients to identify negative or irrational thought patterns. Once they identify negative thoughts, patients learn to change them into healthier or more rational alternatives. This is necessary because thoughts dictate emotions and behaviors. Therapists use CBT to help people with delusions because this type of therapy can change the way people think about and respond to these experiences. The objective is to make somatic delusions less harmful to a person’s everyday functioning and teach patients healthier coping mechanisms or skills they need to improve their quality of life. For that purpose, patients often get homework to practice skills they learned during the session until the next appointment. Speaking of appointments, the number of sessions may vary from patient to patient because it depends on the severity of their somatic delusion. People usually need 16 or more sessions of full CBT for psychotic disorders over at least six months, as per Cognitive Behavioral Therapy for Psychosis fact sheet by Dr. Kate Hardy. According to Mayo Clinic, people generally need five to 20 sessions of CBT). It’s also useful to mention CBT in the treatment of somatic delusions as it is helpful for making a person aware their problem is more linked to worrying about the disease and less related to the presence of the actual disease.
- Medications: healthcare professionals only prescribe medications in combination with therapy. Drugs are never the only treatment option for somatic delusion. Patients receive medications that are most suitable for their symptoms. The first-line drug for delusions is an antipsychotic medication. The antipsychotics work by blocking dopamine receptors in the brain and thereby reduce delusions. Certain antipsychotics block both dopamine and serotonin receptors. Besides these, the doctor may prescribe antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine inhibitors (SNRIs). Antidepressants are prescribed when patients have major depression, bipolar disorder, or other problems with depressive symptoms. They act on neurotransmitters and may help lessen the impact of delusions. The main objective of medications is to reduce symptoms i.e., somatic delusions, they don’t really fix the root of the problem. That explains why it is necessary to go to therapy sessions regularly. Medications may take several hours to a few days to exhibit initial effects and provide relief, but the best results occur after several weeks.
- Hospitalization: not all people with somatic delusions need to be hospitalized. A healthcare professional will recommend hospitalization only when symptoms are severe and the risk of self-harm is high. In a hospital setting, patients receive therapy and medications under medical supervision. The duration of hospitalization depends on the severity of the symptoms. Patients may need to spend a few days in the hospital, but a longer stay could be necessary for people with the most severe symptoms.
Do somatic delusions have a cure?
There is no cure that would eliminate somatic delusions entirely. Somatic delusions are treatable with well-structured therapy and medications. However, according to a review by M. Skelton et al. published on Cochrane in May 2015, treating delusions of any kind is a complicated process mainly because the patients refuse to admit their beliefs are false. For that reason, it tends to be difficult for them to commit to the treatment process and adhere to the recommendations. A combination of strong willpower, support from loved ones, and professional help is useful for enabling patients to overcome their delusions. Patients can overcome their disorder and achieve full recovery, but those who can’t achieve a full recovery can still reduce the intensity and severity of their delusions for a better quality of life.