Thursday, May 14, 2015

Life with an anxiety disorder - Part III: Somatoform autonomic dysfunction

I've talked about somatoform autonomic dysfunction in the previous two installments of this series and I really want to go into more detail about it. It's a new diagnosis that my psychiatrist and I arrived at after a long talk about my symptoms and how to properly classify them. Before that, I did not even know such a disorder exists, and I was under the assumption that the symptoms I experienced were just regular things experienced with generalized anxiety disorder.

I'll start with the official ICD-10 definition of somatoform autonomic dysfunction (F45.3), the defintion system all psychiatrists - at least over here - use:
Symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory and urogenital systems. The symptoms are usually of two types, neither of which indicates a physical disorder of the organ or system concerned. First, there are complaints based upon objective signs of autonomic arousal, such as palpitations, sweating, flushing, tremor, and expression of fear and distress about the possibility of a physical disorder. Second, there are subjective complaints of a nonspecific or changing nature such as fleeting aches and pains, sensations of burning, heaviness, tightness, and feelings of being bloated or distended, which are referred by the patient to a specific organ or system. (Source)
Now that is really interesting to me. As I briefly described in part II of this series, this is the type of diagnosis that fits what I go through perfectly. It's just spot on.

What started the conversation was a letter for a high profile long-term therapy clinic I had applied to and went to a preliminary examination at. I described to them my panic attacks, and how they are often based on actual physical symptoms that my brain assumes to be something really bad and usually deadly. The letter from the clinic to my psychiatrist described that as "hypochondriasis-like symptoms". I disagreed, because it just doesn't seem right. With hypochondriasis, you have a specific illness in mind, and you obsess over it, think about it all the time. In my case, I don't think I have any bad illness, and I don't really think about having one. However, when I feel a stinging in the center of my chest, I always assume it's the heart. If it's more to the side, I assume it's the smoking having fucked up my lungs. Even worse when there's discomfort in my throat, I assume it's an asthma attack that will kill me. Discomfort in the back of my head is interpreted as a stroke. That kind of thinking. However, unlike hypochondriacs, once the discomfort is gone, I no longer think about it.

I write this post with the full awareness that anything related to hypochondriasis is the most ridiculed and least taken seriously area of mental illness. I don't blame anyone. In fact, when I was at a psych ward around a month ago for about a week, there was a hypochondriac at the ward, and I referred to him as "the whiny guy." It was accurate in a way, since whining was literally all he did. And being a minority does not make you exempt from ridicule. However, it's also a shame we see some mental illnesses that way. The sad fact of the matter is that any mental illness is a lot less funny when you are affected by it. And the symptoms and experiences I described may sound ridiculous, but the panic attacks it causes sure are devastating and crippling. A feeling of certain death is never the nicest experience you can think of. Yeah, it's all in your head, but try to tell your head that when it's in the middle of telling you you're about to kick the bucket. Like any anxiety disorder it can be debilitating, or at the very least affect the number of things you can do in your life in a very negative way.

It was my psychiatrist who then suggested somatoform autonomic dysfunction, something which, as I said, I had never heard of before, and read the above description to me from his book (in German, of course). It was like an eye-opener to me, because to that point I had always struggled to get what I felt across to doctors. They always gave me some wild mishmash of diagnoses, usually with psychosis thrown in. I'm not psychotic, and I keep having to tell everyone, but they throw around that nonsense anyway because they just don't know how my symptoms fit anywhere. It is incredibly frustrating to have to deal with doctors who can't give you a proper diagnosis, because you end up with the wrong medication and the wrong treatment and everything wrong, just because they have no idea what they're talking about, coming up with all sorts of guesses that all miss the mark. It wastes my time and theirs and usually does more harm than good. Everyone who has ever had symptoms that don't fit into the "popular" (as in most wide-spread) mental illnesses will be able to relate to that.

Now I have this convenient diagnosis that when a doctor asks me what is wrong with me I can just tell them, and they'll know what's going on. And a few of them might even know what to do. Of course this isn't my only issue, I still struggle with other anxieties, particularly a very, very bad case of social anxiety (more on that in a later post), but the reason I am so relieved to have the proper diagnosis for my body-related symptoms is that those are the main reason I often end up with the psychosis stamp - which brings with it a whole lot of problems, as it is as much a stigma as a diagnosis and often prevents you to get proper treatment for your actual issues. Now I know that what I experience is something related to an anxiety disorder, and it is something that is treated very similarly, and usually treated effectively. May take a while to get rid of it, but getting the proper diagnosis is always the first step, and now I know in which direction to go.

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