Senestopathy - unpleasant, painful sensations localized on the surface of the body or in the region of internal organs. They may resemble squeezing, burning, tightening, twisting, bursting, throbbing, turning over, etc. The distinctive features of senestopathies are a feeling of unusualness, the absence of objectivity and an objectively existing pathological process that could explain such sensations. Usually occur against the background of other mental disorders. The diagnosis is established on the basis of anamnesis, patient complaints, examination data and the results of objective studies. Treatment is the correction of the underlying pathology.
Senestopathies are unusual painful, unpleasant, sometimes painful bodily sensations that do not have a pathological somatic basis. Occur in a variety of mental disorders. As a rule, they are associated with the depressive component of mental pathology. The term senestopathy was proposed by French neurologists and psychiatrists E. Dupre and P. Camus in 1907. This disorder, along with a change in the threshold of sensitivity, refers to the pathologies of sensations. Despite the absence of somatic disorders, it can cause serious inconvenience to the patient, aggravate and complicate the picture of the underlying mental illness. Treatment of senestopathies is carried out by specialists in the field of psychiatry.
Senestopathies are psychological sensations that the patient projects into the image of his own body. They are a fairly common manifestation of mental disorders, are included in the structure of the Kandinsky-Clerambault syndrome, depression and hypochondria. Senestopathy can also be detected in neurosis, manic-depressive psychosis (in the depressive phase), psychoorganic syndrome, oneiroid, affective-delusional syndromes, paranoia, paraphrenia, senestopathosis and some other mental disorders.
Depending on the content of sensations, the following types of senestopathies are distinguished:
Taking into account clinical manifestations, elementary, simple, psychosensory, interpretative and hallucinatory senestopathies are distinguished.
Elementary senestopathies are internal sensations that do not have a specific modality and localization (“everything inside is tense and stretched like a string”, “it presses inside, everything is numb”). There is a clear connection with emotional experiences, senestopathies reflect a feeling of fear, anxiety, melancholy and tension. Such sensations are often detected in depressive disorders and reflect not only affective disturbances, but also disturbances in the perception of one's own body. Some psychiatrists consider such sensations as a variant of depersonalization.
Simple senestopathies - sensations with a pronounced modality (pain, a feeling of heat or cold, all kinds of paresthesias). They can be diffuse or localized in a specific organ or anatomical zone. Among simple senestopathies, algic, thermal, senestopathies in the form of paresthesias and senestopathies with a sensation of a change in the weight of a body part are distinguished. With algic senestopathies, patients complain of pain with an unusually rich "set" of shades: burning, squeezing, shooting, cutting, dull, eversion. The nature and localization of pain can change, pain can be constant or paroxysmal.
Patients with thermal senestopathies describe their sensations as “burning in the head”, “coldness between the shoulder blades”, etc. With senestopathies in the form of paresthesias, patients are concerned about itching, numbness, tingling, crawling, sensation of electric shock or electrification of the body. Senestopathy with a change in weight manifests itself in the form of a local feeling of heaviness or lightness: "the head is so heavy that it is difficult to hold", "the arm is heavy, it is impossible to lift it."
Psychosensory senestopathies - sensations with a change in size, volume and direction. “The stomach is tied into a knot”, “it bursts in the chest”, “it presses from the inside in the head, as if the brain swells”, “the joints are twisted, as if the legs are now turned with their heels forward”. There may be short-term sensations of a change in the size and location of some part of the body. Sometimes such senestopathies are combined with true violations of the body scheme.
Interpretive senestopathies are sensations with rich and varied interpretations. Interpretations can be very unusual (“the brain freezes”, “the spleen itches”, “the inner surface of the rib hurts”). There are organotopic senestopathies (with a clear localization), associated senestopathies (with a combination of many sensations in different parts of the body into one overall picture) and delusional senestopathies (with a deliberately implausible version of the cause of the occurrence, for example, “blood does not enter the liver”).
Hallucinatory senestopathies are sensations resembling hallucinations. They can be geometric (“the circle on the stomach hurts, pain radiates from it throughout the body”), reminiscent of tactile hallucinations (“as if they hit the arm with a fist”, “as if pulling the hair”), with the projection of tactile sensations into the body ( “chest itches”), reminiscent of hallucinations of transformation (“the brain exfoliates from the skull”, “bubbles seem to burst in the lungs, and the lungs collapse from this”) or kinesthetic hallucinations (“head swings to the right and left”).
Hallucinatory senestopathies can be accompanied by visual, olfactory, gustatory and acoustic sensations (“in the head, as if something is burning, crackling and smelling of burning”). A constant sign that allows distinguishing hallucinatory senestopathies from true hallucinations are the expressions “as if”, “like”, “as if”, “like”, indicating the conditional nature of the descriptions.
The hallmarks of this pathology are the richness and variety of sensations uncharacteristic of somatic diseases, the pretentious nature of complaints and the difficulty in trying to describe one's sensations. There is an unusual emotional intensity. Patients with senestopathies talk about their feelings as painful, sometimes painful. Some say that such sensations are much harder to bear than severe physical pain. The attention of patients is constantly riveted to pathological signals; patients cannot relax, distract and switch.
Another feature of senestopathies is their unusual projection (“inside the head”, “along the inner surface of the rib”, “it itches in the stomach area”, “a vessel in the abdomen pulsates”). Patients indicate a localization that cannot be determined using existing receptors and/or complain about sensations that cannot be felt using such receptors. For example, when talking about sensations in the area of the internal organs, patients with senestopathies can use words that describe signals characteristic of skin sensitivity (presses, touches, bakes, freezes, etc.).
Most often, patients complain of unusual sensations in the head area, less often in the chest and abdomen, and even less often in the limbs. Feelings migrate. Senestopathies can be episodic, constant or paroxysmal. Paroxysmal senestopathies are often accompanied by profuse autonomic symptoms, fear of going crazy and other reactions resembling reactions during panic attacks. Gradual complication of complaints is characteristic - from rather simple to more and more pretentious and unusual.
The diagnosis is made on the basis of the anamnesis, complaints of the patient, the results of an external examination and data from additional studies. Senestopathy should be differentiated from paresthesias and sensations in somatic diseases. Complaints in diseases of the internal organs are characterized by a constant clear localization, uniformity and connection with the location of a particular organ. Often there is hypersensitivity in the Zakharyin-Ged zones. When conducting instrumental studies (radiography, ultrasound, MRI, CT), signs of somatic pathology are revealed.
Unlike senestopathies, paresthesias are the result of vascular or neurological pathology. Paresthesias in neurological disorders are localized on the surface of the skin, correspond to a certain zone of innervation and are combined with other neurological symptoms. Paresthesias in circulatory disorders occur as a result of external influences (cold, increased load on the limbs), accompanied by a change in temperature and color of the limbs, trophic disorders (with pathology of the veins), disappearance or weakening of the pulse in the peripheral arteries (with pathology of the arteries).
Symptomatic treatment of senestopathies is ineffective. Analgesics, physiotherapy and other therapeutic techniques used to relieve somatic pain do not bring relief. The condition of patients improves only when the symptoms of the underlying mental disorder are relieved. With depression and neurosis, tranquilizers and antidepressants are used, with psychosis, antipsychotics, etc. Psychotherapy is carried out according to indications. The prognosis for senestopathies depends on the type, severity and characteristics of the course of the underlying disease.