What Are Somatic Delusions?

A somatic delusion is a false belief that a person's internal or external bodily functions are abnormal. This belief may also extend to viewing one's physical appearance as very irregular. 

Also known as monosymptomatic hypochondriacal psychosis, this condition is a very rare form of a delusion. It's hard to convince people suffering from somatic delusions that their beliefs or symptoms are anything but correct. 

Parasitic infestations are the most common form of somatic delusion noticed in individuals. Other examples include body dysmorphia and unwavering mouth odor. Patients with this condition also experience anxiety and nervousness.

Types of Somatic Delusions

Instances of somatic delusions may be bizarre or non-bizarre. A bizarre somatic delusion is an imagined situation that has no chance of ever occurring in real life. For instance, this might look like a person reporting they've had an organ harvest despite having no surgical scars.

On the other hand, a non-bizarre somatic delusion involves scenarios that are unlikely to happen in real life, but which can occur under normal circumstances. For example, this might look like a person hearing voices where there are none.

Conditions That May Involve Somatic Delusions

Somatic delusions are a common feature of psychotic conditions. These delusions may also manifest in persons living with mental health conditions such as:

• Schizophrenia
• Major depression 
• Delirium
• Neurocognitive disorders such as dementia
• Bipolar disorder
• Schizophreniform disorder (a psychotic illness similar to schizophrenia which lasts for less than 6 months)

Causes of Somatic Delusions

The circumstances that bring on somatic delusions aren’t perfectly understood. It is strongly suspected that genetic, environmental, biological, neurological, and psychological factors may have a role to play in the development of this condition.

Dopamine Levels

The body needs dopamine, a chemical in our bodies that regulates mood, sleep, dreams, cognitive ability, learning as well as punishment and reward. When dopamine activity is excessively high, this may lead to the formation of delusions. 

Hyperactive levels of dopamine may lead to paranoia. These levels may also cause undue importance and attention to be attached to everyday experiences, as seen where an individual fixates on a body part during somatic delusions.

Regional Cerebral Blood Flow

To function properly, the brain requires a steady supply of oxygen and energy. The cerebral blood flow determines how much blood is supplied to the brain. This by extension regulates the supply of oxygen and energy to the brain.

When blood flow to the brain is low—a process known as hypoperfusion—this may contribute to the development of delusions. Studies have revealed that the regional cerebral blood flow in patients with somatic delusions may be altered.

Genetics

In regulating immunity, your body has a gene family made up of related proteins. This family is known as the Human Leukocyte Antigen system, and it helps the body to differentiate between its own proteins and proteins produced by foreign invaders which are usually attacked. 

While it isn't certain how these genes may encourage delusions, there is a chance that the increased presence of a particular gene—HLA-A*03—either alone, with other genes, or even in conjunction with non-HLA genes, may increase the chances of experiencing delusions.

Paranoid Personality Disorder

This condition is characterized by a strong distrust of people without any basis for suspicions. While its origins are unknown and often shuttled between biological and psychological factors, it is commonly found in families with psychotic disorders such as somatic delusions, leading to a suspicion that both conditions are linked.

Symptoms of Somatic Delusion

Somatic delusions may be presented in any number of ways. This is largely due to the fact that the scenarios are not rooted in reality and can take on any shape and form.

Physical Sensations Without Apparent Cause

Individuals experiencing somatic delusions tend to experience very specific physical sensations. For instance, oral somatic delusions or oral cenesthopathy may be observed when individuals complain of unusual oral sensations like excessive mucous production, a slimy feeling in the mouth, or a foreign body existing in their mouths.

The nagging feeling of coils and wires in the mouth may also be a sign of somatic delusions. In some instances, the individual affected is certain that they have very bad breath, despite being assured of the contrary.

Patients experiencing this form of delusion can spend hours examining their mouths. Efforts may also be made to catch the offending body they believe is living in their mouths.

Examples of Somatic Delusions

In one case of a 45-year old man living with bipolar disorder, his delusions came about following tensions in his personal life. For about a month, he lost interest in his usual activities and became increasingly worried that his self-care was deteriorating. To remedy his condition, he sought treatment at a hospital, making specific complaints about insufficient sleep. He claimed his insomnia was causing pain in his mind.

Despite observations revealing that he was getting an average of 8 hours of rest a night, he became agitated when informed, maintaining that he was awake and aware of his surroundings through the duration of any observations.

Somatic delusions were also observed in the case of a 62-year old man with a history of believing insects crawling over his body. The patient had dealt with his condition for many years, noting that the insects first started their movement from a portion of his scalp before taking over its entirety and moving on to his face and trunk.

He experienced itching and irritation due to the insect movements. Despite examinations revealing only scratch marks and dry skin, the patient was insistent that the insects were too small to be seen by the naked eye.

Diagnosis of Somatic Delusion

If a person is exhibiting symptoms of somatic delusion, a healthcare professional will begin by taking their medical history and performing a physical examination to rule out the chances of any other illnesses at play.

Where the professional is unable to make physical confirmation of the condition, they may refer the patient to a psychologist or psychiatrist who is better suited to diagnose and treat the condition. Whatever type of healthcare professional the patient is referred to will then observe the symptoms, behavior, and attitude.

A diagnosis may then be made using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment of Somatic Delusions

When treatment is initiated for somatic delusions, it's important to exercise caution with the person who is coping with the delusions when explaining that the physical symptoms being experienced may be the product of genetic, neurological, or other factors.

If someone you know is experiencing somatic delusions, it's important to realize that repeatedly denying their reality will likely only further frustrate them. Being supportive, then, may simply be acknowledging their symptoms as real, offering an ear if they want to talk about it, avoiding judging them, and helping them to seek help from a medical professional.

The healthcare professional consulted should make sure regular visits are made to ensure that the symptoms are not reflective of a life-threatening condition. The following treatments may be employed:

Psychotherapy

This form of treatment is necessary first to teach the patient how to manage their symptoms, but also to inform them of the warning signs in the event of a relapse. It can also help with improving the patient's overall functioning.

Psychotherapy options include:

• Cognitive behavioral therapy: This form of therapy has proven effective for effective improvements in the individual's welfare. This therapy helps people with somatic delusions recognize and change negative thoughts and behaviors into a more positive outlook on life.
• Family therapy: This is very important for the loved ones of the person dealing with somatic delusions. It is important to learn the proper ways to care for a person with this condition.

However, caring for a person suffering from delusions can also take a serious toll on emotional and mental health. Seeing a professional to help navigate the difficult terrain can contribute to improved results for the patient and their loved ones.

Medication

In treating somatic delusions, sedative medication such as benzodiazepines should be avoided. Instead, the following may be used:

• Antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine inhibitors (SNRIs)
• Antipsychotic medication

It's important to note that these drugs should be given at their lowest doses and then increased slowly to achieve symptom improvement. A healthcare professional will be able to help you with dosage and monitoring its effects of symptoms.

A Word From Verywell

A person that suffers from somatic delusions is convinced that they have a physical defect or that there is something strongly abnormal about their physical appearance. In reality, no defects are present, or where present, are grossly exaggerated.

While somatic delusions can seriously disrupt day-to-day life, there are proven measures to help limit the damage done, as well as to contain the effects. To make sure a patient with somatic delusions is getting the best treatment, it's always advisable to consult with a healthcare professional who can help to guide the treatment plan.