Mood disorders, in particular depression, are among the most important and frequent psychiatric disorders. There depression It is a public health problem with high prevalence that involves serious repercussions on individual functioning. There are different forms of this disorder (including the “masked depression“), So much so that some authors hypothesized the existence of a” depressive continuum “. That is, the presence of depressive symptoms in growing continuity from subclinical forms to clinical forms full -blown of growing gravity.
In the common imagination the depressed person He cannot carry out his activities with constant and regularity: he is always sad or discouraged, he cannot smile, he is desperate and apathetic. But this form of depression It is not the only one to exist: among the various atypical forms of this disease the so -called “masked depression“.
This term indicates that depressive form that manifests itself almost exclusively on the somatic level. That is, with the presence of physical symptoms that compromise individual functioning. Emotions and experiences do not seem to be oriented in a pessimistic or depressive sense.
There masked depression It can manifest itself with:
- cramp
- palpitations
- dizziness
- headache
- sweating
- gastroenteric symptoms
- heaviness in the limbs, in the back
- muscle pain
- Loss of energy and easy fatigue
- insomnia
- persistent tiredness
- sexual/genital problems.
Physical and psychic pain and mental disorders
The conceptual division between physical and psychic pain often confuses health and patient specialists. Even if not in all cases the pain is correlated to a physical disease, it is still real (except in simulation). It is an unpleasant experience on the physical and emotional level and must be addressed by finding the effective modality.
The psychiatric diseases who are unleashed, accompany or “They mask themselves” in the form of pain They must be known, considered and treated. This is because their improvement corresponds to the reduction or disappearance of the pain itself. Within each of these pathologies, pain takes on a specific role and presents itself with different frequency, intensity and meaning.
Diagnose masked depression
To be able to diagnose masked depression It is essential to exclude a series of clinical paintings only apparently similar to it. Somatophormic disorders, for example, constitute a group of disorders with physical symptoms In which either there is no medical pathology or the intensity of the symptoms is disproportionate to the disease present.
In hypochondria, another example, the patient is convinced of suffering for physical illness, in spite of the reassurances that the doctor provided him or despite the results of special exams.
The conversion disorder (first known as “hysteria”) it manifests itself with neurological symptoms such as motor difficulties, instability and real paresis and/or paralysis without any neuromuscular structure being actually damaged.
Voluntary production or the simulation of pain to take on the role of sick person can fall within the nosographic category of fictitious disorders. The person suffering from this particular disorder has a pathological personality that leads him to be desired to receive continuous medical treatments. Finally, the simulation of a disease or a symptom without the individual really suffers from it can also be motivated by the intent of:
- absent from work
- profit on compensation
- subtract from a judicial proceeding
- get drugs
Finally, in chronic pain syndrome, painful symptomatology is continuously exhibited alongside physical disability, suffering, looking for others’ attention. These are only some of the conditions that the clinician must exclude to proceed with the definition of a correct diagnosis of masked depression.
Indications of treatment of masked depression
Unlike the typical forms of depressionwho is suffering from one masked depression I almost always interpose the doctor in the first instance. These play a fundamental role because primarily must exclude the physical nature of malaise. Once this is done, the therapeutic tools available are pharmacological and psychotherapeutic, to be implemented according to the specificities of the case.
In general, the integration of pharmacological and psychotherapeutic interventions allows to obtain the best results.
The essential objectives of the psychotherapy According to the cognitive-behavioral approach are:
- learn to record their life experiences consciously;
- Learn to observe one’s emotions and reactions to one’s emotions;
- understand their thoughts and observe their typical “bias” of interpretation;
- consciously observe one’s behavior.
In particular, it is advisable to estimate the presence of alexithymia and a concrete cognitive style oriented towards external reality. Both elements that, together with the poverty of imagination, the lack of introspection, to social conformism and the tendency to express emotions through action, can represent important Maintenance factors of masked depression.
Essential bibliography
- Kielholz, P. (1979). The concept of masked depression. Encepharal; 5: 459-62.
- Kielholz, P. (1975). Treatment for Masked Depression. Psychopharmacology Bullettin; 11 (1): 31-4.
- Kroenke, K. (2003). Patients presenting with Somatic Complaints: Epidemiology, Psychiatric Comorbideity and Management. International Journal of Methods in Psychiatric Research; 12 (1): 34-43.
- Pancheri, P. (2006). Masked depression. Masson, Milan.
- Zung, WW; King, Re (1983). Identification and Treatment of Masked Depression in a General Medical Practice. The Journal of Clinical Psychiatry, 44 (10), 365-368.
