Masked depression: what it is, symptoms, causes, and what to do

On many occasions, physical pain such as headaches, gastrointestinal discomfort and back pain can have a psychological origin. These symptoms may actually be the somatization of a psychological disorder, such as depression.

Masked depression is one of the ways in which this disorder can present itself, only in a way that makes it seem like the main problem is physical. Apathy and sadness are hidden under the patient's somatic complaints.

Below we will discover in more depth what masked depression is, what are the somatic symptoms that can be related to it and what explanation is there for it to manifest itself.

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What is masked depression?

Our body is the faithful reflection of our mental state, and masked or somatoform depression is a clear example of how closely mind and body are related.

This type of depression is one in which the main symptom that the affected person complains about is not psychological, such as deep sadness or great apathy, but rather physical

. His depression is silenced by all the organic aches and pains that he experiences every day and it is these physical symptoms for which he seeks professional help.

The person is suffering a lot psychologically, but it is difficult for him to accept it, and he focuses on curing the physical problems for which he complains over and over again. It is believed that almost 10% of the people who go to Primary Assistance centers complaining of physical pain are actually suffering from depression and only half of them receive a diagnosis appropriate. The rest will go from doctor to doctor to see if they solve their physical complaints, without much success, since, as we have indicated, the problem is not physical, but mental.

The person suffering from somatoform depression puts a lot of means and spends a lot of money to find out what causes their physical discomfort. He takes all kinds of drugs prescribed (or not) by his doctor, such as anti-inflammatories, analgesics, sleeping pills or antacids in the hope that the symptoms will disappear.

But despite giving all kinds of pills, there is rarely any improvement, and the patient continues to see all kinds of professionals. As both the pharmacological pathway and other pathways focused on solving the organic fail, many call masked depression the "specialist frustrating" because, until the psychological origin is considered, the physical symptoms do not disappear.

Symptoms

As might be expected, the psychological symptom of masked depression is pathological sadness and apathy. However, the person either does not seem to be aware of his psychological discomfort or the physical symptoms, a consequence of this disorder, focus his attention.

Physical symptoms further mask psychological discomfort and since it is often assumed that organic aches and pains are easier to solve, the person puts all their efforts and resources into trying to solve them.

Among the most common physical symptoms of this type of depression, in which psychological discomfort is somatized, turning it into physical symptoms, we have:

• headaches
• Paresthesia
• back pain
• Vertigo
• cardiac disorders
• Anxiety
• Digestive problems
• Tiredness, asthenia and fatigue
• loss of appetite
• Loss of sexual desire
• Sleeping problems
• late insomnia

Diagnostic problems

Diagnosing this type of depression is complicated because, as we have said, the physical symptoms hide the psychological discomfort. The person suffers mentally, but, by focusing on his physical discomfort, on many occasions he does not even report to his doctor that he is deeply depressed. This is why, as the patient does not indicate his state of mind, the professional rarely contemplates the hypothesis that the physical discomfort of the affected person is due to depression.

Fortunately, many doctors do consider that the patient's physical discomfort is due to a psychological cause. This is especially raised when, after prescribing drugs to the patient, no improvement has been noted. The problem is that, despite the fact that the doctor assumes that there is a psychological discomfort behind it that can explain it, the patient is reluctant to accept it. People who suffer from this disorder often do not connect with their feelings or emotions.

In addition, we live in a society in which, despite the increasing awareness of the importance of mental health, not everyone recognizes that they have a psychological problem. Physical symptoms, such as back pain or an upset stomach, suffer less stigmatization than psychological problems such as depression or anxiety. This means that many people with depression end up somatizing their psychological discomfort in the form of all kinds of physical discomfort.

• You may be interested in: ""Major depression: symptoms, causes and treatment"

Masked depression in children and the elderly

The masked depression seems to be very common in boys and girls. Infants do not have sufficient linguistic ability or assertiveness to indicate that they are feeling deeply sad and apathetic, so they may end up somatizing their psychological discomfort in all kinds of more obvious problems such as hyperactivity, aggressive behavior, antisocial behaviors and mental disorders. learning.

Some depressed children show their psychological discomfort by complaining, above all, of a stomachache or headache.. Many alleged cases of hyperactivity, bedwetting, mood swings, eating problems, and behavior problems could be caused by depression.

Interestingly, depression has been a diagnosis that has hardly been recognized in children. In much of the 20th century it was thought that depression did not manifest itself in childhood. It was not until 1972 that it was found that boys and girls could also suffer from this disorder, and it was recognized as a masked depression by psychiatrists Leon Cytryn and Donald H. McKnew. It is currently accepted that boys and girls can manifest both masked depression and the most obvious form of the disorder.

Masked depression also occurs in the elderly, but this does not have to be due to difficulties in recognizing that they are suffering from a psychological problem. On many occasions the physical symptoms of normal aging can be confused with the same physical symptoms that manifest in masked depression, causing doctors who treat elderly people to consider that, in reality, it is nothing more than any pain attributed to age.

However, this mindset should change. It has been stated that between 15% and 20% of the elderly population suffers from some psychiatric disorder and, of course, depression could be among them. This masked depression, regardless of whether it is because the patient does not want to acknowledge her psychological discomfort or because his physical problems cover his mental disorder, it is very harmful to the patient's health and can accelerate his death.

The importance of diagnosis

As we have seen, we live in a society in which the physical is much less stigmatized than the psychological, having serious consequences when it comes to seeking help. People Seek Professional Care for Stomach Aches Before Depression, and it is also difficult for him to accept that he could suffer from a mental disorder. All this does is aggravate the situation even more, making it take longer for the help they need to arrive and, even, making their psychological discomfort more chronic.

Fortunately, many times the professional sees what the true cause of the patient's physical discomfort is, and motivates him to follow a psychological treatment. It is here where we can highlight the importance of diagnosis and treatment, since addressing the basic psychological problem will greatly improve the patient's health. You will improve physically and psychologically, acquiring strategies that allow you to manage your psychological discomfort and, consequently, acquiring healthier habits.

Understanding that not all physical problems have an organic origin is fundamental, since, as we have commented, 10% of patients who go to their doctor could be suffering from depression that caused their discomfort physical. It must be understood that an unhealthy state of mind will negatively affect our physical health, and that one cannot expect to be healthy just by doing sports or eating a varied diet. Physical pain will never be cured if we don't cure the psychological one first.

Bibliographic references:

• Ford C.V. (1992) Illness as a lifestyle. The role of somatization in medical practice. Spine 17:338.
• Goic A (1991). Masked depression: Medical face of mental depression. Rev. Med. Chile 119 (3): 321-326.
• López Ibor J.J. (1972). Masked depression. Brit. J. Psychiatry. 12: 120-245.