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

Masked depression is a variant of this disorder in which symptoms are somatized.

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

Masked depression is one of the forms in which this disorder can present itself.Only in a form in which it seems that the main problem is physical. Apathy and sadness are hidden under the patient's somatic complaints.

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

What is masked depression?

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

This type of depression is one in which the main symptom that the affected person complains about is not psychological, such as a deep sadness or a great apathy, but physical.. His depression is silenced by all the pains and organic discomfort 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 assume 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 come to primary care centers complaining of physical pain are actually suffering from depression and only half of them receive a proper diagnosis. The rest will go from doctor to doctor to see if they can 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 it is that produces his physical discomfort.. He takes all kinds of drugs prescribed (or not) by his doctor, such as Anti-Inflammatory drugs, 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 go to all kinds of professionals. As both the pharmacological and other ways focused on solving the organic fail, many call masked depression the "specialist frustrator" because, until the psychological origin is addressed, the physical symptoms do not go away..

Symptoms

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

The physical symptoms further mask the psychological distress. and since it is often assumed that organic pain and discomfort are easier to solve, the person puts all his efforts and resources into trying to solve them.

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

• Headaches
• Paresthesias
• Pain in the back
• Vertigo
• Cardiac disorders
• Anxiety
• Digestive problems
• Tiredness, asthenia and fatigue
• Loss of appetite
• Loss of sexual desire
• Sleep problems
• Delayed insomnia

Diagnostic problems

Diagnosing this type of depression is complicated because, as we have said, the physical symptoms hide the psychological distress. The person suffers mentally, but, by focusing on their physical discomfort, they often do not even report to their physician that they are deeply depressed. This is why, since the patient does not indicate his or her state of mind, the practitioner rarely considers the hypothesis that the patient's physical discomfort is due to depression..

Fortunately, many physicians do consider that the patient's physical discomfort is due to a psychological cause. This is especially the case when, after prescribing drugs to the patient, no improvement has been noted. The problem is that, although the physician assumes that there is a psychological malaise behind it that can explain it, the patient is reluctant to accept it. People suffering from this disorder often do not connect with their feelings and emotions.

In addition, we live in a society where, despite increasing awareness of the importance of mental health, not everyone recognizes that they have a psychological problem, not everyone recognizes that they have a psychological problem.. Physical symptoms, such as back pain or stomach discomfort, 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.

Masked depression in children and the elderly

Masked depression seems to be very common in children. Infants lack the language skills and assertiveness to indicate that they feel deeply sad and apathetic, so they may end up somatizing their psychological distress into all sorts of more obvious problems such as hyperactivity, aggressive behavior, antisocial behaviors and learning disorders.

Some depressed children show their psychological distress by complaining, in particular, of stomach aches or headaches.. Many suspected cases of hyperactivity, bedwetting, mood swings, feeding problems and behavioral problems may have their origin in depression.

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

Masked depression also occurs in the elderly, but this need not be due to difficulties in recognizing that one is suffering from a psychological problem. Often the physical symptoms of normal aging can be confused with the same physical symptoms that manifest in masked depression, causing physicians treating the elderly to consider that it is really nothing more than any pain blamed on old age..

However, this mentality should change. It has been said 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 recognize his psychological discomfort or because his physical problems cover up his mental disorder, 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, with serious consequences when it comes to seeking help. People seek professional care for a stomach ache rather than for depression, and it is difficult for them to accept this.and also find it difficult to accept that they might suffer from a mental disorder. This only aggravates the situation even more, making the help they need take longer to arrive and even making their psychological discomfort chronic.

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

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

Bibliographical references:

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