keywords: Heat in the head, crawling sensations, somatic symptom disorder, Nigeria.
Introduction.
Heat in the Head Complaints – Nigeria. Is heat in the head a mental health condition? How common is SSD in Nigeria? What are the causes or risk factors to Somatic Symptoms Disorder (SSD)? How does SSD come about? Is there treatment for SSD?
Many Africans including Nigerians prefer to make complaints of mental health issues in the form of physical health issues. This is because physical health issues are better accepted and attract attention culturally and socially.
Under normal circumstances, mental health issues in Africa, Nigeria inclusive, are stigmatized. So to avoid being referred to as a ‘mad person’ many people, who have mental illness, will make physical complaints. And one of these physical complaints some of those people who have mental illness make, is heat in the head.
Many of these physical complaints, such as heat in the head, are parts of Somatic Symptom Disorder (SSD). Somatic Symptom Disorder was originally known as somatization disorder.
Is heat in the head a mental health condition?
Heat in the head is one of the symptoms of a mental health condition known as SSD.
Somatic Symptom Disorder is a mental health condition that comes with multiple physical complaints that keeps recurring. These physical or somatic complaints may come alone, or may come with other illnesses like heart diseases, hypertension, etc.
So SSD is characterized by reoccurring multiple physical complaints that begins before the person is 30 years old. These physical or somatic complaints include headaches, dizziness, heat in the head or body and crawling sensations on the body. Heat in the Head Complaints in Nigeria is very common.
Others somatic complaints include abdominal pain, chest pain, limb pain and other aches, as well as fatigue or tiredness. And some of the aches and pains experienced, maybe chronic in nature.
There also can be nausea, vomiting and even diarrhea and even constipation. Also pounding heart or palpitations, shortness of breath, the feeling of lump in throat and poor sleep can occur.
These symptoms felt by the people who suffer from SSD are real symptoms and not faked. But the symptoms are over dramatized by these people. Let us take for example, a person with SSD who has heat in the head. This person will present the heat as if he or she is about to die from it. The heat will be excessively dramatized when in actual fact it is just a feeling of warmth at the head.
Apart from the symptoms being excessively presented, these people think too much about their symptoms. Their minds are always hooked on their symptoms. And this thinking takes so much of their time, that it prevents them from carrying out their daily activities. Some people may not even want to go to work, stop working or refuse to do house chores.
How common is SSD in Nigeria?
Among adolescents in Eastern Nigeria in a research in 2017, about 63% had both head and body symptoms. Then about 52% had head features and 54% had body symptoms.
In an outpatient department in a tertiary hospital in southwestern Nigeria, 93.3% of the patients had SSD. And in as much as any of the already mentioned symptoms can occur crawling sensation is the most occurring symptom. The person may explain the crawling sensation as worms in the head, or ants crawling under the skin.
For those who are uncomfortable in reporting sexual related symptoms, they may complain of burning sensations at their private parts. In actual fact, these persons may be having painful intercourse, etc.
Most cases of SSD are seen in Primary Healthcare Centres (PHC) in Nigeria. In one such PHC in southwestern Nigeria, about 48% of the patients had SSD in 2020.
What are the causes or risk factors to Somatic Symptoms Disorder (SSD)?
It is important to understand that SSD are physical symptoms due to mental health conditions. The physical health condition is being presented or complained of, instead of an underlying mental illness the person has.
These underlying mental illnesses include depressive disorders, anxiety disorders. Those with anxiety will have palpitations or fast heart beat. They could also have poor sleep.
The person does not actually know about the underlying depression or anxiety. Even if the underlying mental illness is known, the person will not want to complain of it due to stigmatization. So he or she will complain of heat in the head or crawling sensations on the body or both.
Thus what actually brings about these physical or somatic complaints or SSD?
Genetics:
This means that it runs in the family. So the parent(s) must have had SSD.
Adverse Childhood Experiences:
These include family conflicts, divorce, separation, child abuse of any sort, including child sexual abuse.
Substance abuse:
These include the abuse of cannabis, cocaine, alcohol, etc.
Modeling:
A person can present any of these somatic symptoms because as a child, he or she saw someone do so.
Cultural acceptance:
Some people make these complaints because it is culturally accepted and gets the person great attention or care.
Stressful life events:
Financial problems, marital issues, loss of job or unemployment are all risk factors to developing SSD.
Personality disorders:
The SSD tend to also occur more in persons with personality disorders such as paranoid, avoidant, and obsessive compulsive disorders.
How does SSD come about?
How SSD comes about is really not fully known, but some aspects are known. Somatic symptom disorder comes about from the fact that the person has an increased awareness of body sensations. Also the person wrongly interprets these body sensations to be a medical illness.
Is there treatment for SSD?
Most people who suffer from SSD go to PHC for treatment they most often go through many investigations. Majority of the time these investigations are unnecessary, very expensive and money wasting. But it is important to carry out some investigations to find out if there are medical conditions causing such symptoms.
Then most often, the symptoms are chronic, affecting the person for years, even when the person consults medical personnel. One of the reasons could lie in the fact that many doctors miss the diagnosis and treat unnecessarily. This may cause the patient to do doctor shopping, i.e. going from one doctor to another in quick successions. So the doctors and the patients get angry with each other and fall out with one another.
Actually, if there are medical conditions discovered during the investigations, it is important to treat them. These medical conditions could be heart diseases, diabetes, hypertension, etc. But then most times, no medical condition is seen.
It is important to consult with a psychiatrist whether a medical condition was found or not. This is because even after treating the medical condition found, the somatic symptoms still do continue, thus requiring a psychiatrist. So there is need for combined efforts of the two doctors.
What the psychiatrist will do is to find out the underlying mental illness that could lead to the somatic complaints. These underlying mental illnesses could be a depressive disorder, an anxiety disorder, etc. The illness could even be due to drug addiction which will also require the services of the psychiatrist.
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