Cenesthopathy is a psychiatric term dating back to the early 20th century. Cenesthopathic schizophrenia has never been regarded as a subtype of schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM-5).
Oral cenesthopathy, which is characterized by persistent sensations that feel like symptoms of dental problems, can occur as part of schizophrenia, as well as with other psychiatric conditions. An understanding of cenesthopathy can be useful in characterizing some of the abnormal behaviors associated with schizophrenia.
What Is Cenesthopathy?
Cenesthopathy is a syndrome in which a person persistently complains of aberrant or bizarre sensations in a particular part of their body, often with odd descriptions, that are medically unexplainable. Because the definition is broad and can apply to many different disorders, the sensations are rarely defined as cenesthopathies.
In the DSM-5, cenesthopathies may potentially also be part of the diagnosis of delusional disorder, somatic type. The term somatic describes anything related to the body.
Cenesthopathic schizophrenia has never been classified as a subtype of schizophrenia in the DSM, in part because the symptoms can be seen in several psychiatric disorders.
In fact, the current DSM-5 eliminated all subtypes in 2013, citing their lack of reliability and limited value in managing the disorder. Nevertheless, abnormal body sensations are common in schizophrenia.
Symptoms
The symptoms of cenesthopathy are subjective and can vary in terms of the location on the body and the exact description of the sensation. While your experience with cenesthopathy can differ from someone else’s experience with the syndrome, there are certain sensations commonly reported in adults and adolescents with cenesthopathy.
Common descriptions include:
“Moving” sensations, like cold, running through the bodyFeeling that there are nodules for foreign bodies inside of the bodyFeeling as if a part of the body is detached, stretched, or compressed A feeling that the brain is either hardening or softeningFeeling as if part of the body is hollow or open to the air
Something that differentiates cenesthopathy from other delusions is the bizarre way a person will describe the sensation.
For example, someone with sensations in the head might claim that there is “cotton in my head” or explain that their brain is “falling sloppily” when describing the symptoms.
One of the most common manifestations of cenesthopathy is oral cenesthopathy, also referred to as oral somatic delusions. Symptoms of oral cenesthopathy include:
A slimy sensation in the mouthA sense that there are coils around the mouthA feeling that there is excess mucus secretion in the mouthA feeling that there is an object in the mouth
Most importantly, a hallmark of the delusion is that the affected person would rather see a dentist and undergo extensive dental exams to get treatment for these symptoms rather than than see a psychiatrist.
Diagnosis
Medically unexplained symptoms sometimes mask the symptoms of schizophrenia—and doctors and dentists might not consider a psychiatric cause of these symptoms—even when a person insists that something is physically wrong and returns repeatedly despite a lack of physical signs or symptoms of disease.
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It is often when the behavior severely diminishes a person’s quality of life or work/home life that psychiatric care is sought.
The DSM-5 criteria for schizophrenia include having at least two of the following symptoms for a significant amount of time throughout a six month period, with an associated negative impact on a person’s life (at least one of the symptoms should be one of the first three).
Delusions (false beliefs)Hallucinations (imagined sensory disturbances)Disorganized speechDisorganized or catatonic (unresponsive) behaviorNegative symptoms (lack of emotion, motivation, or interaction)
Cenesthopathy meets the criteria for delusion even if it not described as such. Before a diagnosis of schizophrenia is made, other conditions with similar features must be ruled out.
These conditions include schizoaffective disorder and depressive or bipolar disorder with psychotic features. These conditions are managed differently, so getting a correct diagnosis helps ensure the correct treatment.
Causes
The exact cause of these somatic sensations in schizophrenia is not fully understood, but there are several theories. One theory is that cenesthopathy is an extension of body image disturbances, in which a person with schizophrenia has a distortion about the anatomical size, shape, or functions of the body.
The theory of body image dysfunction is evidenced in part by research in which people with schizophrenia have a strong tendency to underestimate the size of their legs.
The most common distortions involve:
Body boundaries: How our sense of space is shaped by perceptions of our embodied state Dysmorphia: A sense of abnormal body shape Morbid identification: View the body or body part as “lifeless”
A person who has schizophrenia may depersonalize their body, objectifying what they see in the mirror.
Treatment
There are no specific treatments for cenesthopathy, and the management of this symptom is focused on achieving remission from schizophrenia in all its form. Treatment for schizophrenia includes antipsychotic medications and psychotherapy. Schizophrenia requires lifelong treatment, and there is no cure for this chronic mental illness.
In addition to antipsychotic medications, other treatments such as antidepressants and electroconvulsive therapy have been tried, albeit with a response rate of less than 50%.
Coping
Cenesthopathy is difficult to treat and typically requires long-term psychotherapy and pharmaceutical treatment. While the attention may be focused on the symptoms of the disease—in this case, cenesthopathy—the greater focus should be placed on how to live and cope with schizophrenia in order to achieve and sustain remission.
Positive strategies for living with schizophrenia include:
Utilizing distractionKeeping a symptom diaryJoining a support groupAvoiding alcohol and drugsEmploying relaxation techniques
These strategies are associated with an improved quality of life with schizophrenia.
Continuous psychiatric care, adherence to medications, and a connection with a support network are among the cornerstones of living well with schizophrenia.
