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Somatization disorder is characterized by multiple physical complaints (eg, pain; GI, sexual, and neurologic symptoms) over several years that cannot be explained fully by a physical disorder. Symptoms usually begin before age 30 and are not intentionally produced or feigned. Diagnosis is based on history after excluding physical disorders. Treatment focuses on establishing a consistent, supportive physician-patient relationship that avoids exposing the patient to unnecessary diagnostic testing and therapies.
Somatization disorder is often familial, although the etiology is unknown. Somatization disorder occurs more often in women. Male relatives of affected women have an increased risk of antisocial personality and substance-related disorders.
Symptoms and Signs
Recurring and multiple physical complaints usually begin before age 30. Severity may fluctuate, but symptoms persist for at least several years. Complete symptom relief for any extended period is rare. Some people become more overtly depressed.
Any body part may be affected, and specific symptoms and their frequency vary among cultures. In the US, typical symptoms include headache, nausea and vomiting, bloating, abdominal pain, diarrhea or constipation, dysuria, dysmenorrhea, dyspareunia, and loss of sexual desire. Men frequently complain of erectile or ejaculatory dysfunction. Neurologic symptoms are also present. Anxiety and depression may occur. Typically, patients are dramatic and emotional when recounting their symptoms, often referring to them as “unbearable,” “beyond description,” or “the worst imaginable.”
Patients may become dependent on others, demanding help and emotional support and becoming angry when they feel their needs are not met. They may also threaten or attempt suicide. Often dissatisfied with their medical care, they typically go from one physician to another or seek treatment from several physicians concurrently.
The intensity and persistence of symptoms may reflect a strong desire to be cared for. Symptoms may help patients avoid responsibilities but may also prevent pleasure and act as punishment, suggesting underlying feelings of unworthiness and guilt.
Diagnosis
Patients are unaware of their underlying mental problem and believe that they have physical ailments, so they pressure physicians for tests and treatments. Physicians usually do many examinations and tests to eliminate a physical disorder as the cause. Because such patients may develop concurrent physical disorders, appropriate examinations and tests should also be done when symptoms change significantly or when objective signs develop. Patients, even those who have a satisfactory relationship with a primary physician, are commonly referred to a psychiatrist.
Specific diagnostic criteria include the following:
The diagnosis is supported by the dramatic nature of the complaints and the patient's sometimes exhibitionistic, dependent, and suicidal behavior. Somatization disorder is distinguished from generalized anxiety disorder, conversion disorder, and major depression by the predominance, multiplicity, and persistence of physical symptoms.
Patients who do not meet the above diagnostic criteria for somatization disorder but who have ≥ 6 mo of ≥ 1 or more physical complaints that are not fully explained by a physical disorder or another mental disorder and who have clinically significant distress or impairment in functioning, are said to have undifferentiated somatoform disorder.
Treatment
Treatment is usually difficult. Drug treatment of concurrent mental disorders (eg, depression) may help. Psychotherapy, particularly cognitive-behavioral therapy, may also help. Patients benefit from having a supportive relationship with a primary care physician, who coordinates all of their health care, offers symptomatic relief, sees them regularly, and protects them from unnecessary tests and procedures.
Last full review/revision June 2008 by Katharine A. Phillips, MD
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