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Overview of Somatization

by Joel E. Dimsdale, MD

Somatization is the expression of mental phenomena as physical (somatic) symptoms. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously and nonvolitionally to those in which symptoms develop consciously and volitionally. This continuum includes somatic symptom and related disorders, factitious disorders, and malingering. In all of the disorders, patients focus prominently on somatic concerns. Thus, somatization typically leads patients to seek medical evaluation and treatment rather than psychiatric care.

Somatic symptom disorder and related disorders are characterized by persistent physical symptoms that are associated with excessive or maladaptive thoughts, feelings, and behaviors in response to these symptoms and associated health concerns. These disorders are distressing and often impair social, occupational, academic, or other aspects of functioning. They include conversion disorder, factitious disorder, illness anxiety disorder, psychological factors affecting other medical conditions, and somatic symptom disorder; somatic symptom disorder and illness anxiety disorder are the most common.

Factitious disorders involve the falsification of physical or psychologic symptoms and/or signs in the absence of obvious external incentives (eg, obtaining time off from work, disability payments, or drugs of abuse; avoiding military service or criminal prosecution). The term Munchausen syndrome is no longer used for factitious disorders.

Malingering is intentional feigning of physical or psychologic symptoms motivated by an external incentive, which distinguishes malingering from factitious disorders.

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