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Somatization is the expression of mental phenomena as physical (somatic) symptoms. Typically, the symptoms cannot be explained by a physical disorder. 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 somatoform disorders, factitious disorders, and malingering. Somatization typically leads to seeking medical evaluation and treatment.
Somatoform disorders are characterized by physical symptoms that are not fully explained by another disorder—physical or mental. Symptoms of somatoform disorders are not volitional. Somatoform disorders are distressing and often impair social, occupational, academic, or other aspects of functioning. These disorders include body dysmorphic disorder, conversion disorder, hypochondriasis, pain disorder, somatization disorder, undifferentiated somatoform disorder, and somatoform disorder not otherwise specified. Body dysmorphic disorder differs somewhat from other somatoform disorders in that it is characterized by preoccupation with perceived defects in physical appearance.
Factitious disorders involve the conscious and volitional feigning of symptoms without any external incentive (eg, time off from work) and is thus distinguished from malingering. Patients gain gratification from assuming the sick role through the simulation, exaggeration, or aggravation of symptoms and signs. Symptoms and signs may be mental, physical, or both. The most severe and chronic form is Munchausen syndrome.
Malingering is intentional feigning of physical or mental symptoms motivated by an external incentive (eg, feigning illness to avoid work or military duty, to evade criminal prosecution, or to obtain financial compensation or drugs for abuse). Malingering is suspected in the following cases:
Last full review/revision June 2008 by Katharine A. Phillips, MD
Content last modified June 2008
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