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
Malingering (not a psychiatric disorder)
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. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) includes the following disorders in this group (1):
Functional neurological symptom disorder (formerly conversion disorder)
Factitious disorders: Factitious disorder imposed on self; factitious disorder imposed on another (previously factitious disorder by proxy)
Somatic symptom disorder is characterized by multiple persistent physical complaints that are not feigned and are associated with excessive and maladaptive thoughts, feelings, and behaviors related to those symptoms. See table Somatic Symptom 8 Scale, which is used to determine how frequently the patient has been bothered by 8 selected symptoms during the previous 7 days.
Illness anxiety disorder is preoccupation with and fear of having or acquiring a serious disorder.
Functional neurological symptom disorder (conversion disorder) consists of neurologic symptoms or deficits (typically involving motor or sensory function) that develop unconsciously and nonvolitionally and are incompatible with known pathophysiologic mechanisms or anatomic pathways.
Psychological factors affecting other medical conditions is diagnosed when psychological or behavioral factors adversely affect the course or outcome of an existing medical condition.
Factitious disorders involve the falsification of physical or psychological symptoms and/or signs in the absence of obvious external incentives (eg, obtaining time off from work, disability payments, or prescription medications; avoiding military service or criminal prosecution). The term Munchausen syndrome is no longer used for factitious disorders. Malingering, which is not a factitious disorder but may be confused with it, is intentional feigning of physical or psychological symptoms motivated by an external incentive, which distinguishes malingering from factitious disorders.
Somatic symptom disorder and illness anxiety disorder are the most common.
Somatic Symptom Scale 8*
Symptom | Not at all | A little bit | Somewhat | Quite a bit | Very much |
|---|---|---|---|---|---|
Back pain | 0 | 1 | 2 | 3 | 4 |
Chest pain or shortness of breath | 0 | 1 | 2 | 3 | 4 |
Dizziness | 0 | 1 | 2 | 3 | 4 |
Feeling tired or having low energy | 0 | 1 | 2 | 3 | 4 |
Headaches | 0 | 1 | 2 | 3 | 4 |
Pain in your arms, legs, or joints | 0 | 1 | 2 | 3 | 4 |
Stomach or bowel problems | 0 | 1 | 2 | 3 | 4 |
Trouble sleeping | 0 | 1 | 2 | 3 | 4 |
* Scoring: Patient was not or only minimally bothered (0 to 3). Increasing scores indicate incrementally greater levels of discomfort: low (4 to 7); medium (8 to 11); high (12 to 15); very high (16 to 23). | |||||
Adapted with permission from Gierk B, Kohlmann S, Kroenke K, et al. The Somatic Symptom Scale-8 (SSS-8): A brief measure of somatic symptom burden. JAMA Intern Med 174(2):400, 2014. doi: 10.1001/jamainternmed.2013.12179 | |||||
Reference
1. Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, 2022, pp 349-370.
