What Is It?
A person with somatization disorder is chronically preoccupied with numerous "somatic" (physical) symptoms over many years. These symptoms, however, cannot be explained fully by a non-psychiatric diagnosis. Nonetheless, the symptoms cause significant distress or impair the person's ability to function.
The person is not "faking." Somatization disorder is a medical problem. The disorder, however, is probably related to brain functioning or emotional regulation rather than the area of the body that has become the focus of the patient's attention. The symptoms are real and are not under the person's conscious control.
People with somatization disorder report multiple medical problems over many years, involving several different areas of the body. For example, the same person might have back pain, headaches, chest discomfort, and stomach or urinary distress. Women often report irregular periods. Men may report erectile dysfunction (impotence). The person may:
Describe symptoms in dramatic and emotional terms
Seek care from more than one physician at the same time
Describe symptoms in vague terms
Lack signs of defined medical illness
Have complaints that medical tests fail to support
People with somatization disorder do get diagnosable medical illnesses, too, so doctors must be careful not to dismiss symptoms too easily.
A person with somatization disorder also may have symptoms of anxiety and depression. He or she may begin to feel hopeless and attempt suicide, or may have trouble adapting to the stresses of life. The person may abuse alcohol or drugs, including prescription medications.
Spouses and other family members may become distressed because the person's symptoms continue for long periods of time and no medical treatment seems to help.
Symptoms of somatization disorder vary by culture, sometimes depending on how illness or "sick roles" are viewed in a given culture. Cultural factors also affect the proportions of men and women with the disorder.
Female relatives of people with somatization disorder are more likely to develop the disorder. Male relatives are more likely to develop alcoholism and personality disorder.
Scientists do not know the cause of the symptoms reported by people with somatization disorder, but researchers have some theories. It is possible, for example, that people with this disorder perceive bodily sensations in an unusual way. Or they may describe feelings in physical (rather than mental or emotional) terms. Trauma or stress may cause a person's physical sensations to change.
Symptoms usually occur over many years. The person may be distressed and function poorly at work and at home. Medical evaluation does not explain the symptoms, or the symptoms may exceed what would be expected in any medical illness that is found. Symptom categories, with examples:
Pain — headache, back ache, stomach ache, joint pain and chest pain
Gastrointestinal symptoms — Nausea, vomiting, diarrhea, bloating, difficulty swallowing
Sexual symptoms — Erectile dysfunction, lack of interest, pain during intercourse
Menstrual problems — Irregular periods, extremely painful menstruation
Neurological symptoms — Problems with coordination or balance, paralysis, numbness, weakness, vision problems or seizures
There are no laboratory tests to determine whether a person has somatization disorder. The doctor may suspect it when a person has multiple complaints over a period of years, with little evidence of a definable medical illness. The doctor may do tests to check for diseases that can look like somatization disorder, such as multiple sclerosis and systemic lupus erythematosus (lupus), or syndromes such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome.
Many people with somatization disorder also have a problem with depression or anxiety, so doctors may consider these diagnoses. If the person is willing, it is helpful to consult with a mental health professional for further evaluation.
Somatization disorder is a chronic (long-lasting) problem. The disorder usually starts before the age of 25 or 30, although it can begin in adolescence. It can last for many years.
Although there is no way to prevent this disorder, a correct diagnosis of somatization can help the person avoid excessive medical testing. This is a challenge both for the person with the disorder and the doctor, because new symptoms could be caused by a medical problem other than somatization disorder.
People with somatization disorder may find it difficult to accept a referral to a mental health professional or to accept that medical evaluation and treatment cannot relieve the symptoms. They are particularly sensitive to the stigma associated with mental disorders. In addition, they sometimes are dismissed by a subset of physicians who do not see their symptoms as a legitimate cause for concern.
Ideally, if a primary care physician and mental health professional work together, the person's physical symptoms can be evaluated while he or she also gets help managing the frustration of not having a clear diagnosis or treatment plan.
But mental health treatment can sometimes reduce symptoms or improve quality of life.
There is some preliminary evidence that cognitive behavioral therapy (CBT) can help reduce symptoms or address any accompanying anxiety or depression. Sometimes, an antidepressant medication or other psychiatric medication can provide relief from the physical symptoms that stem from somatization disorder (especially if the person also has an anxiety or mood disorder). Treatment is often aimed at managing conflict at home or coping with secondary problems, such as problems with work and social functioning.
Psychotherapy can help the person deal with or manage chronic physical discomfort. Stress management (for example, relaxation techniques) may be useful. Some cognitive behavior therapists teach patients to identify the thoughts and feelings that are associated with changes in physical symptoms. They may help an individual reduce the tendency toward "body scanning," or the constant monitoring of body sensations.
When To Call A Professional
The earlier a person with somatization disorder can be evaluated by a mental health professional, the easier it will be to help the person deal with the consequences of the disorder, such as exposure to unnecessary tests and treatment, difficulty with relationships and poor productivity at work. However, a person with this disorder may avoid treatment by a mental health professional.
Medications may provide some relief. Psychotherapy tends to proceed slowly, because the person probably has been living with the disorder for many years before starting treatment. It is difficult to give up long-standing patterns of behavior, but with persistence and support, progress is possible.
American Psychiatric Association
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American Psychological Association
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National Mental Health Association
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National Institute of Mental Health
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Bethesda, MD 20892-9663