Somatization disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: Briquet's disorder

Overview

Somatization disorder is a psychiatric diagnosis applied to patients who chronically and persistently complain of varied physical symptoms that have no identifiable physical origin. One common general etiological explanation is that internal psychological conflicts are unconsciously expressed as physical signs.

Pathophysiology

There is usually co-morbidity with other psychological disorders, particularly mood or anxiety disorders.

Epidemiology and Demographics

Prevalence

Somatization disorder is not common in the general population.

Gender

It is thought to occur in 0.2% to 2% of females,[1][2][3][4] and, according to the DSM-IV, 0.2% of males.[5]

Natural History, Complications and Prognosis

This condition is chronic and has a poor prognosis.

Diagnosis

History and Symptoms

Criteria

Somatization disorder is a somatoform disorder. The DSM-IV establishes the following five criteria for the diagnosis of this disorder:

  • A history of somatic symptoms prior to the age of 30
  • Pain in at least four different sites on the body
  • Two gastrointestinal problems other than pain such as vomiting or diarrhea
  • One sexual symptom such as lack of interest or erectile dysfunction
  • One pseudoneurological symptom similar to those seen in Conversion disorder such as fainting or blindness.

Such symptoms cannot be related to any medical condition. The symptoms do not all have to be occurring at the same time, but may occur over the course of the disorder. If a medical condition is present, then the symptoms must be excessive enough to warrant a separate diagnosis. Two symptoms can not be counted for the same thing e.g.if pain during intercourse is counted as a sexual symptom it can not be counted as a pain symptom. Finally, the symptoms cannot be being feigned out of an effort to gain attention or anything else by being sick, and they can not be deliberately induced symptoms.

Treatment

No one treatment has been found to cure somatization disorder. However, setting up a physician that screens complaints from patients before they are allowed to see a specialist significantly cuts down on cost of the disorder. Antidepressants and cognitive behavioral therapy have been shown to help treat the disorder.

Collaboration between a psychiatrist and primary care physician may help.[6]

Related Chapters

References

  1. deGruy F, Columbia L, Dickinson P. (1987) "Somatization disorder in a family practice," J Fam Pract., 25(1):45–51.
  2. Lichstein, P. R. (1986). "Caring for the patient with multiple somatic complaints," Southern Medical Journal, 79(3), 310-314
  3. Gordon, G.H. (1987). "Treating somatizing patients," Western Journal of Medicine, 147, 88-91.
  4. Farley J, Woodruff RA, Guze SB (1968). "The prevalence of hysteria and conversion symptoms," The British Journal of Psychiatry, 114:1121–1125 (1968).
  5. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC.
  6. Smith GR, Monson RA, Ray DC (1986). "Psychiatric consultation in somatization disorder. A randomized controlled study". N. Engl. J. Med. 314 (22): 1407–13. PMID 3084975.

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