Somatization disorder

Definition

Somatization disorder is a long-term (chronic) condition in which a person has physical symptoms that involve more than one part of the body, but no physical cause can be found.

The pain and other symptoms people with this disorder feel are real, and are not created or faked on purpose (malingering).

Alternative Names

Briquet syndrome

Causes, incidence, and risk factors

The disorder usually begins before age 30 and occurs more often in women than in men. The disorder is more common in people with irritable bowel syndrome and chronic pain.

In the past, this disorder was thought to be related to emotional stress. The pain was dismissed as being "all in their head."

However, patients who have a somatization disorder seem to experience pain or other symptoms in a way that increases the level of pain. Pain and worry create a cycle that is hard to break.

People who have a history of physical or sexual abuse are more likely to have this disorder. However, not every person with a somatization disorder has a history of abuse.

As researchers study the connections between the brain and body, there is more evidence that emotional well-being affects the way in which people perceive pain and other symptoms.

Symptoms

People with this disorder have many physical complaints that last for years. Most often, the complaints involve chronic pain and problems with the digestive system, nervous system, and reproductive system.

The symptoms often interfere with work and relationships, and lead to many visits to different health care providers.

Stress often worsens the symptoms.

Some of the many symptoms that can occur with somatization disorder include:

• Abdominal pain
• Amnesia
• Back pain
• Bloating
• Chest pain
• Diarrhea
• Difficulty swallowing
• Dizziness
• Headaches
• Impotence
• Joint pain
• Nausea and sometimes vomiting
• Pain during intercourse
• Pain during urination
• Painful menstruation
• Pain in the legs or arms
• Palpitations
• Paralysis or muscle weakness
• Sexual apathy
• Shortness of breath
• Vision changes

Signs and tests

A thorough physical examination and diagnostic tests are performed to identify physical causes. The types of tests that are done depend on what symptoms you have.

A psychological evaluation is performed to identify related disorders.

If, after you have a thorough evaluation, no physical cause is found to explain the symptoms, somatization disorder may be diagnosed.

Treatment

The goal of treatment is to help you learn to control your symptoms.

Having a supportive relationship with a health care provider is the most important part of treatment.

• You should have only one primary care provider, to avoid having too many tests and procedures.
• Schedule regular appointments to review your symptoms and how you are coping. The health care provider should explain any test results.

Finding a mental health provider who has experience treating somatization disorders with talk therapy (psychotherapy) can be helpful. Cognitive behavioral therapy (CBT), a kind of talk therapy, can help you deal with your pain. During therapy, you will learn:

• To recognize what seems to make the pain worse
• To develop methods of coping with the symptoms
• To keep yourself more active, even if you still have pain

If you have depression or an anxiety disorder, it may respond to antidepressant medications.

You should not be told that your symptoms are imaginary. Many health care providers now recognize that real physical symptoms can result from psychological stress.

Support Groups

Expectations (prognosis)

Complications

You can become dependent on pain relievers or sedatives.

Calling your health care provider

Having a good relationship with your primary health care provider is helpful. Call for an appointment if you notice a major change in your symptoms.

Prevention

Counseling or other psychological interventions may help people who are prone to somatization learn other ways of dealing with stresses. This may help reduce the intensity of the symptoms.

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References

Greenberg DB, Braun IM, Cassem NH. Functional somatic symptoms and somatoform disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 24.

Witthöft M, Hiller W. Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol. 2010;6:257-283.

deGruy FV. The somatic patient. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 61.