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Somatization disorder
Classification and external resources
ICD-10 F45.0
ICD-9 300.81
DiseasesDB 1645
MedlinePlus 000955
eMedicine ped/3015
MeSH D013001

Somatization disorder (also Briquet's disorder or, in antiquity, hysteria) 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. Patients with Somatization Disorder will typically visit many doctors trying to get the treatment they think they need. However, it must be remembered that this behavior would also occur if the patient had a genuine physical condition that previous physicians had failed to diagnose. The first step for a physician must be to take the patient's claims seriously and consider if their symptoms match any other known condition.

Contents

Criteria

Somatization disorder is a somatoform disorder.[1] The DSM-IV establishes the following five criteria for the diagnosis of this disorder:[2 ]

  • 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 cannot be counted for the same thing e.g.if pain during intercourse is counted as a sexual symptom it cannot 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 cannot be deliberately induced symptoms.

People suffering from temporal lobe epilepsy are often misdiagnosed as having somatization disorder. This occurs because their seizures are not convulsive, sometimes involve hallucinations, and are often difficult to capture on an EEG.

Somatization disorder is a hard disorder to diagnose but, there are two tests to determine if you have it. A physical examination of the specified areas that the symptom seems to be in is the first test, along with thorough clinical evaluation of the patients expressed symptoms. This is to determine whether or not the pain is due to a physical cause. Once the physical cause is ruled out, then a psychological test is performed to rule out any other related disorders. Since there is no definite way to determine somatization disorder just from a simple test, those other tests are performed to rule out the other possibilities[3].

Causes

Although somatization disorder has been studied and diagnosed for over a century now, there is still little known of what causes it. The basic concept behind it is a misconnection between the mind and the body. Experts really do not know the cause of it or why it occurs. There is a possibility in some cases that the condition is more a factor of the physicians lack of knowledge, or attitude to chronic illness, than any psychological factor in the patient. It seems that the disorder is often familial. Three theories provide the best reasons of this disorder. The first theory and one of the oldest theories is that it is your body’s own defense against psychological stress. The mind can only handle so much stress and strain. Therefore, when the brain reaches a point where the stress is too much, it transfers the pain and stress throughout the body but mainly the digestive system, nervous system, and reproductive system. Over the years researchers have found connections between the brain, immune system, and digestive system which may be the reason why somatization affects those systems and that people with Irritable bowel syndrome are more likely to get somatization disorder. This theory also helps explain why depression is related to somatization.

The second theory for the cause of somatization disorder is that the disorder occurs due to the heightened sensitivity of internal physical sensations. Some people have the ability to feel even the slightest amount of discomfort or pain within their body. With this hypersensitivity the patient would feel possibly the little pains that the brain normally would not register in the average person such as minor changes in heartbeat. Somatization disorder would then be very closely related to panic disorder under this theory. However, not much is known about hypersensitivity and its relevance to somatization disorder. The psychological or physiological origins of hypersensitivity are still not that well understood by experts.

The third theory is that somatization disorder is caused by one’s own negative thoughts and overemphasized fears. Their catastrophic thinking about even the slightest ailments such as thinking a cramp in their shoulder is a tumor, or shortness of breath is due to asthma, could lead those who have somatization disorder to actually worsen their symptoms. This then causes them to feel more pain for just a simple thing like a headache. Often the patients feel like they have a rare disease. This is due to the fact that their doctors would not be able to have a medical explanation for their over exaggerated pain that the patient actually thinks is there. This thinking that the symptom is catastrophic also often reduces the activities they normally do. They fear that doing activities that they would normally do on a regular basis would make the symptoms worse. The patient slowly stops doing activities one by one until they practically shut themselves from a normal life. With nothing else to do it leaves more time to think about the “rare disease” they have and consequently ending in greater stress and disability[4].

Prevalence

Somatization disorder is not common in the general population. It is thought to occur in 0.2% to 2% of females,[5][6][7][8] and, according to the DSM-IV, 0.2% of males.[2 ] There is usually co-morbidity with other psychological disorders, particularly mood or anxiety disorders. This condition is chronic and has a poor prognosis. Although the disorder occurs most often in women, the male relatives of affected women have an increased risk of substance-related disorders and antisocial personality disorders.Phillips, Katherine A. MD. "Somatization Disorder." www.merck.com/mmpe/sec15/ch204/ch204g.html. June 2008. Oct. 13, 2008. Certain symptoms of the disorder vary across different cultures as well. For example, the symptom of a sensation of worms in the head or ants crawling under the skin is more prone to those of African and South Asian countries than those in North American countries[4].

Treatment

Somatization disorder is usually chronic and difficult to treat as patients are over-focused on the physical symptoms and are lacking insight on their psychological difficulties. However, the financial cost of the disorder is lower when patients need a referral from a family physician before they can consult a specialist. Antidepressants[9] and cognitive behavioral therapy[10][11] have been shown to help treat the disorder. Collaboration between a psychiatrist and primary care physician may help.[12] These will not fully treat the disorder though. The CBT helps with the patient realizing that the ailments are not as catastrophic. Enabling them to slowly get back to doing activities that they once were able to do without fear of “worsening their symptoms.”

Because the symptoms of somatization disorder can come and go or the severity of the pain can vary drastically, it is often that patients with the disorder usually leave it untreated. If the disorder is left untreated then many serious problems could arise. The main concern if not treated, is the possibility of eventually becoming handicapped. The pain that is caused by somatization disorder may eventually become too much to deal with and the patient would be incapable to work or even do simple everyday things.

Another consequence of not properly treated somatization disorder is not as drastic as becoming disabled or handicapped. Since somatization disorder can be difficult to diagnose, in some cases doctors will tell their patients that the symptoms are “just in their heads” or imaginary, leaving the disorder untreated. Doctors may just prescribe medicine for the pain. Since the pain is due to a psychological issue the patient would not feel any better after taking the pain medications. Thus, they would take more and more, leading to an addiction to the medication. Addiction to any medication has a psychological effect on the brain and may interfere with other brain functions[4].

Prevention

There is really no way to prevent the acquisition of somatization disorder. However those who are prone to obtaining the disorder should have greater awareness of it. This can be obtained by going to counseling or other psychological conventions. Also having a good relationship with a health care provider is very beneficial. With early knowledge of the disorder, patients will be well aware of how to deal with stressors, which could help keep the symptoms from becoming more severe[13].

References

  1. ^ Noyes R, Stuart S, Watson DB, Langbehn DR (2006). "Distinguishing between hypochondriasis and somatization disorder: a review of the existing literature". Psychother Psychosom 75 (5): 270–81. doi:10.1159/000093948. PMID 16899963. http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=PPS2006075005270.  
  2. ^ a b American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC.
  3. ^ healthguide.howstuffworks.com/somatization-disorder-dictionary.htm. July 25, 2006. Oct. 14, 2008
  4. ^ a b c www.minddisorders.com/Py-Z/Somatization-disorder.html. Oct. 10, 2008
  5. ^ deGruy F, Columbia L, Dickinson P. (1987) "Somatization disorder in a family practice," J Fam Pract., 25(1):45–51.
  6. ^ Lichstein, P. R. (1986). "Caring for the patient with multiple somatic complaints," Southern Medical Journal, 79(3), 310-314
  7. ^ Gordon, G.H. (1987). "Treating somatizing patients," Western Journal of Medicine, 147, 88-91.
  8. ^ Farley J, Woodruff RA, Guze SB (1968). "The prevalence of hysteria and conversion symptoms," The British Journal of Psychiatry, 114:1121–1125 (1968).
  9. ^ Stahl, S.M. (2003). Antidepressants and somatic symptoms: Therapeutic actions are expanding beyond affective spectrum disorders to functional somatic syndromes. Journal of Clinical Psychiatry, 64(7), 745-746.
  10. ^ Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM (2006). "Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial". Arch. Intern. Med. 166 (14): 1512–8. doi:10.1001/archinte.166.14.1512. PMID 16864762. http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=16864762.  
  11. ^ Mai F (2004). "Somatization disorder: a practical review". Can J Psychiatry 49 (10): 652–62. PMID 15560311.  
  12. ^ 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.  
  13. ^ adam.about.com/encyclopedia/infectiousdiseases/Somatization-disorder.htm. A.D.A.M. Inc. Aug. 24, 2008. Oct 10, 2008

See also

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