Somatization disorder

Somatization disorder (also Briquet's disorder or, in antiquity, hysteria) is a psychiatric diagnosis
applied to patients who 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 in pursuit of effective treatment.

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.[citation needed] This occurs because their seizures are not convulsive, sometimes involve
hallucinations, and are often difficult to capture on an EEG.

Somatization disorder is difficult to diagnose but there are two tests that may help to determine if
a patient has the condition. 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 patient's 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 from a simple test,
other tests are performed to rule out the other possibilities.[3]

[edit] Causes

Although somatization disorder has been studied and diagnosed for more than a century, there is
debate and uncertainty regarding its pathophysiology. Most current explanations focus on the
concept of a misconnection between the mind and the body. Widely held theories on this
troublesome, often familial disorder fit into three general categories.

The first and one of the oldest theories is that the symptoms of somatization disorder represent
the body’s own defense against psychological stress. This theory states that the mind has a finite
capacity to cope with stress and strain. Therefore, increasing social or emotional stresses beyond
a certain point are experienced as physical symptom, principally affecting the digestive, nervous,
and reproductive systems. In recent 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.[citation needed] 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
heightened sensitivity to 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 sense pain that the brain normally would not register in the average person such as
minor changes in one's 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 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]

[edit] Prevalence

Somatization disorder is uncommon 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. [9] 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].
[edit] 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.[citation needed] Antidepressants[10] and cognitive behavioral
therapy[11][12] have been shown to help treat the disorder. Collaboration between a psychiatrist and
primary care physician may help.[13] 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.”

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.[citation needed] Addiction to any medication has a psychological effect on the
brain and may interfere with other brain functions[4].

[edit] Prevention

While there is no known way to prevent the acquisition of somatization disorder, those who are
prone to it should benefit from greater awareness of the condition. This can be obtained by going
to counseling or other psychological conventions. In addition, 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.[14]