Somatization disorder
Somatization disorder: Excerpt from Professional Guide to Diseases (Eighth Edition)
When multiple recurrent signs and symptoms of several years’ duration suggest that physical disorders exist without a verifiable disease or pathophysiologic condition to account for them, somatization disorder is present. The patient with somatization disorder usually undergoes repeated medical examinations and diagnostic testing that — unlike the symptoms themselves — can be potentially dangerous or debilitating. However, unlike the hypochondriac, she isn’t preoccupied with the belief that she has a specific disease.
Somatization disorder is usually chronic, with exacerbations occurring during times of stress. The patient’s signs and symptoms are involuntary, and she consciously wants to feel better. Nonetheless, she’s seldom entirely symptom-free. Signs and symptoms usually begin in adolescence; rarely, in the 20s. This disorder primarily affects women; it’s seldom diagnosed in men.
Causes and incidence
Genetic and environmental factors contribute to the development of somatization disorder. It usually develops before age 30 and is more common in females than in males.
Signs and symptoms
Examination of a patient with somatization disorder is characterized by physical complaints presented in a dramatic, vague, or exaggerated way, typically as part of a complicated medical history in which many medical diagnoses have been considered. An important clue to this disorder is a history of multiple medical evaluations by different physicians at different institutions — sometimes simultaneously — without significant findings.
The patient usually appears anxious and depressed. Common physical complaints include:
❑ conversion or pseudoneurologic signs and symptoms (for example, paralysis or blindness)
❑ GI discomfort (abdominal pain, nausea, or vomiting)
❑ female reproductive difficulties (such as painful menstruation) or male reproductive difficulties (such as erectile dysfunction)
❑ psychosexual problems (for example, sexual indifference)
❑ chronic pain (for example, back pain)
❑ cardiopulmonary symptoms (chest pain, dizziness, or palpitations).
The patient typically relates her current complaints and previous evaluations in great detail. She may be quite knowledgeable about tests, procedures, and medical jargon. Attempts to explore areas other than her medical history may cause noticeable anxiety. She tends to disparage previous health care professionals and previous treatments, typically with the comment, “Everyone thinks I’m imagining these things.” In some cases, this may actually be true. (See Factitious disorders, page 472.)
Ongoing assessment should focus on new signs or symptoms or any change in old ones to avoid missing a developing physical disorder.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing somatization disorder, page 473.
Diagnostic tests rule out physical disorders that cause vague and confusing symptoms, such as hyperparathyroidism, porphyria, multiple sclerosis, chronic fatigue syndrome, and systemic lupus erythematosus. In addition, multiple physical signs and symptoms that appear for the first time late in life are usually due to physical disease rather than somatization disorder.
Treatment
The goal of treatment is to help the patient learn to live with her signs and symptoms. After diagnostic evaluation has ruled out organic causes, the patient should be told that she has no serious illness currently but will receive care for her genuine distress and ongoing medical attention for her symptoms.
The most important aspect of treatment is a continuing supportive relationship with a health care provider who acknowledges the patient’s signs and symptoms and is willing to help her live with them. The patient should have regularly scheduled appointments to review her complaints and the effectiveness of her coping strategies. The patient with somatization disorder seldom acknowledges any psychological aspect of her illness and rejects psychiatric treatment.
Special considerations
❑ Acknowledge the patient’s symptoms and her efforts to cope despite distress. Don’t characterize her symptoms as imaginary. Tell her test results and their significance.
❑ Emphasize her strengths, for example, “It’s good that you can still work with this pain.” Gently point out the time relationship between stress and symptoms.
❑ Help her manage stress. Typically, her relationships are linked to her symptoms; relieving them can impair her interactions with others.
❑ Negotiate a plan of care with input from the patient and, if possible, her family. Help them to understand the patient’s need for troublesome symptoms.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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