From the Guidelines
Somatization disorder, now known as somatic symptom disorder, is a mental health condition where a person experiences physical symptoms that cause significant distress but cannot be fully explained by a medical condition. This condition is characterized by excessive thoughts, feelings, or behaviors related to physical symptoms, resulting in significant impairment in psychosocial functioning, such as relationships with family or friends, academic or occupational difficulties 1. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition recognizes 7 distinct somatic symptom and related disorders, including somatic symptom disorder, illness anxiety disorder, conversion disorder, psychological factors affecting other medical conditions, factitious disorder, other specified somatic symptom and related disorder, and unspecified somatic symptom and related disorder 1.
Key Characteristics of Somatic Symptom Disorder
- The complaints or fixations are not associated with material gain, nor are they intentionally produced 1
- Symptoms that are intentionally created are classified as factitious disorders; those that result in material gain are categorized as malingering 1
- The symptoms result in significant impairment in psychosocial functioning 1
- Common symptoms include pain, gastrointestinal issues, neurological problems, and sexual dysfunction
Epidemiology and Impact
- Somatic symptom and related disorders are common and a significant contributor to health care usage and costs 1
- In adult primary care populations, between 10% and 15% of patients have a diagnosis of one of these disorders 1
- Among children and adolescents, recurrent abdominal pain and headaches account for 5% and between 20% and 55% of pediatric office visits, respectively; 10% of adolescents report frequent symptoms 1
Treatment and Management
- Treatment usually involves a combination of cognitive-behavioral therapy to address unhelpful thought patterns, antidepressants like SSRIs to manage associated anxiety and depression, and regular appointments with a consistent primary care provider to avoid doctor-shopping and unnecessary medical tests 1
- Physical therapy and stress management techniques may also help
- A compassionate, understanding approach is essential for effective treatment, as patients genuinely experience these symptoms and aren't faking them 1
From the Research
Definition and Characteristics of Somatization Disorder
- Somatization disorder is a psychiatric disorder characterized by the somatic expression of psychological distress, resulting in chronic, medically unexplained physical symptoms (MUPS) 2, 3.
- Patients with somatization disorder often experience substantial distress and impairment, and may exhibit abnormal illness behavior, such as excessive utilization of healthcare services 3.
- The disorder is associated with significant healthcare costs and can be challenging to manage, as patients may be reluctant to see psychiatrists and may be managed by non-psychiatric physicians with limited understanding of the condition 2.
Diagnosis and Treatment of Somatization Disorder
- Diagnosis of somatization disorder requires alertness to characteristic features and skillful interview techniques, as well as the use of screening instruments to determine the presence of the disorder 3, 4.
- Treatment of somatization disorder may involve cognitive-behavioral therapy (CBT), antidepressants, and supportive psychotherapy, with CBT being the most efficacious treatment 2, 4.
- Pharmacological interventions, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, may also be effective in alleviating symptoms, although the evidence is limited and of low to very low quality 5.
- Combination treatment with SSRI and CBT has been shown to be effective in youth with depression and anxiety, and may be beneficial for patients with somatization disorder as well 6.
Management and Prognosis of Somatization Disorder
- Management of somatization disorder requires a comprehensive approach, including regular appointments, establishment of a strong therapeutic alliance, and limitation of diagnostic testing or referrals to subspecialists 4.
- Prognosis of somatization disorder is variable, and may depend on the effectiveness of treatment and the patient's response to therapy 2, 5.
- Further research is needed to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods 5.