From the Guidelines
Somatization disorder, now referred to as Somatic Symptom Disorder (SSD), is a mental health condition characterized by physical symptoms that cannot be fully explained by a medical condition, resulting in significant distress and impairment in psychosocial functioning. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD is one of the 7 distinct somatic symptom and related disorders, each with specific diagnostic criteria applicable to both adults and children 1. Patients with SSD experience excessive thoughts, feelings, or behaviors related to their physical symptoms, often focusing intensely on them and believing they indicate serious illness despite medical reassurance.
Key Characteristics of SSD
- Physical symptoms that cause significant distress and cannot be fully explained by a medical condition
- Excessive thoughts, feelings, or behaviors related to these physical symptoms
- Significant impairment in psychosocial functioning, such as relationships with family or friends, academic or occupational difficulties
- Symptoms are not intentionally produced and are not associated with material gain 1
Epidemiology and Impact
- Somatic symptom and related disorders are common, affecting between 10% and 15% of adult primary care populations and contributing significantly to healthcare usage and costs 1
- Among children and adolescents, recurrent abdominal pain and headaches account for a significant proportion of pediatric office visits, with 10% of adolescents reporting frequent symptoms 1
Diagnosis and Management
- Accurate diagnosis and appropriate referrals are crucial, as patients with SSD may undergo extensive medical testing and procedures, which can be avoided with proper management 1
- Treatment typically involves a combination of cognitive behavioral therapy, antidepressants, and regular appointments with a consistent healthcare provider to address unhelpful thought patterns, manage associated anxiety and depression, and avoid unnecessary tests and procedures.
From the Research
Definition and Characteristics of Somatization Disorder
- Somatization disorder (SD) is a syndromatic classification that allows physicians to identify patients with a lifelong history of chronic subjective physical complaints that are unverified by objective examinations 2.
- The somaticizing process is believed to be an expression of emotional distress, and common complaints of SD patients include recurrent pain, conversion symptoms, nervousness or depression, sexual and marital discord, and menstrual difficulties 2.
- Somatizing patients are characterized by abnormal illness behavior and psychological distress, such as failure to respond to treatment, excessive utilization of care, depressive symptoms, and psychosocial stressors 3.
Symptoms and Diagnosis
- Somatizers are characterized by multiple symptoms from many organ systems, and their physical complaints simulate most types of somatic disorder 4.
- The use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder has been questioned, as somatizers often present with different illness pictures at different admissions 4.
- Recognition of somatization requires alertness to characteristic features and skillful interview technique, and successful management begins by legitimizing symptoms 3.
Treatment and Management
- Restraint should be used in performing workups and assigning diagnoses to somatizing patients, and treatment goals should be clarified and regular visits scheduled 3.
- Depression and anxiety should be treated when present, and pharmacologic and psychological treatments for somatizing patients have been described, although none has proven efficacy 3.
- Selective serotonin-reuptake inhibitors (SSRIs) have been used to treat various disorders, including major depression, dysthymia, panic disorder, and obsessive-compulsive disorder, but their role in the treatment of somatization disorder is not well established 5, 6.