Somatization Disorder - How the Body Talks

Patients with somatization disorder are usually in pain and are often misdiagnosed until a specialist identifies the real problem.
Somatization Disorder - How the Body Talks

Last update: 02 March, 2021

People with somatization disorder often have multiple somatic (bodily) symptoms that cause discomfort and other significant problems in daily life. However, they may sometimes manifest with only one severe symptom. The most characteristic symptom in these cases is pain.

Symptoms may be specific, such as localized pain, or relatively nonspecific, like fatigue. In addition, these sometimes denote normal bodily sensations or discomfort that doesn’t usually imply a serious disease. Be that as it may, this is a rather common type of condition.

Note that psychosomatic disorder receives special attention in the new version of the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). Experts on the subject, such as Dr. Teah Rosic, from the University of Toronto, Canada, point out that this is a psychological reality that requires more research and attention.

Patients with a somatization disorder often go through several failed diagnoses and treatments before finding the origin of their symptomatology.

“The partner of head is heart. Body has no opposite. In body, heart and head are one.”

-Georgi Y. Johnson-

Birds flying off a head shaped tree.

The suffering of the person with a somatization disorder is real

A person experiencing somatization disorder is in great pain. Their discomfort is authentic, whether or not medicine can explain it. Thus, the symptoms may or may not be associated with another medical condition. In fact, these individuals often have medical illnesses, along with somatization disorder.

  • For example, a person may be severely disabled by the symptoms of a somatization disorder after an uncomplicated myocardial infarction. This is true even if the myocardial infarction didn’t result in disability.
  • The thoughts, feelings, and behavior associated with this illness would be excessive in these persons if there was another medical illness or an elevated risk for it.
  • People with somatization disorder tend to worry extremely about the disease.
  • Thus, they unduly evaluate their symptoms and consider them threatening, harmful, or bothersome. In fact, they often think they’re worse than they are.
A woman concerned about a somatization disorder.

Health problems assume a central role in an individual’s life

In somatization disorder, problems may eventually become part of a person’s identity and eventually dominate interpersonal relationships.

People with somatization disorder often experience distress that focuses primarily on somatic symptoms and their meaning.

Some people describe it in relation to other parts of their lives when asked directly about their distress. However, others deny any source of distress in addition to somatic symptoms.

Thus, studies, such as the one conducted by Dr. Roy Abraham Kallivay, MD, point out the importance of making sense of a reality that’s apparently meaningless (for many medical professionals). Somatoform disorders completely undermine the lives of many people.

Quality of life declines in these people

This condition affects health-related quality of life both physically and mentally. Impairment is characteristic of somatization disorder and can lead to disability if it’s persistent. The patients often consult different specialists but it rarely mitigates their worries.

  • These individuals often appear unresponsive to medical interventions, and further interventions may aggravate symptoms, entering a vicious cycle.
  • Some of these individuals seem unusually sensitive to the side effects of medications. In addition, some feel their medical evaluation and treatment aren’t good enough.

Characteristics of people with somatization disorder

These include the following:

Cognitive or thinking characteristics

These include focused attention on somatic symptoms and the attribution of normal bodily sensations to physical illness (possibly with catastrophic interpretations).

In addition, they also include worries about illness and fear that any physical activity may harm the body.

Behavioral characteristics

Relevant associated behavioral traits may include repeated body checking for abnormalities, repetitive seeking of medical attention and reassurance, and avoidance of physical activity. These behavioral characteristics are more pronounced in severe and persistent somatization disorders, as one might expect.

These characteristics are usually associated with frequent medical advice consultations for different somatic or bodily symptoms. This can result in medical consultations in which individuals are so focused on their concerns about somatic symptoms that they can’t redirect the conversation to other issues.

There’s often a high degree of medical care utilization. However, this rarely relieves the individual of their concerns. As a result, they may receive medical care from several physicians for the same symptoms.

A person undergoing blood pressure monitoring.

Frequent visits to the doctor

Any attempt by a given physician to reassure and explain that the symptoms aren’t indicative of a serious physical illness is usually short-lived. Individuals take it as if the physician isn’t taking them seriously.

People with somatization disorder often seek general medical health services rather than mental health services. This is because focusing on bodily symptoms is a major characteristic of the illness.

The suggestion of a referral to a mental health specialist to individuals with somatization disorder may be met with surprise or even outright rejection.

In addition, somatization disorder is associated with depressive disorders. Thus, there’s an increased risk of suicide. It isn’t clear whether somatization disorder is associated with suicide risk independently of its associations with depressive disorders.

The prevalence of somatization disorder

This isn’t really clear, although estimates indicate that it may be between five and seven percent in the general adult population. Also, some believe it might be lower than that of undifferentiated somatoform disorder.

In addition, women tend to report more somatic symptoms than men. Thus, the prevalence of somatization disorder is probably higher in the former than in the latter.

Criteria for the diagnosis of somatization disorder

This is as follows:

  1. One or more somatic symptoms that cause discomfort or result in significant problems in daily life.
  2. Excessive thoughts, feelings, or behaviors related to somatic symptoms or associated with health concerns, as evidenced by one or more of the following characteristics:
    • Disproportionate and persistent thoughts about the severity of one’s symptoms.
    • A persistently high degree of anxiety about health or symptoms.
    • Excessive time and energy devoted to said symptoms or health concerns in general.
  3. The symptomatic state is persistent (usually more than six months), although some somatic symptoms may not be continuously present.

Development and course of somatization disorder

Somatic symptoms and concurrent medical illnesses are common in older people. Thus, a focus on the second criterion above is crucial when diagnosing.

  • Somatization disorder may be underdiagnosed in older adults. This is because certain somatic symptoms such as pain and fatigue are also part of normal aging.
  • It’s also because concern about illness is “understandable” in older people, who generally have more medical illnesses and need more medications than younger people.
  • Depression is also common in older people with numerous somatic symptoms.

Somatization disorder in children

Their most common symptoms are recurrent abdominal pain, headache, fatigue, and nausea. It’s more common for a single symptom to predominate in children than in adults. Young children may have somatic complaints. However, it’s rare for them to be concerned about health conditions before adolescence.

A sick child.

Parental response to symptoms is important, as this may determine the level of associated distress. In addition, parents are instrumental in interpreting symptoms, missing time from school, and seeking medical help.

As you can see, somatization disorder is associated with a significant deterioration in health status and with other disorders such as depression or anxiety. In this regard, seeking psychological help is essential to improve the quality of life of these patients.

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  • American Psychiatry Association (2014). Manual diagnóstico y estadístico de los trastornos mentales (DSM-5), 5ª Ed. Madrid: Editorial Médica Panamericana.
  • Hilty, D. M., Bourgeois, J. A., Chang, C. H., & Servis, M. E. (2001). Somatization Disorder. Current Treatment Options in Neurology3(4), 305–320. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11389802