Somatization Disorder: When The Body Speaks

People with somatization disorder often have multiple somatic (physical) symptoms that cause discomfort or can cause significant problems in daily life. However, sometimes they may have only one serious symptom and not several of them. In these cases, the most characteristic symptom is pain.

Symptoms can be specific (eg, localized pain) or relatively nonspecific (eg, fatigue). Symptoms sometimes denote normal physical sensations or discomfort which usually does not indicate serious illness.

The suffering of the person with a somatization disorder is real

The person with somatization disorder is actually in pain. His discomfort is genuine, whether or not it can be explained medically. Thus, the symptoms may or may not be associated with another medical disorder. Indeed, these people often present health problems with somatization disorder. For example, a person may be severely disabled by symptoms of a somatization disorder following an uncomplicated myocardial infarction. This is also true even when the myocardial infarction itself did not generate any disability.

If there is another disease or a high risk of having it, the thoughts, feelings and behaviors associated with that disease would be excessive in these people. On the other hand, people with somatization disorders tend to have very high levels of concern about the disease. Therefore, they unduly assess their physical symptoms and consider them threatening, harmful or bothersome. They often think of the worst when it comes to their health.

Health problems play a central role in the life of the individual

L es health problems can play a central role in the life of the person with somatization disorder. These problems can end up becoming a feature of their identity and thus end up dominating interpersonal relationships.

People with somatization disorders often experience discomfort that primarily focuses on somatic symptoms and their meaning. When we ask them directly about their discomfort, some people also describe it in relation to other aspects of their life. Others deny any source of distress other than somatic symptoms.

The quality of life of these people is declining

The quality of life in relation to health is often affected both physically and mentally. In somatization disorders, the deterioration is characteristic and, when it persists, can produce disability. In these cases, the patient often resorts to consultation and even consults with different specialists. However, this rarely alleviates their concerns.

These people often seem unresponsive to medical interventions, and new interventions can worsen the presentation of symptoms, entering a vicious cycle. Some of these people seem to be exceptionally sensitive to the side effects of drugs. In addition, some feel that their medical evaluation and treatment have not been sufficient.

What are the characteristics of people with somatization disorders?

The traits that characterize people with somatization disorder are:

Cognitive or thought characteristics

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

On the other hand, they also include concerns about the disease and the fear that any physical activity could harm the body.

Behavioral characteristics

Associated behavioral characteristics may be repeated physical checking for abnormalities, repeated seeking medical and safety care, and avoidance of physical activity. These behavioral characteristics are more pronounced in severe and persistent somatization disorders, as we may assume.

These characteristics are usually associated with frequent consultations for medical advice for different somatic or physical symptoms. This can lead to medical consultations in which individuals are so focused on their concerns about somatic symptoms that the conversation cannot be redirected to other topics.

Frequent visits to the doctor

Any attempt by the physician to reassure and explain that symptoms are not indicative of serious physical illness is usually fleeting. People experience it as if the doctor does not take his symptoms seriously.

Since an emphasis on physical symptoms is a major hallmark of the disease, people with somatization disorders often turn to general health services rather than mental health services.

The suggestion made to people with somatization disorder for referral to a mental health specialist may be experienced with surprise or even in the form of outright rejection.

To the extent that somatization disorder is associated with depressive disorders, there is an increased risk of suicide. We do not know whether somatization disorder is associated with suicide risk independent of its association with depressive disorders.

What is the prevalence of somatization disorder?

The prevalence of somatization disorder is unknown although we estimate it may be between 5 and 7% in the general adult population. We further believe that it is lower than that of undifferentiated somatoform disorder. In addition, women tend to report more somatic symptoms than men, and the prevalence of somatization disorders is, therefore, higher in women than in men.

Criteria that must be present for the diagnosis of somatization disorder

The criteria that mental health specialists should consider when making a diagnosis of somatization disorder are:

A. One or more somatic symptoms that generate discomfort or cause significant problems in daily life.

B. Excessive thoughts, feelings or behaviors related to somatic symptoms or associated with a health problem, evidenced by one or more of the following characteristics:

Disproportionate and persistent thoughts about the severity of the symptoms themselves.
Constantly high level of anxiety about health or symptoms.
Excessive time and energy spent on these symptoms or health concern.

C. Although some somatic symptoms are not always present, the symptomatic condition is persistent (usually more than six months).

How does somatization disorder develop and what is its course?

Somatic symptoms and concomitant medical conditions are common in the elderly, making it crucial to focus on criterion B in order to make the diagnosis.

Somatization disorder may be underdiagnosed in older adults, either because certain somatic symptoms (eg, pain, fatigue) are considered part of normal aging, or because the concern is considered “understandable” in older adults. older people, who tend to have more illnesses and need more medication than younger people. Depression is also common in older people with many somatic symptoms.

Somatization disorder in children

In children, the most common symptoms are recurrent abdominal pain, headache, fatigue and nausea. Unlike adults, it is more common for a single symptom to predominate in children. Although young children may present with somatic complaints, they rarely worry about the “disease” itself until they reach adolescence.

Parents’ response to symptoms is important because it can determine the level of distress associated with it. Parents can be decisive in interpreting symptoms, in how long they miss school, and in seeking medical help.

As we have seen, somatization disorder is associated with a significant deterioration in health status and other disorders such as depression or anxiety. This is why seeking psychological help is essential to improve the quality of life of these patients.

Bibliographical references

American Psychiatry Association (2014). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th Ed. Madrid: Editorial Medica Panamericana.