What is somatization disorder?
This is a condition when a patient’s complaints or symptoms are explainable by a psychological disease instead of an established physical disease or abnormality. Medical diagnosis is a science of pattern recognition. Diseases and conditions present with a pattern due to their effect on a particular part of our body or mind. Some patients present with symptoms and signs that to them suggest a physical disease, but when analyzed in logical terms do not fit in the diagnostic criterion of a physical disease. Instead, the pattern matches the criterion of a psychological condition.
Do patients with somatization disorder complain of symptoms that are just “in their mind”?
That is not how this condition is understood. Someone might say the same about depression but there are known electrochemical or biological explanation for depression. Somatization disorder probably has similar electrochemical or biological basis. Patients with this disorder may also have heightened awareness or sensitivity to an otherwise not significant issue.
How common is somatization disorder?
It is quite common in a primary care setting. It is about as common as migraine, affecting more than 15% of patients. For some reason, it is much more common in female gender. All age groups, including children are affected.
Is there a genetic basis for somatization disorder?
Probably yes and there is some evidence to corroborate this theory, but so far, no genetic basis has been defined. There is significant influence of environmental and social factors.
Who is at risk of having somatization disorder?
Following conditions increase risk of somatization disorder:
- Depression
- Anxiety
- Post-traumatic stress disorder
- Psychosocial stresses
- Medicolegal situations
- Personality disorders
- Frontal lobe atrophy
- Drug abuse
- Obsessive compulsive disorder
- Fibromyalgia
- Irritable bowel syndrome
Is somatization disorder same as malingering?
No. Patients with somatization disorder have physical symptoms such as pain or weakness, while a patient with malingering is faking a pain or weakness.
How is somatization disorder distinguished from malingering?
It is done by recognizing a particular pattern. For example, a patient with malingering may come to the office for back pain and difficulty walking, using a cane or a walker, and seemed to be in distress. If, for some reason he was not seen, let’s say due to lack of proper health insurance documentation, he may walk out hurriedly with no sign of distress or problem with walking. This is malingering, not a somatization disorder. At the end, it requires years of clinical experience and clinical acumen to make a diagnosis.
What is the biological basis of somatization disorder?
Its exact basis has not been determined. There is some data suggesting that patients with somatization disorder have shrinking in certain areas of brain.
How is somatization disorder diagnosed?
What is required is a careful evaluation of complaints or symptoms, a physical examination, and a logical analysis of patient’s situation. Many patients end up seeing a neurologist. There is no test for its diagnosis. It is not appropriate to “rule everything out,” which some physicians try to do, or some patients may demand. This type of approach can be counterproductive, both for the patient’s wellbeing and the associated caretakers.
How is somatization disorder treated?
Once the diagnosis is established, the first step is to inform and educate the patient about this condition, a kind of intervention, best done confidently but compassionately. Many times, a patient might already have consulted multiple specialists and gone through variety of tests, in which case it might be an easier understanding. In some other situations, it could be an uphill task for the patient and the family to accept this diagnosis.
There is no specific medicine or a drug. It is treated by helping patients cope with their symptoms without putting them to additional risks, such as addictive medicines, or risky or costly testing. Non-pharmacological means of treatment should be maximized. Counseling or therapy can be helpful. Some patients may benefit from a medicine for associated anxiety, or depression.
How long somatization disorder may last?
It can be a chronic condition lasting for years or it can be permanent.
What are the complications of somatization disorder?
It may lead to frustration, anxiety, and depression. It may also lead to problems with social and work life, including disability.
Who should I see if I am diagnosed with somatization disorder?
Many patients can be managed by their primary care physicians. A behavioral therapist can be particularly helpful. Some patients may need consultation with a psychiatrist. A neurologist may help with the diagnosis but usually they do not treat this condition.
Where may I get more information about somatization disorder?
American Psychiatric Association
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