Somatization Disorder

Somatization disorder, also known as Briquet's syndrome, is a chronic psychiatric condition in which patients experience physical symptoms that have no apparent physiological cause. It is one of several somatoform disorders. Formerly, patients with this condition were dismissed, believed to be imagining their pain or malingering. In recent decades, however, research has shown that pain, whether of physiological or psychogenic origin, is still experienced as pain. Patients are not faking, but suffering real symptoms, whatever their cause.

Somatization disorder, while its precise causes are unknown, is more common in women than in men. There appears to be a correlation between patients who have irritable bowel syndrome (IBS) or have suffered chronic pain and somatization disorder.

Causes of Somatization Disorder

While no precise cause for this disorder has been identified, individuals with heightened sensitivities to stimuli have been found to be at greater risk, as have patients who tend to have catastrophic thinking. An example of the latter would be a person who worries that a bad headache indicates the presence of a brain tumor. It has also been postulated that patients who develop somatization disorder may have psychiatric issues but, because of a fear of stigmatization, manage to unconsciously sublimate them, exhibiting physical symptoms instead.

Symptoms of Somatization Disorder

Most frequently, patients with somatization disorder have digestive, neurological or reproductive issues that begin before the age of 30 and are ongoing for several years. Symptoms of the condition involve several different areas of the body and are troubling enough to interfere with normal functioning. The symptoms of patients with somatization disorder are made worse by stress.

Typically, such patients have consulted a number of professionals about their physical problems but none has been able to pinpoint an underlying medical reason for their pain or disturbance. The more research is done, however, the greater the connection between body and mind is found to be. It has been scientifically determined that physical symptoms and pain perception are significantly affected by emotional well-being.

Symptoms of somatization disorder cover a very wide range and include:

Abdominal pain, bloating, diarrhea
Nausea or vomiting
Headache, dizziness, balance problems
Shortness of breath or chest pain
Back or joint pain
Pain in arms or legs
Palpitations
Muscle weakness or paralysis
Difficulty swallowing
Impotence, sexual disinterest
Menstrual difficulties, pain during intercourse
Visual difficulties
Amnesia, hallucinations, fainting

Diagnosis of Somatization Disorder

In order to diagnose somatization disorder, an identifiable medical cause for the pain or discomfort must be ruled out through thorough physical examination and diagnostic tests, or the presenting symptoms must be considered excessive in view of the condition identified. Prescribed medications and recreational drugs must also be eliminated as causative factors in the illness. Once the physician is convinced beyond a reasonable doubt that the patient's physical problem is psychogenic, a psychologist or psychiatrist will administer a full psychological evaluation. This process will include establishing that the patient's symptoms are not intentionally produced.

According to the Diagnostic and Statistical Manual of Mental Disorder(DSM), certain very specific criteria must be met in order for a patient to be diagnosed with somatization disorder. These criteria include a patient history of:

Physical complaints beginning before 30 years of age
Pain affecting at least four different body sites
Two or more gastrointestinal symptoms, such as bloating or diarrhea
One or more neurological symptoms such as hallucinations or seizures
One or more sexual or reproductive symptoms, such as pain during intercourse

Treatment of Somatization Disorder

Successful treatment of somatization disorder usually involves psychotherapy and medication. It is very important that patients have good relationships with their physicians or therapists and feel understood and taken seriously. For patients with this disorder, having one doctor monitor the condition is best, so that an overview can be taken and unnecessary tests can be avoided.

Cognitive behavioral therapy has been found to be particularly effective, since it helps patients be mindful of what worsens or alleviates symptoms. Physical activity, in spite of the presence of pain, can also prove helpful. In many cases, because of the strong body-mind connection, medications like antidepressants can help by lessening the perception of pain and relieving anxiety around the symptoms.

Complications of Somatization Disorder

There can be serious consequences if effective treatment is not administered. Patients can become dependent on pain relievers or sedatives, become substance abusers in an attempt to self-medicate, or become severely depressed or even suicidal as a result of their symptoms.

Desmond Kaplan MD FAPA

Child, Adolescent & Adult Psychiatry

Patient Education