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Somatization DisorderWhat Is It?A person with somatization disorder is chronically preoccupied with numerous "somatic" (physical) symptoms over many years. These symptoms, however, cannot be explained fully by a non-psychiatric diagnosis. Nonetheless, the symptoms cause significant distress or impair the person's ability to function. The person is not "faking." Somatization disorder is a medical problem. The disorder, however, is probably related to brain functioning or emotional regulation rather than the area of the body that has become the focus of the patient's attention. The symptoms are real and are not under the person's conscious control. People with somatization disorder report multiple medical problems over many years, involving several different areas of the body. For example, the same person might have back pain, headaches, chest discomfort, and stomach or urinary distress. Women often report irregular periods. Men may report erectile dysfunction (impotence). The person may:
Many people with a non-psychiatric illness describe their symptoms in dramatic terms. Thus, if a person is dramatic, it does not necessarily mean he or she has somatization disorder. People with somatization disorder get other diagnosable medical illnesses, too, so doctors must be careful not to dismiss symptoms too easily. A person with somatization disorder also may have symptoms of anxiety and depression. He or she may begin to feel hopeless and attempt suicide, or may have trouble adapting to the stresses of life. The person may abuse alcohol or drugs, including prescription medications. Spouses and other family members may become distressed because the person's symptoms continue for long periods of time and no medical treatment seems to help. Symptoms of somatization disorder vary by culture. Cultural factors also affect the proportions of men and women with the disorder. Female relatives of people with somatization disorder are more likely to develop the disorder. Male relatives are more likely to develop alcoholism and personality disorder. Scientists do not know the cause of the symptoms reported by people with somatization disorder, but researchers have some theories. It is possible, for example, that people with this disorder perceive bodily sensations in an unusual way. Trauma or stress may cause a person's physical sensations to change. SymptomsSymptoms usually occur over many years. The person may be distressed and function poorly at work and at home. Either medical evaluation does not explain the symptoms, or the symptoms exceed what would be expected in any medical illness that is found. Symptoms include:
DiagnosisThere are no laboratory tests to determine whether a person has somatization disorder. The doctor may suspect it when a person has multiple complaints over a period of years, with little evidence of a definable medical illness. The doctor may do tests to check for diseases that can look like somatization disorder, such as multiple sclerosis and systemic lupus erythematosus (lupus), or syndromes such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome. If a doctor believes a person has somatization disorder, he or she should screen the person for depression and anxiety and refer the person to a mental health professional for further evaluation. Expected DurationSomatization disorder is a chronic (long-lasting) problem. The disorder usually starts before the age of 25 or 30, although it can begin in adolescence. It can last for many years. PreventionAlthough there is no way to prevent this disorder, a correct diagnosis of somatization can help the person avoid excessive medical testing. This is a challenge both for the person with the disorder and the doctor, because new symptoms could be caused by a medical problem other than somatization disorder. TreatmentSometimes, an antidepressant medication or other psychiatric medication can provide relief from the physical symptoms that stem from somatization disorder. But in most cases, treatment is aimed at coping with secondary problems, such as problems with work and social functioning and any accompanying anxiety or depression. Psychotherapy can help the person cope with chronic physical discomfort and understand how to manage it better. People with somatization disorder may find it difficult to accept a referral to a mental health professional or to accept that medical evaluation and treatment cannot relieve the symptoms. They are particularly sensitive to the stigma associated with mental disorders. In addition, they sometimes are dismissed by a subset of physicians who do not see their symptoms as a legitimate cause for concern. Ideally, if a primary care physician and mental health professional work together, the person's physical symptoms can be evaluated while he or she also gets help managing the frustration of not having a clear diagnosis or treatment plan. Help may be possible by treating any anxiety and depression, helping to manage conflict at home, and finding ways to help the person to function better. When To Call A ProfessionalThe earlier a person with somatization disorder can be evaluated by a mental health professional, the easier it will be to help the person deal with the consequences of the disorder, such as exposure to unnecessary tests and treatment, difficulty with relationships and poor productivity at work. However, a person with this disorder may avoid treatment by a mental health professional. PrognosisMedications may provide some relief. Psychotherapy tends to proceed slowly, because the person probably has been living with the disorder for many years before starting treatment. It is difficult to give up long-standing patterns of behavior, but with persistence and support, progress is possible. Additional InfoAmerican Psychiatric Association 1000 Wilson Blvd. Suite 1825 Arlington, VA 22209-3901 Phone: 703-907-7300 Toll-Free: 1-888-357-7924 E-mail: apa@psych.org Web site: http://www.psych.org/ Public information site: http://www.healthyminds.org/ American Psychological Association 750 First St., NE Washington, DC 20002-4242 Phone: 202-336-5510 Toll-Free: 1-800-374-2721 TTY: 202-336-6123 http://www.apa.org/ National Mental Health Association 2001 N. Beauregard St., 12th Floor Alexandria, VA 22311 Phone: 703-684-7722 Toll-Free: 1-800-969-6642 TTY: 1-800-433-5959 Fax: 703-684-5968 http://www.nmha.org/ National Institute of Mental Health Office of Communications 6001 Executive Blvd. Room 8184, MSC 9663 Bethesda, MD 20892-9663 Phone: 301-443-4513 Toll-Free: 1-866-615-6464 TTY: 301-443-8431 Fax: 301-443-4279 E-mail: nimhinfo@nih.gov http://www.nimh.nih.gov/ |
