Somatization

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Somatization

• Jameel Adnan, MD.
• Community Primary Health CareKAAU-RABEG BRANCH

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Round Map

• Introduction
• Somatoform disorders categories
• Epidemiology
• Clinical presentation
• Screening
• Treatment

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Introduction
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Introduction

• Somatization refers to the tendency to experience
  psychological distress in the form of somatic
  symptoms and to seek medical help for these
  symptoms

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Introduction

• Emotional responses such as anxiety and
  depression can initiate symptoms.
• Somatization can be conscious or unconscious and
  may be influenced by psychological distress or a
  desire for personal gain

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Introduction

• One study identified somatization,
• Patients with somatization generated twice
  the costs for medical care and utilized medical
  services (outpatient and inpatient) twice as
  often as non-somatizing patients.

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Introduction

• Somatization disorder, which was called hysteria
  or Briquet's syndrome in the past, is one of the
  somatoform disorders. It is diagnosed when the
  patient has requested help for numerous medically
  unexplained symptoms in various different organ
  systems.
• Less than 1 of patients who present with
  unexplained somatic symptoms meet the criteria
  for somatization disorder

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Somatoform disorder categories
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Somatoform disorder categories

• The DSM-IV divides the somatoform disorders into
  a spectrum of disorders that include the
  following categories
• Somatization disorder
• Undifferentiated somatoform disorder
• Conversion disorder 
• Somatoform pain disorder
• Hypochondriasis
• Factitious disorder 
• Malingering

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Somatoform disorder categories

• Somatization disorder
• Refers to patients with a history of many
  physical complaints beginning before age 30 years
  that occur over a period of several years and
  result in treatment being sought or significant
  impairment in social, occupational, or other
  important areas of functioning.
• All of the following are present at any time
  during the course of illness four pain symptoms
  two gastrointestinal tract symptoms one sexual
  symptom and one pseudoneurologic symptom.

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Somatoform disorder categories

• Undifferentiated somatoform disorder 
•  Refers to one or more physical symptoms that
  cause significant distress or impairment in
  functioning lasting at least six months.

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Somatoform disorder categories

• Conversion disorder 
•  Refers to symptoms or deficits of voluntary or
  sensory function suggesting a neurologic or
  general medical condition and associated with
  psychological factors.
• Typically there is a sudden onset of a dramatic
  but physiologically impossible condition like
  paralysis, aphonia, blindness, deafness, or
  pseudoseizures. The presentation fits the
  patient's view of the disorder rather than
  physiology.
• Unlike somatization disorder, patients with
  conversion disorder focus upon only one symptom.

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Somatoform disorder categories

• Somatoform pain disorder 
• Refers to pain in one or more sites of
  significant focus or severity, causing
  significant distress or impairment and associated
  with psychological factors.

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Somatoform disorder categories

• Hypochondriasis 
• Refers to preoccupation with the fear of having a
  serious disease based on a misattribution of
  bodily symptoms or normal functions
• often seen in generalized anxiety disorder,
  obsessive compulsive disorder, panic disorder,
  major depressive disorder, and separation
  anxiety.

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Somatoform disorder categories

• Body dysmorphic disorder 
•  Refers to preoccupation with an imagined or
  exaggerated defect in physical appearance.

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Somatoform disorder categories

• Factitious disorder 
• Tends to occur in patients who have some medical
  knowledge.
• Wound healing difficulty, infection, bleeding,
  hypoglycemia, and gastrointestinal ailments are
  common presentations.
• Munchausen syndrome,
• occurs in a subgroup of patients who feign
  disease, move from hospital to hospital, and
  submit to repeated procedures for illness they
  have voluntarily manufactured

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Somatoform disorder categories

• Malingering 
• Malingering (ie, purposely faking symptoms)
  occurs in the setting of substance abuse,
  antisocial personality disorder, and legal
  battles over disability, criminal prosecution, or
  financial compensation. Patients will not
  cooperate with diagnostic evaluation a
  discrepancy between findings and symptoms is
  evident.

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Epidemiology
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Epidemiology

• True somatization disorder as defined by DSM-IV
  is relatively uncommon (0.3 one year prevalence
  in the population)
• The process of somatization is very common in the
  general population. Over one-half of people
  presenting to clinicians in an outpatient setting
  have no organic disease ,and less than one-third
  of new complaints have an organic disease basis

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Clinical Presentation
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Clinical Presentation

• almost any symptom that occurs in patients with
  organic pathology
• Pain
• Gastrointestinal symptoms
• Cardiopulmonary symptoms
• Pseudoneurologic symptoms
• Reproductive organ symptoms

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• Even Syndromes
• Atypical chest pain,
• Fibromyalgia,
• Chronic fatigue syndrome,
• Premenstrual syndrome,
• Temporomandibular joint syndrome.

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Screening
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Screening tests

• Amnesia, Burning in sex organs, Dysmenorrhea,
  Lump in throat, Painful extremities, Shortness of
  breath, and Vomiting.
• In one study, the presence of three of these
  seven symptoms was highly accurate for diagnosing
  somatization disorder

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Treatment
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General Principles of treatment

• There is no specific therapy for somatization.
• Communication among physicians is key.

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General Principles of treatment

• Basic principles of care include
• Taking a thorough history
• Performing a physical examination
• Arranging good communication
• Treating associated depression and anxiety
• Encouraging and facilitating psychotherapy (CBT)

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• Naming the illness  
• Patients often feel better if they can have a
  name to describe his multiple symptoms
• Avoid the debate of whether this is an organic or
  psychiatric illness.
• more reasonable to explain that there is no
  evidence of a life-threatening illness results in
  the set of symptoms

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Psychotropic medication 

• Major depressive disorder and anxiety disorder
  are commonly comorbid in patients with
  somatization.
• Thus, treatment with antidepressant
  medications should be considered. Somatization
  symptoms frequently resolve when clinical
  depression and anxiety disorder are treated
  appropriately

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Psychosocial intervention 

•  In a review of randomized trials, cognitive
  behavioral treatments were the most effective
  intervention

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