Somatization

Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them.[1][2] More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.[3]

Somatization is a worldwide phenomenon.[4] A somatization spectrum can be identified, up to and including at one extreme somatization disorder.[5]

Somatization can be, but is not always, related to a psychological condition such as:[6]

The American Psychiatric Association (APA) has classified somatoform disorders in the DSM-IV and the World Health Organization (WHO) have classified these in the ICD-10. Both classification systems use similar criteria. Most current practitioners will use one over the other, though in cases of borderline diagnoses, both systems may be referred to. In spite of extensive research over the last 20 years, researchers are still perplexed by somatoform disorders.[7]

Ego defense

In psychodynamic theory, somatization is conceptualized as an ego defense, the unconscious rechannelling of repressed emotions into somatic symptoms as a form of symbolic communication (organ language).[8]

Sigmund Freud's famous case study of Anna O. featured a woman who suffered from numerous physical symptoms, which Freud believed were the result of repressed grief over her father's illness, although treatment did not resolve her symptoms and later research is skeptical of Freud's diagnosis.[9]

Children

While it is normal for stresses and strains in a child's life to be expressed in bodily pains/upsets,[10] there is evidence that children in families where bodily complaints receive special attention are significantly more likely to use somatization as a defence in later life.[11]

Treatment

Treatment for somatic symptom disorders combine different strategies for managing the patient's symptoms, including regularly scheduled outpatient visits, psychosocial interventions (such as joint meetings with family members),[12] psychoeducation, and treatment of prominent comorbid symptoms of anxiety or depression.

Based on multiple systematic reviews,[13][14] the initial suggested treatment for somatic disorder is regular, scheduled outpatient visits (every 4–8 weeks) that are not based on active symptoms. These visits should focus on establishing a therapeutic alliance, legitimizing the somatic symptoms, and limiting diagnostic tests and referral to specialists.

Cultural examples

Author Virginia Woolf's mental and emotional difficulties were often expressed directly in physical symptoms: "Such 'sensations' spread over my spine & head...the horror – physically like a painful wave about the heart".[15]

See also

References
  1. Lipowski ZJ (1988). "Somatization: the concept and its clinical application". Am J Psychiatry. 145 (11): 1358–68. doi:10.1176/ajp.145.11.1358. PMID 3056044.
  2. Adriana Feder, M.D. Somatization
  3. R. L. Woolfolk/L. A. Allen, Treating Somatization (2006) p. 5
  4. P. S. Sutker/H. E. Adams, Comprehensive Handbook of Psychopathology (2001) p. 217
  5. Woolfolk/Allen, pp. 14–5
  6. Smith RC, Gardiner JC, Lyles JS, et al. (2005). "Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms". Psychosomatic Medicine. 67 (1): 123–9. doi:10.1097/01.psy.0000149279.10978.3e. PMC 1894627. PMID 15673634.
  7. Antai-Otong, D, (2008), Psychiatric Nursing Biological and Beahvioural Concepts, 2nd ed, Delmar, New York
  8. P. S. Sutker/H. E. Adams, Comprehensive Handbook of Psychopathology (2001) p. 216
  9. Gupta, Deepti; Perez Edgar (Jan 2012). "The role of temperament in somatic complaints among young female adults". Journal of Health Psychology. 17 (1): 26–35. doi:10.1177/1359105311405351. PMID 21562070.
  10. D. W. Winnicott, The Child, the Family, and the Outside World (1973) p. 129
  11. Woolfolk/Allen, p. 217
  12. Woolfolk, pp. 41–3
  13. Gordon-Elliott, Janna S.; Muskin, Philip R. (November 2010). "An approach to the patient with multiple physical symptoms or chronic disease". The Medical Clinics of North America. 94 (6): 1207–1216, xi. doi:10.1016/j.mcna.2010.08.007. ISSN 1557-9859. PMID 20951278.
  14. Croicu, Carmen; Chwastiak, Lydia; Katon, Wayne (September 2014). "Approach to the patient with multiple somatic symptoms". The Medical Clinics of North America. 98 (5): 1079–1095. doi:10.1016/j.mcna.2014.06.007. ISSN 1557-9859. PMID 25134874.
  15. Quoted in Hermione Lee, Virginia Woolf (1996) p. 187
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