Somatization disorder
| Somatization disorder | |
|---|---|
| Other names | parental neglect, abuse |
| Differential diagnosis | Conversion disorder, physical illness |
| Treatment | Cognitive behavioral therapy, electroconvulsive therapy |
Somatization disorder was a
Criteria
DSM-5
In the DSM-5 the disorder has been renamed somatic symptom disorder (SSD), and includes SSD with predominantly somatic complaints (previously referred to as somatization disorder), and SSD with pain features (previously known as pain disorder).[5]
DSM-IV-TR
The
- A history of somatic complaints over several years, starting prior to the age of 30.
- Such symptoms cannot be fully explained by a general medical condition or substance use or, when there is an associated medical condition, the impairments due to the somatic symptoms are more severe than generally expected.
- Complaints are not feigned as in malingering or factitious disorder.
The symptoms do not all have to occur at the same time, but may occur over the course of the disorder. A somatization disorder itself is chronic but fluctuating that rarely remits completely. A thorough physical examination of the specified areas of complaint is critical for somatization disorder diagnosis. Medical examination would provide objective evidence of subjective complaints of the individual.[6]
Diagnosis of somatization disorder is difficult because it is hard to determine to what degree psychological factors are exacerbating subjective feelings of pain. For instance, chronic pain is common in 30% of the U.S. population,[7] making it difficult to determine whether or not the pain is due to predominantly psychological factors.
ICD-10
In
"The main features are multiple, recurrent and frequently changing physical symptoms of at least two years duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour."
ICD-10 also includes the following subgroups of somatization syndrome:[4]
- Undifferentiated somatoform disorder.
- Hypochondriasis.
- Somatoform autonomic dysfunction.
- Persistent somatoform pain disorder.
- Other somatoform disorders, such ones predominated by pruritus and torticollis.
- Somatoform disorder, unspecified.
Cause
Although somatization disorder has been studied and diagnosed for more than a century, there is debate and uncertainty regarding its pathophysiology. Most current explanations focus on the concept of a misconnection between the mind and the body. Genetics probably contributes a very small amount to development of the disorder.[8]
One of the oldest explanations for somatization disorder advances the theory that it is a result of the body's attempt to cope with emotional and psychological stress. The theory states that the body has a finite capacity to cope with psychological, emotional, and social distress, and that beyond a certain point symptoms are experienced as physical, principally affecting the digestive, nervous, and reproductive systems. There are many different feedback systems where the mind affects the body; for instance, headaches are known to be associated with psychological factors,
Another hypothesis for the cause of somatization disorder is that people with the disorder have heightened sensitivity to internal physical sensations and pain.[11] A biological sensitivity to somatic feelings could predispose a person to developing SSD. It is also possible that a person's body might develop increased sensitivity of nerves associated with pain and those responsible for pain perception, as a result of chronic exposure to stressors.[12]
Cognitive theories explain somatization disorder as arising from negative, distorted, and catastrophic thoughts and reinforcement of these cognitions. Catastrophic thinking could lead a person to believe that slight ailments, such as mild muscle pain or shortness of breath, are evidence of a serious illness such as cancer or a tumor. These thoughts can then be reinforced by supportive social connections. A spouse who responds more to his or her partner's pain cues makes it more likely that he or she will express greater pain.[13] Children of parents who are preoccupied or overly attentive to the somatic complaints of their children are more likely to develop somatic symptoms.[14] Severe cognitive distortions can make a person with SSD limit the behaviors he or she engages in, and cause increased disability and impaired functioning.[15]
Neuroimaging evidence
Some literature reviews of cognitive–affective neuroscience on somatization disorder suggested that
Treatments
To date,
Epidemiology
Somatization disorder is estimated to occur in 0.2% to 2% of females,[25][26] and 0.2% of males.
There are cultural differences in the prevalence of somatization disorder. For example, somatization disorder and symptoms were found to be significantly more common in Puerto Rico.[27] In addition the diagnosis is also more prevalent among African Americans and those with less than a high school education or lower socioeconomic status.[28]
There is usually co-morbidity with other psychological disorders, particularly
About 10-20 percent of female first degree relatives also have somatization disorder and male relatives have increased rates of alcoholism and sociopathy.[31]
See also
- Body-centred countertransference
- Culture-bound syndrome
- Hypochondriasis
- Medically unexplained symptoms
- Psychosomatic illness
- Munchausen syndrome
References
- ^ "Somatic Symptom Disorder: What It Is, Symptoms & Treatment". Cleveland Clinic. Retrieved March 2, 2024.
- ^ Drs; Sartorius, Norman; Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin, Xu; Strömgren, E.; Glatzel, J.; Kühne, G.-E.; Misès, R.; Soldatos, C.R.; Pull, C.B.; Giel, R.; Jegede, R.; Malt, U.; Nadzharov, R.A.; Smulevitch, A.B.; Hagberg, B.; Perris, C.; Scharfetter, C.; Clare, A.; Cooper, J.E.; Corbett, J.A.; Griffith Edwards, J.; Gelder, M.; Goldberg, D.; Gossop, M.; Graham, P.; Kendell, R.E.; Marks, I.; Russell, G.; Rutter, M.; Shepherd, M.; West, D.J.; Wing, J.; Wing, L.; Neki, J.S.; Benson, F.; Cantwell, D.; Guze, S.; Helzer, J.; Holzman, P.; Kleinman, A.; Kupfer, D.J.; Mezzich, J.; Spitzer, R.; Lokar, J. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). www.who.int World Health Organization. Microsoft Word. bluebook.doc. p. 116. Retrieved 23 June 2021 – via Microsoft Bing.
- ^ "Highlights of Changes from DSM-IV-TR to DSM-5" (PDF). American Psychiatric Association. May 17, 2013. Retrieved September 6, 2013.
- ^ a b c "ICD-10 Version:2015". Retrieved 2015-05-23.
- ISBN 978-0890425558.
- ^ ISBN 978-0-89042-025-6.
- PMID 17209691.
- PMID 18578896.
- PMID 19556046.
- PMID 8379555.
- PMID 22149912.
- .
- S2CID 25760377.
- S2CID 144392281.
- ^ "Somatization disorder". Encyclopedia of Mental Disorders. Retrieved October 10, 2008.
- S2CID 9660237.
- S2CID 34380841.
- PMID 16864762.
- PMID 15560311.
- ^ S2CID 28344833.
- PMID 3084975.
- PMID 12934972.
- PMID 3042587.
- ^ Kenny M, Egan J (February 2011). "Somatization disorder: What clinicians need to know" (PDF). The Irish Psychologist. 37 (4): 93–96. Retrieved 9 December 2011.
- PMID 3598478.
- S2CID 220552356.
- ^ Canino G, Bird H, Rubio-Stipec M, Bravo M (2000). "The epidemiology of mental disorders in the adult population of Puerto Rico". Revista Interamericana de Psicologia. 34 (1X): 29–46.
- S2CID 38387817.
- S2CID 25319341.
- S2CID 143736408.
- ISBN 9780323047432.