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Somatization is the expression of mental phenomena as physical (somatic) symptoms. Typically, the symptoms cannot be explained by a physical disorder. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously and nonvolitionally to those in which symptoms develop consciously and volitionally. This continuum includes somatoform disorders, factitious disorders, and malingering. Somatization typically leads to seeking medical evaluation and treatment.
Somatoform
disorders are characterized by physical symptoms or by perceived defects in appearance. Development of the symptoms or perceived defects is unconscious and nonvolitional. Symptoms or perceived defects cannot be explained by an underlying physical disorder. Somatoform disorders are distressing and often interfere with social, occupational, or other functioning. These disorders include body dysmorphic disorder, conversion disorder, hypochondriasis, pain disorder, somatization disorder, undifferentiated somatoform disorder, and somatoform disorder not otherwise specified.
Factitious
disorders involve the conscious and volitional feigning of symptoms in the absence of any external incentive (eg, time off work) and is thus distinguished from malingering. The patient gains gratification from assuming the sick role through the simulation, exaggeration, or aggravation of signs and symptoms. Signs and symptoms may be mental, physical, or both. The most severe form is Munchausen syndrome.
Malingering is recurrent intentional feigning of physical and mental symptoms motivated by an external incentive (eg, feigning illness to avoid work or military duty, evade criminal prosecution, or obtain financial compensation or drugs for abuse). Malingering is suspected when a patient reports severe symptoms, yet little is revealed through unannounced observation, a physical examination, or laboratory testing. Malingering may also be suspected when a patient does not cooperate with efforts to diagnose or treat potential underlying causes of symptoms.
Last full review/revision November 2005
Content last modified November 2005
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