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Pronunciations hypochondriasis neurologic somatoform

Somatization disorder is a chronic, severe disorder characterized by many recurring physical symptoms that cannot be fully explained by a physical disorder. These symptoms include some combination of pain and digestive, sexual, and neurologic symptoms.

• People typically have many symptoms (such as headache, nausea, diarrhea, constipation, and fatigue) over a period of several years.
• They seek treatment for their physical complaints, and many physical examinations and tests may be done to make sure symptoms do not result from a physical disorder.
• Having a supportive, trustful relationship with a doctor can be very helpful; cognitive-behavioral therapy can also help.

Somatization disorder often runs in families and occurs predominantly in women. Male relatives of women with the disorder tend to have a high incidence of antisocial personality (see Personality Disorders: Antisocial Personality) and substance-related disorders. Many people with somatization disorder also have symptoms of depression and anxiety, a personality disorder, and excessive dependence on others (see Personality Disorders: Dependent Personality).

Did You Know... People with a somatization disorder are not faking their symptoms.

The physical symptoms in somatization disorders may reflect a plea for help and attention and a desire to be cared for. The symptoms may also have other purposes, such as enabling people to avoid the responsibilities of adulthood. However, symptoms are not intentionally produced or feigned. The symptoms tend to be uncomfortable and prevent people from engaging in many enjoyable pursuits.

Symptoms

Symptoms first appear during adolescence or early adulthood (before age 30). People have many physical complaints, which they may describe as “unbearable,” “beyond description,” or “the worst imaginable.”

Any part of the body may be affected. Specific symptoms and their frequency vary among different cultures. Typical symptoms include headaches, nausea and vomiting, abdominal pain, diarrhea or constipation, painful menstrual periods, fatigue, fainting, pain during intercourse, and loss of sexual desire. Men frequently complain of erectile or other sexual dysfunction. Anxiety and depression also occur.

People with somatization disorder demand help and emotional support and may become angry when they feel their needs are not being met. Often dissatisfied with their medical care, they may go from doctor to doctor, seeking medical tests and treatment.

Diagnosis

People with somatization disorder are not aware that their basic problem is psychologic, so they press their doctors for diagnostic tests and treatments. Doctors usually conduct many physical examinations and tests to determine whether a physical disorder adequately explains the symptoms. Referrals to specialists for consultations are common, even for people who have developed a reasonably satisfactory relationship with one doctor.

Once a doctor determines that the problem is psychologic, somatization disorder can be distinguished from similar mental health disorders by its many symptoms and their tendency to persist over a period of years.

Prognosis

Somatization disorder tends to fluctuate in severity but may persist throughout life. Symptoms are rarely completely relieved for any length of time. Some people become more depressed after many years. Suicide is a risk.

Treatment

Treatment is difficult. Psychotherapy, particularly cognitive-behavioral therapy, may help. Drugs may lessen symptoms of coexisting mental disorders such as depression.

Usually, people with this disorder are best helped by a supportive, trustful relationship with a doctor who coordinates their health care, offers symptomatic relief, sees them regularly, and protects them from unnecessary diagnostic or therapeutic procedures. However, the doctor must remain alert to the possibility that these people may develop an actual physical disorder that requires evaluation and treatment.

Last full review/revision June 2008 by Katharine A. Phillips, MD