Somatization Disorder
Somatization disorder is a chronic, severe disorder characterized by many recurring physical symptoms, particularly some combination of pain and digestive, sexual, and neurologic symptoms, that cannot be explained by a physical disorder.
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 socially disapproved behavior (antisocial personality (see Section 7, Chapter 105)) and substance-related disorders. People with somatization disorder tend to also have personality disorders and exaggerated dependence on others (dependent personality (see Section 7, Chapter 105)).
The physical symptoms that people with somatization disorder experience appear to be a way of communicating a plea for help and attention. The intensity and persistence of the symptoms reflect the person's intense desire to be cared for in every aspect of life. The symptoms may also serve other purposes, such as allowing the person to avoid the responsibilities of adulthood. The symptoms tend to be uncomfortable and prevent the person from engaging in many enjoyable pursuits, suggesting that the person also suffers feelings of worthlessness and guilt.
Symptoms
Symptoms appear first in adolescence or early adulthood. A person with somatization disorder has many vague physical complaints, often described as "unbearable," "beyond description," or "the worst imaginable." Any part of the body may be affected, and 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 increasingly demand help and emotional support and may become enraged when they feel their needs are not being met. In an attempt to manipulate others, they may threaten or attempt suicide. Often dissatisfied with their medical care, they go from doctor to doctor.
Diagnosis
People with somatization disorder are not aware that their basic problem is psychologic, so they press their doctors for diagnostic tests and treatments. The doctor usually conducts many physical examinations and tests to determine whether the person has a physical disorder that adequately explains the symptoms. Referrals to specialists for consultations are common, even if the person has 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. Adding to the diagnosis are the dramatic nature of the complaints and the person's dependent and sometimes suicidal behavior.
Prognosis and Treatment
Somatization disorder tends to fluctuate in severity but persists throughout life. Complete relief of symptoms for an extended period is rare. Some people become more depressed after many years. Suicide is a risk.
Treatment is extremely difficult. People with somatization disorder tend to be frustrated and angered by any suggestion that their symptoms are psychologic. Therefore, doctors cannot deal directly with the problem as a psychologic one, even when they recognize it. Drug therapy does not help much, and even if the person agrees to a mental health consultation, specific psychotherapeutic techniques are not likely to be beneficial. Usually, a person with this disorder is best helped by a trusting relationship with a doctor, who can offer symptomatic relief and protect the person from very costly and possibly dangerous diagnostic or therapeutic procedures. However, the doctor must remain alert to the possibility that the person may develop an actual physical disorder.
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