Somatization disorder

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Somatization disorder

Post  counselor on Wed Aug 27, 2014 7:33 am

Somatization disorder (also Briquet's syndrome or hysteria) is a somatoform disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. Symptoms often include reports of pain, gastrointestinal distress, sexual problems, and pseudoneurological symptoms such as amnesia or breathing difficulties. Somatization disorder can also occur during the course of, or be associated with, a medical condition. Patients with somatization disorder also show high levels of worry, anxiety, and increased reactions in response to physical symptoms. Individuals with somatization disorder typically visit many doctors in pursuit of effective treatment. Somatization disorder also causes challenge and burden on the life of the caregivers or significant others of the patient.

The DSM-IV-TR diagnostic criteria are:

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 object evidence of subjective complaints of the individual.

In the DSM-5 the disorder has been renamed to 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).

Diagnosis of somatic symptom 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, making it difficult to determine whether or not the pain is due to predominately psychological factors.

Somatic symptoms are defined as distressing physical or bodily symptoms, including pain. In somatic symptom disorder (SSD) the responses to somatic symptoms is excessive and causes intense fear, concerns, and disturbances in optimal functioning. There are a number of symptoms that are commonly seen in patients with SSD.

Pain symptoms:
Diffuse pain
Joint pain
Pain in limbs

Pseudoneurological symptoms:
Loss of voice
Difficulty with walking
Difficulty with swallowing

Reproductive organ symptoms:
Painful sensations in sex organs/genitals
Irregularity in menstrual cycles
Excessive menstrual bleeding
Pain during sex

Cardiopulmonary symptoms:
Chest pain
Shortness of breath at rest

Gastrointestinal symptoms:
Abdominal pain

Other common symptoms:
Vague food allergies
Chronic fatigue
Sensitivity to certain chemicals

Somatic symptom disorder (SSD) in the DSM-5 consists of two subtypes: SSD predominately somatic complaints and SSD with pain features. SSD with primarily somatic complaints is estimated to occur in 0.2% to 2% of females,[6][7][8][9] and 0.2% of males.

There are cultural differences in the prevalence of somatic symptom disorder. For example, somatic symptom disorder and symptoms were found to be significantly more common in Puerto Rico. In addition the diagnosis is also more prevalent among African Americans and those with less than a high school education or lower socioeconomic status.

There is usually co-morbidity with other psychological disorders, particularly mood disorders or anxiety disorders. Research also showed comorbidity between somatic symptom disorder and personality disorders, especially antisocial, borderline, narcissistic, histrionic, avoidant, and dependent personality disorder.

About 10-20 percent of female first degree relatives also have somatic symptom disorder and male relatives have increased rates of alcoholism and sociopathy.

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.

One of the oldest explanations for somatic symptom disorder advances the theory that SSD 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, and stress and the hormone cortisol are known to have a negative impact on immune functions. This might explain why somatic symptom disorders are more likely in people with irritable bowel syndrome, and why patients with SSD are more likely to have a mood or anxiety disorder. There is also a much increased incidence of SSD in women with a history of physical, emotional or sexual abuse.

Another hypothesis for the cause of somatic symptom disorder is that people with SSD have heightened sensitivity to internal physical sensations and pain. 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.

Cognitive theories explain somatic symptom 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. Children of parents who are preoccupied or overly attentive to the somatic complaints of their children are more likely to develop somatic symptoms. Severe cognitive distortions can make a person with SSD limit the behaviors he or she engages in, and cause increased disability and impaired functioning.

Neuroimaging evidence
A recent review of the cognitive–affective neuroscience of somatization disorder suggested that catastrophization in patients with somatization disorders tends to present a greater vulnerability to pain. The relevant brain regions include the dorsolateral prefrontal, insular, rostral anterior cingulate, premotor, and parietal cortices.

To date, cognitive behavioral therapy (CBT) is the best established treatment for a variety of somatoform disorders including somatization disorder. CBT aims to help patients realize their ailments are not catastrophic and to enable them to gradually return to activities they previously engaged in, without fear of “worsening their symptoms.” Consultation and collaboration with the primary care physician also demonstrated some effectiveness. The use of antidepressants is preliminary but does not yet show conclusive evidence. Electroconvulsive shock therapy (ECT) has been used in treating somatization disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT. Overall, psychologists recommend addressing a common difficulty in patients with somatization disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner.

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