Somatization disorder

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.


Diagnosis
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.



Symptoms
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
Headaches


Pseudoneurological symptoms:
Amnesia
Loss of voice
Seizures
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:
Palpitations
Chest pain
Dizziness
Shortness of breath at rest


Gastrointestinal symptoms:
Nausea
Vomiting
Abdominal pain


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



Epidemiology
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.




Explanations
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.



Treatments
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.





Burton, C., McGorm, K., Weller, D., & Sharpe, M. (2010). "Depression and anxiety in patients repeatedly referred to secondary care with medically unexplained symptoms: A case-control study.". Psychological Medicine 41 (3): 555–563. doi:10.1017/s0033291710001017.
^ Jump up to: a b c d American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Association. pp. 486–490. ISBN 0-89042-025-4.
Jump up ^ Association, American Psychiatric. Diagnostic and Statistical Manual of Mental DisordersAmerican Psychiatric Associati. (5th ed. ed.). Arlington: AMERICAN PSYCHIATRIC PUBLISHING. ISBN 0890425558.
Jump up ^ Hoffman, B. M., Papas, R. K., Chatkoff, D. K., & Kerns, R. D. (2007). "Meta-analysis of psychological interventions for chronic lower back pain.". Health Psychology (26): 1–9.
Jump up ^ So, J. K. (2008). "Somatization as a cultural idiom of distress: Rethinking mind and body in a multi-cultural society". Counselling Psychology Quarterly (21): 167–174.
Jump up ^ DeGruy F, Columbia L, Dickinson P (1987). "Somatization disorder in a family practice". J Fam Pract 25 (1): 45–51.
Jump up ^ Lichstein P. R. (1986). "Caring for the patient with multiple somatic complaints". Southern Medical Journal 79 (3): 310–314. doi:10.1097/00007611-198603000-00013.
Jump up ^ Gordon G.H. (1987). "Treating somatizing patients". Western Journal of Medicine 147: 88–91.
Jump up ^ Farley J, Woodruff RA, Guze SB (1968). "The prevalence of hysteria and conversion symptoms," The British Journal of Psychiatry, 114:1121–1125 (1968).
Jump up ^ Canino, Glorisa; Bird, Hector; Rubio-Stipec, Maritza; Bravo, Milagros. (2000). "The epidemiology of mental disorders in the adult population of Puerto Rico". Revista Interamericana de Psicologia. 34 (1X): 29–46.
Jump up ^ Noyes, R., Jr., Stuart, S., Watson, D. B., & Langbehn, D. R. (2006). "Distinguishing between hypochondriasis and somatization disorder: A review of the existing literature.". Psychotherapy and Psychosomatics (75): 270–281.
Jump up ^ Lieb, Roselind; Meinlschmidt, Gunther; Araya, Ricardo. (2007). "Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: An update". Psychosomatic Medicine 69 (9): 860–863. doi:10.1097/psy.0b013e31815b0103.
Jump up ^ Bornstein, Robert F; Gold, Stephanie H (2008). "Comorbidity of personality disorders and somatization disorder: A meta-analytic review". Journal of Psychopathology and Behavioral Assessment 30 (2): 154–161. doi:10.1007/s10862-007-9052-2.
Jump up ^ Stern, Theodore (2008). Massachusetts General Hospital comprehensive clinical psychiatry (1st ed. ed.). Philadelphia, PA: Mosby/Elsevier. p. 323. ISBN 9780323047432.
Jump up ^ Kato, K., Sullivan, P. F., Evengard, B., & Pedersen, N. L. (2009). "A population based twin study of functional somatic syndromes.". Psychological Medicine (39): 497–505.
Jump up ^ Martin, P. R., & MacLeod, C. (2009). "Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy.". Clinical Psychology Review (29): 483–495.
Jump up ^ Pribor, E. F., Yutzy, S. H., Dean, J. T., Wetzel, R. D. (1993). Briquet's Syndrome, dissociation and abuse. american Journal of Psychiatry, 150, 1507-1511.
Jump up ^ Katzer, A., Oberfeld, D., Hiller, W., Gerlach, A. L., & Witthoft, M. (2012). "Tactile perceptual processes and their relationship to somatoform disorders". Journal of Abnormal Psychology (121): 530–543.
Jump up ^ Farrugia, D., & Fetter, H. (2009). "Chronic pain: Biological understanding and treatment suggestions for mental health counselors". Journal of Mental Health Counseling (31): 189–200.
Jump up ^ Williamson, D., Robinson, M. E., & Melamed, B. (1997). "Patient behavior, spouse responsiveness, and marital satisfaction in patients with rheumatoid arthritis". Behavior Modification (21): 97–106.
Jump up ^ Watt, M. C., O'Connor, R. M., Stewart, S. H., Moon, E. C., & Terry, L. (2008). "Specificity of childhood learning experiences in relation to anxiety sensitivity and illness/injury sensitivity: Implications for health anxiety and pain". Journal of Cognitive Psychotherapy: An International Quarterly (22): 128–143.
Jump up ^ http://www.minddisorders.com/Py-Z/omatization-disorder.html. Oct. 10, 2008
Jump up ^ Stein DJ, Muller J. (2008). "Cognitive-affective neuroscience of somatization disorder and functional somatic syndromes: reconceptualizing the triad of depressionanxiety-somatic symptoms". CNS Spectr 13: 379–384.
Jump up ^ Garcia-Campayoa, Javier; Fayed, Nicolas; Serrano-Blanco, Antoni; Roca, Miquel (2009). "Brain dysfunction behind functional symptoms: Neuroimaging and somatoform, conversive, and dissociative disorders.". Current Opinion in Psychiatry 22 (2): 224–231. doi:10.1097/YCO.0b013e3283252d43. PMID 19553880.
Jump up ^ Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM (2006). "Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial". Arch. Intern. Med. 166 (14): 1512–8. doi:10.1001/archinte.166.14.1512. PMID 16864762.
Jump up ^ Mai F (2004). "Somatization disorder: a practical review". Can J Psychiatry 49 (10): 652–62. PMID 15560311.
^ Jump up to: a b c Kroenke, Kurt. (2007). "Efficacy of treatment for somatoform disorders: A review of randomized controlled trials". Psychosomatic Medicine 69 (9): 881–888. doi:10.1097/PSY.0b013e31815b00c4. PMID 18040099.
Jump up ^ Smith GR, Monson RA, Ray DC (1986). "Psychiatric consultation in somatization disorder. A randomized controlled study". N. Engl. J. Med. 314 (22): 1407–13. doi:10.1056/NEJM198605293142203. PMID 3084975.
Jump up ^ Stahl S.M. (2003). "Antidepressants and somatic symptoms: Therapeutic actions are expanding beyond affective spectrum disorders to functional somatic syndromes". Journal of Clinical Psychiatry 64 (7): 745–746.
Jump up ^ Zorumski, Charles F; Rubin, Eugene H; Burke, William J (1988). "Electroconvulsive therapy for the elderly: A review.". Hospital & Community Psychiatry. 39 (6): 643–647.
Jump up ^ Kenny M & Egan J (February 2011). "Somatization disorder: What clinicians need to know". The Irish Psychologist 37 (4): 93–96. Retrieved 9 December 2011.


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