Somatization: Treatment and prognosis
- Donna B Greenberg, MD
Donna B Greenberg, MD
- Associate Professor of Psychiatry
- Harvard Medical School
Somatization is a syndrome of nonspecific physical symptoms that are distressing and may not be fully explained by a known medical condition after appropriate investigation. This syndrome has also been called "medically unexplained symptoms," "medically unexplained physical symptoms," "functional somatic symptoms," and "somatic symptom disorders." The symptoms are associated with distress and may be caused or exacerbated by anxiety, depression, and interpersonal conflicts [1-4]. Somatization can be conscious or unconscious and may be influenced by a desire for the sick role or for personal gain .
Somatization often occurs in primary care patients . It increases use of medical services independent of any accompanying psychiatric or nonpsychiatric disorder, and leads to frustration in both the patient and the clinician [4,6-9].
This topic reviews the treatment and prognosis of somatization. The epidemiology, pathogenesis, clinical features, and medical evaluation of somatization; diagnosis of specific disorders; and the treatment and prognosis of hypochondriasis and conversion disorder are discussed separately. (See "Somatization: Epidemiology, pathogenesis, clinical features, medical evaluation, and diagnosis" and "Illness anxiety disorder: Treatment and prognosis" and "Conversion disorder in adults: Treatment".)
TERMINOLOGY AND DSM-5
The term "somatization" as used in this topic refers to a syndrome consisting of physical symptoms that cause substantial distress and psychosocial impairment, and in some instances, are not explained by a known general medical disease. The syndrome has also been referred to as medically unexplained symptoms and functional somatic symptoms. Somatization can be viewed as a dimensional syndrome with a spectrum of expression ranging from the exaggeration of common symptoms to unrelenting disabling symptoms . The same principles of management apply to patients across the spectrum.
Somatization is an overarching term that encompasses many different illnesses and terms including “somatoform disorders,” which is a group of disorders that are recognized in the World Health Organization's International Classification of Diseases-10th Revision (ICD-10) , and were previously described in the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR) (table 1) . (See "Somatization: Epidemiology, pathogenesis, clinical features, medical evaluation, and diagnosis", section on 'Somatoform disorders'.)
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