Somatization disorder (also Briquet's syndrome or hysteria) is a somatoform disorder characterized by recurring, multiple, clinically significant complaints about pain, gastrointestinal, sexual and pseudoneurological symptoms. Those complaints must begin before the individual turns 30 years of age,^[1] and could last for several years, resulting in either treatment seeking behavior or significant treatment.^[2] 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:^[1]

• A history of somatic complaints over several years, starting prior to the age of 30.
• At least four different sites of pain on the body, AND at least two gastrointestinal problems, AND one sexual dysfunction, AND one pseudoneurological symptom.
• 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.^[1]

  Prevalence and Comorbidity

Somatization disorder is uncommon in the general population. It is thought to occur in 0.2% to 2% of females,^[3][4][5][6] and 0.2% of males. Research showed cultural differences in prevalence of somatization disorder. For example, somatization disorder and symptoms were found to be significantly more common in Puerto Rico.^[7]

There is usually co-morbidity with other psychological disorders, particularly mood disorders or anxiety disorders.^[1][8] Research also showed comorbidity between somatization disorder and personality disorder, especially antisocial, borderline, narcissistic, histrionic, avoidant, and dependent personality disorder.^[9]

  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. Widely held theories on this troublesome, often familial disorder fit into three general categories.

The first and one of the oldest theories is that the symptoms of somatization disorder represent the body’s own defense against psychological stress. This theory states that the mind has a finite capacity to cope with stress and strain. Therefore, increasing social or emotional stresses beyond a certain point are experienced as physical symptoms, principally affecting the digestive, nervous, and reproductive systems. In recent years, researchers have found connections between the brain, immune system, and digestive system which may be the reason why somatization affects those systems and that people with irritable bowel syndrome are more likely to get somatization disorder.^[1] This theory also helps explain why depression is related to somatization. It is also experienced in very high levels in women with a history of physical, emotional or sexual abuse^[10]

The second theory for the cause of somatization disorder is that the disorder occurs due to heightened sensitivity to internal physical sensations. Some people have the ability to feel even the slightest amount of discomfort or pain within their body. With this hypersensitivity, the patient would sense pain that the brain normally would not register in the average person such as minor changes in one's heartbeat. Somatization disorder would then be very closely related to panic disorder under this theory. However, not much is known about hypersensitivity and its relevance to somatization disorder. The psychological or physiological origins of hypersensitivity are still not well understood by experts.

The third theory is that somatization disorder is caused by one’s own negative thoughts and overemphasized fears. Their catastrophic thinking about even the slightest ailments such as thinking a cramp in their shoulder is a tumor, or shortness of breath is due to asthma, could lead those who have somatization disorder to actually worsen their symptoms. This then causes them to feel more pain for just a simple thing like a headache. Often the patients feel like they have a rare disease. This is because their doctors would not be able to have a medical explanation for their unconsciously exaggerated pain that the patient actually thinks is there. This thinking that the symptom is catastrophic also often reduces the activities they normally do. They fear that doing activities that they would normally do on a regular basis would make the symptoms worse. The patient slowly stops doing activities one by one until they practically shut themselves from a normal life. With nothing else to do it leaves more time to think about the “rare disease” they have and consequently ending in greater stress and disability.^[11]

  Neuroimaging Evidence

A recent review of the cognitive–affective neuroscience of somatization disorder suggested that catastrophization in patients with somatization disorders tend to present a greater vulnerability to pain. The relevant brain regions include the dorsolateral prefrontal, insular, rostral anterior cingulate, premotor, and parietal cortices.^[12][13]

  Treatments

To date, cognitive behavioral therapy (CBT) is the best established treatment for a variety of somatoform disorders including somatization disorder.^[14][15][16] CBT helps with the patient realizing that the ailments are not as catastrophic and enabling them to slowly get back to doing activities that they once were able to do without fear of “worsening their symptoms.” Consultation and collaboration with the primary care physician also demonstrated some effectiveness.^[16][17] The use of antidepressants is preliminary but does not yet show conclusive evidence.^[16][18] 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.^[19] 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^[20]

  References

  See also

• Culture-bound syndrome
• Psychosomatic illness
• Hypochondriasis
• Body-centred countertransference
• Medically unexplained symptoms
• List of human diseases associated with infectious pathogens
• Functional somatic syndromes