What Is Somatization?

Somatization disorder is a group of neurosis that is characterized by persistent concerns or beliefs about the predominance of various somatic symptoms. Patients repeatedly seek medical treatment for these symptoms. Negative medical tests and doctors' explanations cannot dispel their doubts. Even if a patient does have a physical disorder, its severity may not be sufficient to explain the patient's pain and anxiety. For patients, even if the symptoms are closely related to stressful life events or psychological conflict, they refuse to explore the possibility of psychological causes.

Basic Information

English name: Somatization disorder
Visiting department: Clinical Psychology
Common causes: Heredity, personality traits, neurophysiology, psychosocial factors

Common symptoms: Gastrointestinal paresthesia, pain, snoring, acid reflux, nausea, vomiting, etc., skin paresthesia, pain, itching, etc., skin spots, anxiety, depression

Causes of somatization disorder

Heredity

The cause of somatization disorder is unknown, but it is undoubtedly a familial disorder. In some studies, approximately 20% of female first-degree relatives of patients with somatization disorder also meet the diagnosis of somatization disorder. This familial aggregation can be affected by genetic, environmental factors, or both.

2. Personality characteristics

Some research results show that female patients with somatization disorders have a common cause and are associated with antisocial personality disorders, while for male patients, somatization disorders are more associated with anxiety disorders.

3. Neurophysiology

Patients with somatization disorder have symmetrical dysfunction in the bilateral frontal lobe. Non-dominant hemispheres have more severe dysfunction at the front than at the back. Patients with somatization disorders have more severe hemisphere dysfunction than healthy controls and patients with depression.

4. Psychosocial factors

Defects in information processing methods may lead to complaints of physical discomfort among patients with somatization disorders and their biological relatives. The symptoms are not clearly localized and pathological. Some scholars have proposed the social model theory for patients with somatization disorder, that is, patients use somatization of symptoms as a way to express emotions (such as pain) in the family, and expect to seek support and care from the core members of the family.

Clinical manifestations of somatization disorder

The clinical manifestations are various, recurring, and frequently changing physical discomfort symptoms, which can involve any part or organ of the body. Various medical examinations cannot confirm that there are any organic lesions sufficient to explain their physical symptoms. The most common symptoms are: stomach Intestinal paresthesia, pain, snoring, acid reflux, nausea, vomiting, etc., skin paresthesia, burning, pain, itching, numbness, ants walking, etc., skin spots, sexual and menstrual symptoms. Symptoms often lead to repeated medical visits and obvious social dysfunction, often accompanied by significant anxiety and depression.

Diagnosis of somatization disorder

CCMD-3 diagnostic criteria for somatization disorder:

Symptom criteria

(1) Meet the diagnostic criteria for somatoform disorders.

(2) It is dominated by various, recurring and frequently changing physical symptoms. Among the following 4 groups of symptoms, there are at least 2 groups with 6 items: gastrointestinal symptoms, such as: abdominal pain; nausea; abdominal distension or flatulence Odorless or thick tongue coating in the mouth; vomiting or nausea; frequent stools, thin stools, or watery stools; symptoms of the respiratory system, such as: shortness of breath; chest pain; symptoms of the urogenital system, such as difficulty in urination or frequent urination; Discomfort in or around the genitals; abnormal or large amounts of vaginal discharge; skin or pain symptoms, such as: scars; pain, numbness, or tingling in limbs or joints.

(3) Physical examination and laboratory examination can not find evidence of physical disorder, and can reasonably explain the severity, variability, persistent or secondary impairment of social function.

(4) The superior concept of the above symptoms makes the patient suffering, constantly seeks treatment, or requires various tests, but the negative test results and the reasonable explanation of the doctor cannot dispel their doubts.

(5) If there are symptoms of hyperactive autonomic nerve activity, but do not dominate.

2. Criterion

It is often accompanied by long-standing serious obstacles in social, interpersonal and family behavior.

3. Course standard

Has met the criteria for symptoms and severity for at least 2 years.

4. Exclusion criteria

Exclude schizophrenia and related disorders, mood disorders, adaptation disorders, or panic disorders.

Differential diagnosis of somatization disorder

Physical illness

Some physical diseases may be difficult to find objective medical evidence at an early stage. Therefore, the diagnosis of somatization disorder requires a course of more than 2 years in order to naturally exclude physical discomfort caused by various physical diseases. Clinically, for those who are over 40 years old and first show physical discomfort as the main symptom, we must be careful not to easily diagnose somatization disorder based on the patient's psychological incentives, no positive signs found in preliminary examination, and some suggestiveness. .

2. Depression

Depression is often accompanied by physical discomfort, and somatization disorders are often accompanied by depression. One side should consider the sequence of the symptoms during the identification; on the other hand, the characteristics of the symptoms should be analyzed. For major depression, there are still some biological symptoms, such as early awakening, early morning and light night rhythm changes, weight loss and mental retardation, self-blame, negative words and deeds can be identified.

3. Schizophrenia

There may be early symptoms of suspected disease, but its content is bizarre and unstable, often with mental and emotional disorders. Patients are not actively seeking treatment, and can be identified.

4. Suspected condition

The focus of patients with somatization disorder is on the symptoms themselves and the individual effects of the symptoms. Patients require treatment to eliminate the symptoms. Patients often have overuse of drugs; and suspected symptoms are more directed towards potentially progressive serious disease processes and their disability and death As a result, patients tend to require tests to identify or confirm underlying disease, and patients are often afraid of drugs and their side effects.

Somatization disorder treatment

General treatment

At the beginning of treatment, attention should be paid to the establishment of doctor-patient relationship. Treat patients' pain and complaints with patience, compassion, and acceptance. The patient should be informed that he is suffering from a disease and the patient should be described in a positive tone about the manifestations of somatization disorder. Doctors should assure patients that there is currently no basis to prove that physical illness causes discomfort, and that patient discomfort may be related to stress.

2. Psychotherapy

Psychotherapy is the main form of treatment, and its purpose is to let patients gradually understand the nature of the disease, change their misconceptions, and reduce the influence of psychological factors.

(1) Supportive psychotherapy Give patients explanation, guidance, and clearing so that they can understand the knowledge about disease symptoms, which is effective for alleviating emotional symptoms and enhancing confidence in treatment.

(2) Psychodynamic psychotherapy Helps patients to explore and understand the internal psychological conflicts behind the symptoms, which is effective for the complete relief of the symptoms.

(3) Cognitive therapy For patients with obvious suspected concepts and suspected personality, cognitive correction therapy has long-term effects.

(4) Morita Therapy enables patients to understand that the symptoms are not serious, and adopting an attitude of acceptance and tolerance is effective for alleviating the symptoms of the disease and improving the quality of life.

3. Drug treatment

Patients with somatization disorder often have symptoms of anxiety and depression. Small doses of antidepressants such as selective serotonin reuptake inhibitors can be used to improve the patient's adverse mood and reduce symptoms. Small doses of anxiolytics can partially improve symptoms in patients with somatization disorder.