View source for Somatization disorder

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{{DiseaseDisorder infobox |
  Name        = Somatization disorder |
  ICD10       = {{ICD10|F|45|0|f|40}} |
  ICD9        = {{ICD9|300.81}} |
 {{MedlinePlusEncyclopedia|000955|Somatization disorder}}
 {{eMedicine|ped|3015|Somatoform Disorder: Somatization}}         
}}
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'''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,<ref name=DSM4TR>{{cite book |author= American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders, Forth Edition, Text Revision: [[DSM-IV-TR]] |publisher=American Psychiatric Association |location=Washington, DC |year=2000|pages=486–490 |isbn=0-89042-025-4}}</ref> and could last for several years, resulting in either treatment seeking behavior or significant treatment.<ref>Goldberg R.J. MD. Practical guide to the care of the psychiatric patient. 3rd ed. Mosby-Elsevier: USA</ref> 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.


==Description==
Somatization disorder is characterized by repeated complaints of physical illness over an extended period of time, that are not related to actual organic illness or injury, and begins in early adulthood. It is a [[somatoform disorder]]. The [[Diagnostic and Statistical Manual of Mental Disorders|''DSM-IV'']] establishes the following five criteria for the diagnosis of this disorder: 
*a history of somatic symptoms prior to the age of 30
*pain in at least four different sites on the body
*two gastrointestinal problems other than pain such as vomiting or diarrhea
*one sexual symptom such as lack of interest or erectile dysfunction
*one pseudoneurological symptom similar to those seen in Conversion disorder such as fainting or    blindness.

Such symptoms cannot be related to any medical condition. The symptoms do not all have to be occurring at the same time just over the course of the disorder. The person does not feel they have any specific illness that symptoms are a sign of, they are simply concerned with the symptoms themselves. If a medical condition is present, then the symptoms must be excessive enough to warrant a separate diagnosis. Two symptoms can not be counted for the same thing e.g.if pain during intercourse is counted as a sexual symptom it can not be counted as a pain symptom. Finally, the symptoms cannot be being feigned out of an effort to gain attention or anything else by being sick, and they can not be deliberately inducing symptoms.

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==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.<ref name="DSM4TR"/> 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<ref>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.</ref>

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.<ref name="minddisorders.com">www.minddisorders.com/Py-Z/Somatization-disorder.html. Oct. 10, 2008</ref>

===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.<ref>{{Cite journal|author= Stein DJ, Muller J. |title= Cognitive-affective neuroscience of somatization disorder and functional somatic syndromes: reconceptualizing the triad of depressionanxiety-somatic symptoms |journal= CNS Spectr |volume=13| pages=379–384 |year=2008}}</ref><ref>{{Cite journal|author=Garcia-Campayoa, Javier; Fayed, Nicolas; Serrano-Blanco, Antoni; Roca, Miquel |title=Brain dysfunction behind functional symptoms: Neuroimaging and somatoform, conversive, and dissociative disorders. |journal=Current Opinion in Psychiatry |volume=22 |issue=2 |pages=224–231 |year=2009 | pmid =  19553880 |doi=10.1097/YCO.0b013e3283252d43}}</ref>

==Treatments==
To date, [[cognitive behavioral therapy]] (CBT) is the best established treatment for a variety of somatoform disorders including somatization disorder.<ref name="pmid16864762">{{cite journal |author=Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM |title=Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial |journal=Arch. Intern. Med. |volume=166 |issue=14 |pages=1512–8 |year=2006 |pmid=16864762 |doi=10.1001/archinte.166.14.1512 |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=16864762}}</ref><ref name="pmid15560311">{{cite journal |author=Mai F |title=Somatization disorder: a practical review |journal=Can J Psychiatry |volume=49 |issue=10 |pages=652–62 |year=2004 |pmid=15560311 |doi=}}</ref><ref name=Kurt>{{Cite journal|author=Kroenke, Kurt.  |title=Efficacy of treatment for somatoform disorders: A review of randomized controlled trials |journal=Psychosomatic Medicine |volume=69 |issue=9 |pages=881–888 |year=2007 |doi=10.1097/PSY.0b013e31815b00c4 |pmid=18040099}}</ref> 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.<ref name="Kurt"/><ref name="pmid3084975">{{cite journal |author=Smith GR, Monson RA, Ray DC |title=Psychiatric consultation in somatization disorder. A randomized controlled study |journal=N. Engl. J. Med. |volume=314 |issue=22 |pages=1407–13 |year=1986 |pmid=3084975 |doi=10.1056/NEJM198605293142203}}</ref> The use of [[antidepressant]]s is preliminary but does not yet show conclusive evidence.<ref name="Kurt"/><ref>{{cite journal | author = Stahl S.M. | year = 2003 | title = Antidepressants and somatic symptoms: Therapeutic actions are expanding beyond affective spectrum disorders to functional somatic syndromes | url = | journal = Journal of Clinical Psychiatry | volume = 64 | issue = 7| pages = 745–746 }}</ref> 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.<ref>{{Cite journal|author= Zorumski, Charles F; Rubin, Eugene H; Burke, William J |title= Electroconvulsive therapy for the elderly: A review. |journal= Hospital & Community Psychiatry. |volume=39 |issue=6 |pages= 643–647 |year=1988}}</ref> 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<ref name = Kenny>{{cite journal | author = Kenny M & Egan J | date = February 2011 | title = Somatization disorder: What clinicians need to know | journal = The Irish Psychologist | volume = 37 | issue = 4 | pages = 93–96 | url = http://www.lenus.ie/hse/bitstream/10147/121822/1/SomatizationDis.pdf | accessdate = 9 December 2011 }}</ref>


==See also==
*[[Body-centred countertransference]]
*[[Culture-bound syndrome]]
*[[Hypochondriasis]]
*[[Psychosomatic illness]]
*[[Medically unexplained symptoms]]
*[[Somatization]]
*[[Somatoform disorders]]


==References==
{{reflist|2}}

==Further reading==

==Key Texts – Books==

==Additional material – Books==

#American Psychiatric Association. (1994). ''Diagnostic and statistical manual of mental disorders'' (4th ed.). Washington, DC.
#Barlow, David H. and V. Mark Durand (2006). ''Essentials of 
Abnormal Psychology'' (4th ed.) Belmont, CA.
#Bizer, J. (2003). "Somatization disorders in obstetrics and gynecology."  ''Achieves of Women’s Mental Health,'' 6, 99-107.
#Hakala, M. (2004). "Volumes of the caudate nuclei in women with somatization disorder and healthy wo
men." ''Psychiatry Research'', 131(1), 71-78.
#Hakala, M., Karlsson, H., Ruotsalainen, U., Koponen, S., Bergman, J., Stenman, H., et al. (2002). "Severe somatization in women is associated with altered cerebral glucose metabolism."  ''Psychological Medicine,'' 32(8), 1379-1385.
#Holder-Perkins, V., & Wise, T.N. (2001). "Somatization Disorder." In J.M. Oldham & M.B. Riba (Series Eds.) & K.A. Phillips (Vol. Ed.), ''Review of Psychiatry: Vol. 20. Somatization and Factitious Disorder (pp 1-26)''. Washington, DC: American Psychiatric Publishing.
#Looper, K.J., & Kirmayer, L.J. (2002). "Behavioral medicine approaches to somatoform disorders."  ''Journal of Consulting and Clinical Psychology,'' 70(3), 810-827.
#Martini, D.R. (Spring 1997). Somatoform disorders in the pediatric population. Journal of Children’s Memorial Hospital. Retrieved December 7, 2004 from http://www.childsdoc.org/spring97/martini/somatoformdis.asp
#Niemi, P.M., Portin, R., Aalto, S., Hakala, M., & Karlsson, H. (2002). Cognitive functioning in severe somatization—a pilot study.  Acta Psychiatrica Scandinavica, 106, 461-463.
#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.
#Temple, S. (2003). A case of multiple chemical sensitivities: Cognitive therapy for somatization disorder and Metaworry.  Journal of Cognitive Psychotherapy, 17(3), 267-277.


==Key Texts – Papers== 

==Additional material -  Papers==

==External links==
* [http://www.thehypochondriac.com Discuss Somatization disorder and other psychiatric disorders]
* {{MedlinePlusEncyclopedia|000955|Somatization disorder}}
* {{eMedicine|ped|3015|Somatoform Disorder: Somatization}}
*[http://www.annals.org/content/130/11/910.abstract Functional somatic syndromes]




[[Category:Psychosomatic medicine]]
[[Category:Somatoform disorders]]

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