The expression of psychological problems as physical symptoms

  • Usually develops in adolescence or early adulthood
  • More common in females
  • Stress is a risk factor
  • Genetics is not a significant factor

Somatization describes a process in which a psychological problem manifests itself as a physical symptom or a range of physical symptoms. Although occasionally bizarre, these symptoms are not fabricated and may be frightening if they are interpreted as signs of a progressive or potentially fatal disease. The condition is related to hypochondriasis, a condition in which there are constant, unfounded worries that minor symptoms are caused by a serious underlying disorder. However, in somatization, psychological problems generate actual physical changes, which cause debilitating symptoms.

People with somatization may make repeated visits to their doctor to ask for investigations into their symptoms and treatment. When test results are normal, and reassurance is given that there is no underlying physical illness, an affected person feels no relief and may consult other doctors to find a physical cause for the symptoms. In extreme cases of somatization, life is continually disrupted by numerous follow-up medical appointments, and health is placed at risk by invasive tests and investigations.

Several psychiatric illnesses may be associated with somatization, including anxiety disorders and depression. Some people may be unable to express their emotions and may use somatic symptoms and complaints to express their emotional state. Somatization usually develops in adolescence or early in adult life and may become a lifelong problem. It is more common in women and is associated with stress.

What are the symptoms?

A person who has a somatization disorder may have a long history of varying physical symptoms that fluctuate in severity and have no identifiable medical cause. Symptoms that sometimes have psychological causes include:

  • Headaches.

  • Chest pain, often accompanied by shortness of breath and palpitations.

  • Abdominal pain and nausea.

  • Tiredness.

  • Itching of the skin.

  • Partial weakness of a limb.

  • Difficulty in swallowing.

In addition, there may be psychological symptoms of anxiety, depression, and substance abuse. Severely affected people may attempt suicide (see Attempted suicide and suicide).

What might be done?

The doctor will first carry out a physical examination and may arrange for blood and urine tests to exclude a physical illness. Medical records will give a picture of past symptoms and investigations.

Treating somatization is often difficult because the affected person may be convinced there is a physical illness in spite of normal test results. The doctor may prescribe treatment for symptoms, such as painkillers for headaches, but will try to avoid further tests and investigations by offering reassurance that physical symptoms are taken seriously and explaining how they may be caused by psychological problems.

The doctor may recommend a psychological assessment to look for an underlying mental health disorder, but this may be resisted by the person. Cognitive–behavioural therapy and behaviour therapy can be particularly helpful for some people.

If depression is causing somatization, it may be treated with antidepressant drugs and a form of psychological therapy

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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