Mental health articles

A somatizing patient may present with many symptoms referred to any body part or organ system, and these symptoms may indicate any type of disease entity, but none of the physical symptoms of somatization disorder are pathognomonic. The clinician working with somatizers needs to be aware that multiple physical symptoms, in and of themselves, do not imply psychopathology. Furthermore, the diagnosis of somatization does not preclude the patient from experiencing true pathological conditions. For example, the co-occurrence of somatization and a medical disorder has been noted in the following conditions: cardiovascular disease, chronic fatigue syndrome, and fibromyalgia.
Pain is by far the most common complaint of somatizers, especially pain involving the back, neck, head, pelvis, abdomen, and diffuse muscle aches. Complaints of fatigue, shortness of breath, dizziness, and palpitations are also common. The presentation of symptoms is often elaborate, involving obsessively detailed symptom descriptions, but the chronology itself can be very vague. Nemiah presents a thorough description of behaviors observed in the somatizer. He noted that somatizers are often exhibitionistic, particularly in terms of overly made-up or overdressed women. These individuals tend to be more revealing of their bodies in session and during physical examinations than necessary. Somatizers display an excessive preoccupation with themselves at the expense of others and, though this is not apparent at first, are highly dependent individuals. They demonstrate a wide range of affect that at times can be bewildering to the clinician. These patients are often perceived as flirtatious and seductive, but evaluation of sexual functioning frequently finds that they are tolerant at best, if not indifferent, toward sex. Somatizers are especially skilled at manipulating family, friends, and the health care system to meet their needs. They are prone to suicide attempts but rarely follow through successfully. Somatizers frequently have a history of multiple hospitalizations and surgeries. These patients represent a major source of health care utilization. An estimated 50% of ambulatory health care costs in the United States has been attributed to somatizers. In 1980, the per capita expenditure of health care costs for hospital services was $543 for the average consumer, whereas it was $4,700 for somatizing patients. Interestingly enough, despite the multiple symptom presentation of somatizers, somatization disorder is not associated with increased mortality.
In addition to multiple somatic symptoms, somatizers also present with a diversity of psychological and psychosocial complaints. Depression and anxiety are prominent features in somatizers. Although patients with somatization disorder appear heterogeneous, they all share one essential feature: a predominant pattern of somatic, rather than cognitive, response to emotional arousal. Barsky, Wyshak, and Klerman went even further in stating that somatic symptoms represent a final common pathway through which emotional disturbances, psychiatric disorders, and pathophysiological processes all express themselves and cause the patient to seek medical care. Psychosocially, somatizers come from inconsistent, unreliable, and emotionally unsupportive family environments. Physical and sexual trauma are common among somatizers. Marital discord, separation, and divorce are also frequently observed. Because of their incapacitating symptomatology, somatizers often have poor occupational histories. Interpersonally, relationships with somatizers tend to be shallow and chaotic.

Tags: cinical, disorder, somatization, symptoms