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definition of somatization disorder

Broadly defined, somatization disorder is a term that covers a broad range of physical symptoms that occur in the absence of organic pathology or the amplification of bodily sensations that accompany physical conditions beyond those that can be explained by organic pathology. Somatization has also been defined as a bodily or somatic expression of psychic distress. In other words, patients who ought to be complaining of problems in daily living often focus on bodily sensations and seek a medical cure for these problems. For example, it is easier for these patients to say to a physician ‘‘my back hurts’’ than it is to say ‘‘I want to die because my life has no meaning.’’ The history of somatization disorder is intimately tied to the history of hysteria. Although the origins of somatization can be attributed to Sydenham in 1682 and Sims in 1799, it was not until 1856 that Paul Briquet published his oft-quoted classical study on hysteria that somatization was more firmly established. Briquet’s work is contained in a 700-page compendium that describes and categorizes symptoms of 430 patients seen during a 10-year period. Except for a handful of patients, most of the cases he studied were women. According to Briquet’s conceptualization, hysteria resulted from stress or stimuli that affect the central nervous system of susceptible individuals, causing a plethora of physical symptoms. He conceptualized this syndrome as a form of hysteria, but it is clear from some of his descriptions that he also captured elements of conversion reactions. In 1909, Briquet’s work was followed by Thomas Saville’s study of 500 hysterical patients. Adopting Briquet’s methodology and conceptualization, Saville came to similar conclusions about hysteria. The term somatization was f irst used by Steckel, who defined somatization as a bodily disorder that arises out of a deep-seated neurosis and as a disease of the conscious. Purtell, Robins, and Cohen later rediscovered the ideas of Briquet and Saville, but their study also emphasized the dramatic, vague, and exaggerated manner in which these patients described their symptoms.
The study of somatization culminated in extensive phenomenological studies conducted by Guze and his colleagues at Washington University in St. Louis. These studies were aimed at defining relatively distinct psychiatric disturbances in terms of characteristics, phenomenology, natural history, prognosis, treatment response, and family history. The emergence of somatization disorder was primarily out of a controversy in the mid-1960s between Samuel Guze and Elliot Slater, then the editor of the British Journal of Psychiatry. Guze’s work on hysteria was seriously questioned by Slater and Glithero’s classical study. As Guze stated, it was because of Slater’s influence and in an attempt to reduce confusion surrounding hysteria, that he renamed hysteria after Briquet. In 1971, hysteria became known as Briquet’s syndrome. Over the years, Guze and his associates and others were able to demonstrate that Briquet’s syndrome had excellent diagnostic stability, a high degree of reliability, and good validity. Briquet’s syndrome was conceived as a polysymptomatic syndrome that begins early in life, occurs primarily in women, and is associated with marital problems, poor work history, teenage delinquency, alcohol problems, and sociopathy in first-degree relatives.

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