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Epidemiology and Demographics of Somatization Disorder

The estimated prevalence of somatization ranges from relatively uncommon. It has been estimated that 20 to 84% of patients seen by primary care physicians suffer from idiopathic somatic complaints. The prevalence of somatization tends to be higher in primary care facilities than in psychiatric facilities. Several studies have examined prevalence rates of somatization disorder in the community at large.
Prevalence estimates of somatization disorder in the community ranged from 0.06 to 0.6%. DSM-IV states that the prevalence of somatization disorder is 0.2 to 2% among women and less than 0.2% in men. In the Epidemiological Catchment Area Study, somatization disorder was most prevalent among African-American women (0.8%) followed by African-American men (0.4%); however, race is not a mediating variable in somatization disorder. Using DSM-III-R criteria for somatization disorder, Kroenke and Spitzer examined gender differences in the reporting of physical symptoms. One thousand patients from four primary care sites were evaluated with the Primary Care Evaluation of Mental Disorders Interview. After controlling for depressive and anxiety disorders, age, race, education, and medical comorbidity, results revealed that twelve out of thirteen physical symptoms were more commonly reported by women (odds ratio ranged from 1.5 to 2.5), and the reporting differences were statistically significant for ten of the thirteen physical symptoms. The authors concluded that increased symptom reporting in women may be a generic phenomenon rather than about specific symptoms, that medically unexplained symptoms are more common in women, and that the effect of gender on symptom reporting is independent of psychiatric comorbidity. The notion used to be generally held that somatization was more common in non-Western cultures, but this view is no longer held.
Although the prevalence and specific features of somatization may vary across cultures, the presentation of somatic symptoms as an expression of emotional distress is worldwide. In a cross-cultural study of somatization disorder, consecutive primary care patients (N = 25, 916) were screened using the General Health Questionnaire, and a stratified sample of 5438 patients was interviewed with the Composite International Diagnostic Interview. Patients were recruited from fourteen countries: Turkey, Greece, India, Germany, Netherlands, Nigeria, United Kingdom, Japan, France, Brazil, Chile, United States, China, and Italy. Across all cultures, somatization was a common problem in primary care settings and was associated with significant health problems and functional disability. Thus, the prevalence of somatization disorder depends much on the clinical setting, patient sample, and definition of somatization used.
Somatization disorder is reportedly more common in individuals from lower socioeconomic status, lower educational level, and rural background. Although Swartz and his associates found an increased rate of somatization disorder in rural areas, in another study they found an increased prevalence of somatization disorder in urban areas. Thus, the role of rural versus urban background in somatization disorder remains to be clarified. The age of onset of somatization disorder is usually in early childhood and adolescence. By definition, somatization disorder has to occur before the age of 30.

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