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Psychodynamic of Somatization Disorder

Psychoanalysts view somatization as a form of symbolic communication, defense mechanism, and conflict resolution. Somatization is a process whereby the body translates mental stress into physical expressions that have symbolic value. The process of somatization also represents primitive defense mechanisms, like denial and repression, against undesirable wishes or urges.
Finally, as a means to resolve conflict, somatizers blame their failures on their bodily symptoms or focus on their symptoms to avoid intolerable situations. As intuitive as the psychodynamic conceptualization of somatization is, it remains extremely difficult to test or validate. Neuropsychological, Neurophysiological, and Psychophysiological.A number of studies propose a neuropsychological, neurophysiological, psychophysiological formulation of somatization disorder. Comprehensive neuropsychological examination, auditory evoked-response potentials, and cerebral blood flow studies of patients with somatization disorder demonstrated that these individuals display excessive distractibility, an inability to habituate to repetitive stimuli, and cognitive functioning characterized as concrete, partial, and circumstantial. These findings are associated with bilateral frontal and right hemisphere dysfunction. Another study examined the laterality of symptoms in sixty-one patients with depressive, anxiety, and somatoform disorders. The authors found that somatic complaints, especially pain, together with other somatic complaints, occurred more often on the left side of the body. They concluded that the right hemisphere of the brain is more involved in somatization symptom formation than the left hemisphere; however, causal statements about the relationship between symptom formation and brain hemisphere cannot be made.
Most recently, Wickramasekera developed a high-risk model of threat perception that identifies three major risk factors for developing somatization. He found that patients who have high hypnotic ability, low hypnotic ability, or who are high on social desirability are most prone to developing somatization and other psychophysiological disorders. Chronic pain subjects high on one or more of these risk factors evidenced higher skin conductance in response to cognitive threat. These studies, however, need to be replicated with more sensitive designs and larger samples sizes to determine the stability of these results.

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