Somatization. Diagnosis and management
R. Noyes Jr, C. S. Holt and R. G. Kathol
Department of Psychiatry, University of Iowa, College of Medicine, Iowa City, USA.
Somatization, the somatic expression of psychological distress, occurs in a
large proportion of primary care patients. It is associated with
substantial distress and impairment and with increased health care
utilization. Some somatizing patients have a history of multiple
unexplained complaints (somatization disorder), others are excessively
worried about serious illness (hypochondriasis), and still others have
psychiatric disorders that present with somatic symptoms (depression and
anxiety). In general, somatizing patients are characterized by abnormal
illness behavior (eg, failure to respond to treatment, excessive
utilization of care) and psychological distress (eg, depressive symptoms,
psychosocial stressors). Recognition requires alertness to characteristic
features and skillful interview technique. Successful management begins by
legitimizing symptoms. Restraint should be used in performing workups and
assigning diagnoses to somatizing patients. Treatment goals should be
clarified and regular visits scheduled. Also, behaviors that threaten the
physician-patient relationship should be dealt with. Depression and anxiety
should be treated when present. Pharmacologic and psychological treatments
for somatizing patients have been described, although none has proven
efficacy.
