Somatization Disorder: SOMATIC EXPRESSION OF PSYCHOLOGICAL DISTRESS

Volume 3 Issue 12 December, 2013

Somatization Disorder also known as Briquet’s Syndrome is a distinct, poorly understood, clinical and public health problem, was first introduced by Stekel (1911), who defined it as “a bodily disorder that arises as the expression of deep-seated neurosis”. This syndrome has been classified under somatoform disorder in ICD-10 (F45.0) and renamed as Somatic Symptom Disorder (SSD) in DSM-5. The disorder usually starts before the age of 30 years and run a chronic course. It is more common in lower socio-economic, less educated, unemployed people, with an estimated life time prevalence of 0.2-2% in females and 0.2% in males. The essential features for the diagnosis are recurrent, multiple, changing distressing somatic symptoms of many years (>2) duration, that are not fully explained by physical factor, which eventually results in significant psychological distress and socio-occupational functioning impairment. Patients generally have long complicated medical history, negative investigations and often fruitless surgeries.

The exact etiology is unknown and probably multifactorial. Biopsychosocial model suggest genetic vulnerability (abnormal proprioceptive acuity, increase sensitivity to pain), early traumatic experiences (violence, abuse), faulty learning, lack of reinforcement of nonsomatic expression of distress, and cultural/social support for somatic symptoms results in somatization disorder. Psychological factors such as inability to express emotions, assumption of sick role, secondary gains along with cultural stigma of psychological suffering than physical, family modeling and reinforcement of abnormal illness behavior contribute in etiology of disorder.

Clinical presentation are multiple and recurrent symptoms from various parts of body, commonly patient may present with gastrointestinal symptoms (e.g. nausea, vomiting, abdominal pain, belching, diarrhea), pain (headache, abdominal, joint, back, chest, during sexual intercourse or diffuse pain), pseudo neurological symptoms (amnesia, aphonia, pseudo seizures, paralysis, vague sensory loss, blindness, deafness , difficulty in swallowing, throat lump), cardiopulmonary symptoms (palpitation, atypical chest pain, dizziness, dyspnea, hyperventilation), reproductive organ symptom (painful sensation in genitals, irregularities in menstrual cycle) and other vague symptoms like food allergies, chronic fatigue or generalized weakness etc. The patients often describe their complaints in an exaggerated, dramatic, vague and in colorful language. Patient expends excessive time and energy for health concern and remains anxious about symptoms. Co-morbid psychiatric disorders particularly mood disorder, anxiety disorder, personality disorder especially antisocial, borderline, narcissistic, and histrionic, avoidant and dependent personality may complicate the overall picture.

Management is difficult and frustrating as there is no single superior treatment approach. Quill, smith (1985) et al proposed three steps management. The first step is rapport establishment, second step is educate the patient about various aspects of somatization disorder in a positive way and reassure that his illness has been understood, diagnosed, and will not lead to chronic mental, physical deterioration, disability or death help in relieving patient’s anxiety and the third step is repeated and consistent reassurance and to link symptoms with “stress”. Such discussion may help in gaining insight that stress may precipitate somatic symptoms. Patients in general responds better to a combination of Pharmacotherapy with other modalities like Cognitive behavior therapy (CBT), Eclectic supportive psychotherapy with emotional tone, exercise, yoga, relaxation and meditation. Untreated somatization disorder is
chronic, fluctuating and relapsing disorder that remits rarely; awareness of this disorder among physicians and non-psychiatrist can reduce its burden and functional disability significantly from society.