Somatization has a long and treasured history in psychiatry. Often it is characterized as the production of bodily symptoms from neurosis. Thus, medically unexplained symptoms (such as noncardiac chest pain, disproportionate pain, chronic fatigue, and fibromyalgia) can be the result of somatization.
Not every form of somatization would fit criteria for a disorder. It is useful to think of four categories of somatization
There are several somatoform disorders
Somatization disorder
The diagnosis of somatization disorder seems somewhat arcane (it was based on Briquet's syndrome, which was more arcane). Somatization disorder requires the following beginning under the age of 30:
The lifetime prevalence of somatization disorder is about 1%, but could be as high as 5% in medical populations. Somatization disorder is 10 times more common in women than in men and symptom onset usually begins in the teens. The patient is often described as having a history of being 'sickly' from an early age and has a variety of medical concerns. Up to 75% of patients with somatization disorder have a comorbid Axis I disorder (often major depressive disorder, panic disorder, dysthymia, substance abuse). panic disorder, dsythmia, su
Hypochondriasis
Hypochondriasis is the fear that one has a serious disease based on misrepresentation of bodily symptoms. Even after being reassured. the patient's anxiety persists. Patients continue to be preoccupied with their body and have the unusual belief that good health is a state of being free of all symptoms. Concern about illness is often a central feature of the individual's self-image, conversation, and response to stress.
The definition of hypochondriasis determines its actual prevalence, which seems to be between 1-50% of patients seen in a physician's office. Hypochondriasis appears equally common in men and women. About 88% of patients with hypochondriasis have a comorbid Axis I disorder, most commonly generalized anxiety disorder, dysthymia, major depression, and somatization disorder).
Conversion disorder
Conversion disorder is the loss or alteration in function that suggests a physical disease (usually neurological) when none exists. The initiation of the symptom is associated with a meaningful stressor.
The prevalence of conversion disorder varies from 0.3% in the general population to up to 5% in medical populations. Unlike solicitation disorder, conversion disorders are typically characterized by symptoms of only one system, which is usually a voluntary nervous system ability (e.g., movement of arms, legs, or pain). In general, conversion disorder is seen in young adults and adolescents, typically with a lower IQ and educational level, and those who belong to lower socio-economic groups.
Body dysmorphic disorder
The key feature of body dysmorphic disorder is the preoccupation with an imagined defect in appearance that causes impairment in functioning. Body dysmorphic disorder usually begins in adolescence but can occur as late as age 30. The defect is often facial, but can involve other body parts. Most patients have a comorbid Axis I disorder, the most common being major depressive disorder.
Pain disorder
In Pain disorder, psychological factors are important in the onset, severity, exacerbation, or maintenance of pain. Patients with pain disorder usually have a history of seeing a number of physicians, misuse drugs, are on disability, are dependent and depressed, and provide dramatic accounts of their illness. Depression is very common in patients with pain disorder.
Factitious disorder
Patients with factitious disorder intentionally feign or induce disease symptoms. One type of factitious disorder is chronic (often referred to as Munchausen syndrome) and found in middle-aged me. Acute forms are found in women age 20-40 who typically work in a health care profession. Patients with factitious disorder are aware of what they do, but their motives are often unconscious.
Malingering
Malingering involves exaggerating faking symptoms for secondary gain.