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Somatization

The term somatization is attributed to Wilhelm Stekel, who, in the early 20th century, defined it as a bodily disorder that is the expression of a psychic conflict. The psychosocial origins of somatic distress have been difficult to verify; therefore, contemporary theories view somatization as the tendency to experience and communicate psychological distress in the form of physical symptoms and to seek medical help for those physical symptoms.

Manifestations of Somatization

A patient presenting with somatization may complain of symptoms—often multiple symptoms—in any body part or organ system. Chest pain, abdominal pain, headache, and backache are by far the most common presenting complaints, along with fatigue. These physical symptoms may or may not involve detectable physiological dysfunction. Some are entirely subjective and may be viewed as culture-specific idioms of distress that are used to express emotional distress or conflict within particular social worlds. Culture-specific examples of somatization include the symptom clusters associated with shenjing shuairuo in China, nervios among Latinos in the United States and Latin America, and koro in Southeast Asia. Other symptoms appear to be manifestations of actual dysfunction in the affected body part or system, such as fibromyalgia, tension headache, and irritable bowel syndrome. In some cases, a demonstrable organic disease does exist, but the patient's complaints are judged to be grossly exaggerated.

Normal and Pathological Somatization

Despite the common perception that somatization is more prevalent in certain cultural groups, cross-cultural research suggests that the tendency to experience and communicate psychological distress in the form of somatic symptoms is widespread in all cultures. About 80% of healthy individuals experience somatic symptoms in any given week. Somatization becomes a clinical problem, however, when an individual who is so predisposed attributes his or her bodily symptoms to physical illness and, as a result, seeks medical diagnosis and treatment. The condition is considered pathological when the patient persists in seeking medical evaluation and treatment in spite of repeated negative findings and reassurances that the symptoms have no physical basis. Among these patients, somatization may cause personal suffering and negatively affect family relationships. Somatization is an important matter of public health, a common cause of absenteeism, and a drain on limited medical resources. It has been estimated that one-fifth of all medical expenses are for patients who somatize or have hypochondriacal concerns. This has been described as medicine's unresolved problem.

Theories and Empirical Studies on Somatization

Somatization can be attributed to multiple causes. Empirical studies suggest that both genetic factors and environmental stresses contribute to somatization.

Somatization, Depression, and Anxiety

Studies have uncovered an association between somatization and depression: Depressed patients tend to have more somatic symptoms than nondepressed individuals, and somatizers tend to be more depressed than patients with physical disease. Somatization has also been described as masked depression. However, there is no conclusive evidence that somatization is a true depressive equivalent, meaning that it has the same etiology, course, and response to treatment.

Similarly, some writers have asserted that somatic sensations are the bodily manifestations of anxiety states. In a correlation study with neurotic patients, somatic symptoms were more strongly associated with anxiety than with depression. Across studies, there is a consistent relationship between emotional and somatic symptoms. Numerous drug studies have shown that somatic symptoms decrease in number and severity when the underlying anxiety or depressive disorder remits, suggesting that somatic symptoms are an integral part of these emotional states rather than a replacement.

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