Sharon Smith-Kemper
Somatization
disorder (SD) is a psychiatric condition listed in the Diagnostic and statistical manual of
mental disorders
(4th ed.)—Text revision (DSM IV-TR). It is characterized by many somatic-symptoms
that cannot be sufficiently explained through
medical tests or physical examinations alone.
According
to the DSM-IV, to be diagnosed
with SD, symptoms must begin prior to the age of
30, and patients must complain of at least four pain
symptoms. The pain history must be related to at least four different sites on the body (e.g., head, abdomen,
back, joints, extremities, chest, and rectum) or functions (e.g., menstruation, sexual intercourse,
urination).
To
meet diagnostic criteria, these four pain symptoms cannot be the result of a
medical condition but must consist of at least two gastrointestinal symptoms,
one sexual symptom, and one pseudo-neurological symptom. Laboratory or physical examinations by a physician must not offer adequate medical explanations
to the origins or causes of these symptoms.
Even
though the cause of SD is
unknown and somatic complaints are numerous, the
pain is often real. The pain is genuinely felt
by the afflicted person and the symptoms can significantly
influence the individual’s social, occupational, and daily functioning levels.
SD
is one of five somatoform disorders, the others being conversion, pain, hypochondriacal,
and dysmorphophobic disorders.
The
common characteristics of Somatoform Disorders are the tendency for individuals who suffer from these disorders to experience emotional or
psychosocial stressors in the form of physical ailments.
Somatoform disorders share some similar features,
such as patients presenting with somatic complaints, an absence of an
identifiable medical cause, and an often-unstated
psychological root. SD often occurs when mental states and
experiences of an individual are expressed as bodily symptoms.
There
is much evidence-based
research that demonstrates how stress can have
an impact on the body and lead to health problems.
However, SD is not just one ailment, but a compilation
of many symptoms or conditions that have no
identifiable cause. SD is a common condition in
urban environments, with a prevalence rate of
about 15%, however, it affects only about 2% of
the population in general.
According to the American Psychiatric Association
statistics for 2005, SD is diagnosed more frequently
in women (about 0.2–2%) than men (less than
0.2%). Women with SD outnumber men 5–20 times,
but these high estimates may be due to the
tendency not to diagnose SD in male patients. The
disorder is also inversely related to social
position and occurs most often among individuals who are less educated and of
lower income.
One
major issue with an SD diagnosis is that due to the physical nature of the complaints, individuals with SD often continuously seek medical care rather
than psychological services. Patients with SD do become
ill and their medical problems need to be diagnosed and
treated appropriately.
Physicians
can assist patients by encouraging
them to seek psychological services for their mental
health needs. If the medical and psychiatric professionals work in tandem to
provide a more holistic approach to patient services, both professions benefit.
A
dual based mode of intervention that considers both the physical and mental states of
patients is a first step toward greater
collaboration. Proper training and a change in
treatment focus can encourage professionals to spend more time exploring
potential problem areas instead of focusing entirely on the body. A
more bio-psychosocial mode of treatment supports communication between professionals,
while facilitating a more empowered client population. Separating the mind from the body in diagnosis can be a disservice to
patients.
Cultural
competence and barriers to
treatment also need to be considered when treating minority populations with SD. The medical community needs to
be made aware that patients from minority or culturally distinct populations
often go to their primary care physicians with
physical complaints. In addition, low-income families may not have primary
care physicians to treat their illnesses since many low paying jobs do not provide health benefits. Hence,
emergency services may be their main route for medical treatment or interventions.
Misdiagnosis of SD can greatly influence patients, including personal health care expenditures and a loss of personal control over their lives. When patients continue to seek out medical explanations for a disorder that needs to be treated psychologically, the result is often an increase in anxiety, depression, and feelings of helplessness. An accurate diagnosis of SD can begin the process of alleviating such symptoms.
The
appropriate diagnosis also helps clients validate their feelings and begin the healing
process, while a relentless search in the wrong
direction can contribute to patient self-doubt about their own beliefs and
healthy functioning. In psychotherapeutic settings,
patients have the opportunity to learn different coping
strategies to better manage particular situations while
also exploring how to express feelings and identify
the underlying roots of their problems.
A
huge barrier to SD treatment is language. This can be addressed by providing patients with a
way to communicate their needs or symptoms through their own cultural frameworks. This can be accomplished through mandatory policies that require easy access to interpreters
that understand not just language translations but
also cultural beliefs. Somatic complaints are expressed
differently in different cultures. Cultural competence training will help
professionals in their evaluation of patients from cultures different than
their own.
Suggested Reading
Aleksandar, J., & Mohan, I. (1996). Somatization: A culture bound or universal syndrome? Journal of Mental Health, 5(3), 219–225.American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders-text revision (4th ed). Washington, D.C.: Author.
Fall, K. (2005). Somatization disorder: A proposed Adlerian conceptualization and treatment. Journal of Individual Psychology, 61(2),149–160.
Suggested Resources
Chronic Fatigue Syndrome—http://www.cfsdoc.org/somat.htm: This website provides information and resources about somatization disorder, specifically chronic fatigue syndrome.
Cultural
Competency website—http://cecp.air.org/cultural/: This website provides links
and resources concerning cultural competency
References
C.
S. Clauss-Ehlers (Ed.), Encyclopedia of Cross-Cultural School
Psychology, DOI 10.1007/978-0-387-71799-9, Springer
Science+Business Media LLC 2010
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