Disorders and Treatment
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A person with somatization disorder has numerous physical symptoms over many years that suggest the person has a medical illness, but the symptoms cannot be explained fully by a medical diagnosis. The symptoms, called somatic complaints, cause significant distress or impair the person's ability to function. The symptoms are real: The patient is not "faking," and the symptoms are not under the person's conscious control.
People with somatization disorder have multiple complaints over many years, involving several different areas of the body. For example, the same person might complain of back pain, headaches, chest discomfort, and gastrointestinal or urinary distress. Sexual complaints are common, such as irregular menstruation in women or erectile dysfunction (impotence) in men. The person may:
- Describe symptoms in dramatic and emotional terms
- Seek care from more than one physician at the same time
- Describe symptoms in vague terms
- Lack specific signs of medical illness
- Have complaints that medical tests fail to support
Some people who have a medical illness describe their problems in dramatic terms, so drama itself does not necessarily mean the person has somatization disorder.
People with somatization disorder get sick, too, so sometimes they have symptoms that can be explained by a medical illness.
A person with this disorder also may have symptoms of anxiety and depression. The person may begin to feel hopeless and attempt suicide, or may develop a personality disorder because of difficulty adapting to the stresses of life. The person also may start abusing alcohol or drugs, and may request prescription medications, such as painkillers and anti-anxiety drugs.
Spouses and other family members may become distressed because the person's symptoms continue for long periods of time with no explanation.
The types of symptoms a person with this disorder develops vary among cultures. Cultural factors also affect the proportions of men and women with the disorder. For example, somatization disorder rarely is seen in men in the United States, but is more common in Greek men.
Female relatives of people with somatization disorder are more likely to develop the disorder. Male relatives are more likely to develop alcoholism and personality disorder.
Symptoms usually occur over many years. The person may be distressed and function poorly at work and at home. Either medical evaluation does not explain the symptoms, or the symptoms exceed what would be expected in any medical illness that is found. Symptoms include:
- Pain - Including headache, back ache, stomach ache, joint pain and chest pain.
- Gastrointestinal symptoms - Nausea, vomiting, diarrhea.
- Sexual symptoms - Erectile dysfunction, problems with menstruation.
- Neurological symptoms - For example, problems with coordination or balance, paralysis, numbness, weakness, vision problems or seizures.
There are no specific laboratory tests to determine whether a person has somatization disorder. The doctor may suspect somatization when a person has multiple somatic complaints over a period of years, with little evidence of medical illness. If a doctor believes a person has somatization disorder, he or she should screen the person for depression and anxiety.
Somatization disorder is a chronic (long-lasting) problem. The disorder usually starts before the age of 25 or 30, although it can begin in adolescence. It can last for many years.
There is no way to prevent this disorder. But a correct diagnosis of somatization can help the person avoid excessive medical testing. This is a challenge for the person with the disorder and the doctor, because new symptoms could be caused by a medical problem, rather than somatization disorder.
When possible the doctor will try to provide some relief of the physical symptoms that stem from somatization disorder. But in most cases, treatment is aimed at coping with secondary problems, such as problems with work and social functioning and any accompanying anxiety or depression. A combination of supportive psychotherapy and medication, such as an antidepressant, can help.
At first, it may be difficult for a person with somatization disorder to accept a referral to a mental health professional. It can be very difficult for a person with this disorder to accept that medical evaluation and treatment cannot relieve the symptoms. Doctors sometimes don't realize how frustrating the syndrome can be for the patient. Ideally, a primary care physician and mental health professional will work together, so that the person's physical symptoms can be evaluated while he or she also gets help managing the frustration of not having a clear diagnosis or treatment plan. The focus should be on areas in which help is possible: treating possible anxiety and depression, managing conflict at home, and finding ways to help the person to function better.
The person with somatization disorder probably will have contacted primary care physicians and various medical specialists. However, treatment by a mental health professional is recommended to help the person deal with the consequences of the disorder - exposure to unnecessary medical tests and treatment, poor functioning and stormy relationships. People with this disorder should be encouraged to seek psychotherapy for their life problems and to consider taking medications for depression or anxiety.
Medications may provide some relief. Psychotherapy tends to proceed slowly, because the person usually has been living with the disorder for a long time prior to starting treatment. It is difficult to give up long-standing patterns of behavior, but with persistence and support, progress is possible.
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