Somatization Disorder

The most common characteristic of the somatoform disorder is the appearance of physical symptoms or complaints for which they have no organic basis. Such dysfunctional symptoms tend to range from sensory or motor disability, hypersensitivity to pain. Four major somatoform disorders exist: conversion disorder (also known as hysteria), hypochondriasis, somatization disorder, and somatoform pain disorder. Somatization disorder is also known as Briquet's Syndrome.

Starting before age thirty, the patient has had many physical complaints occurring over several years and has sought treatment for these symptoms, or they have materially impaired social, work or personal functioning. The patient has at some time experienced a total of at least 8 symptoms from the following list for which the symptoms need not be concurrent.

PAIN SYMPTOMS (4 or more) related to different sites, such as head, abdomen, back, joints, extremities, chest or rectum, or related to body functions such as menstruation, sexual intercourse or urination.

GASTROINTESTINAL SYMPTOMS (2 or more, excluding pain) such as nausea, bloating, vomiting (not during pregnancy), diarrhea, intolerance of several foods.

SEXUAL SYMPTOMS (at least 1, excluding pain) including indifference to sex, difficulties with erection or ejaculation, irregular menses, excessive menstrual bleeding or vomiting throughout all nine months of pregnancy.

PSEUDONEUROLOGICAL SYMPTOMS (at least 1) including impaired balance or coordination, weak or paralyzed muscles, lump in throat or trouble swallowing, loss of voice, retention of urine, hallucinations, numbness (to touch or pain), double vision, blindness, deafness, seizures, amnesia or other dissociative symptoms, loss of consciousness (other than with fainting). None  of these is limited to pain.

For each of the above symptoms, one of these conditions must be met:

Physical or laboratory investigation determines that the symptom cannot be fully explained by a general   medical condition or by substance use, including medications and drugs of abuse, or

If the patient does have a general medical condition, the impairment or complaints exceed what you would expect, based on history, laboratory findings or physical examination.

The patient doesn't consciously feign the symptoms for material gain (Malingering) or to occupy the sick role (Factitious Disorder).

Symptoms:

Vomiting.
Abdominal Pain.
Nausea.
Bloating.
Diarrhea.
Pain in the arms or legs.
Back Pain.
Joint pain.
Pain during urination.
Headaches.
Shortness of breath.
Palpitations.
Chest Pain.
Dizziness.
Amnesia.
Difficulty swallowing.
Vision changes.
Paralysis or muscle weakness.
Sexual apathy
Pain during intercourse
Impotence
painful menstruation
Irregular menses
Excessive menstrual bleeding
Discussion of other aspects of life may cause anxiety

Note: A variety of symptoms may be present at any given time.

Associated Features:

Many somatic complaints and long, complicated medical histories.
Psychological distress and interpersonal problems are prominent>
Medical histories are often circumstantial, vague, imprecise, inconsistent and disorganized.

Differential Diagnosis:

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

None psychiatric medical conditions that may explain the symptoms.

Causes:

The cause is not specific but symptoms begin or worsen after losses (for example, job, close relative, or friend). A greater intensity of symptoms often occurs with stress.

Treatment:

The goal of treatment is to help the person learn to control the symptoms.

A supportive relationship with a sympathetic health care provider is the most important aspect of treatment. Regularly scheduled appointments should be maintained to review symptoms and the person's coping mechanisms.

Acknowledgment and explanation of test results should occur. It is not helpful to tell the people with this disorder that their symptoms are imaginary. People with a somatization disorder rarely acknowledge that their illness has a psychological component and will usually reject psychiatric treatment.