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Somatization disorder

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There are many new developments regarding somatization disorder, which is among the most difficult and cumbersome of the psychiatric disorders encountered in neurology practice. Diagnostic criteria have been revised to facilitate clinical care and research. The differential diagnosis includes neurologic disorders (eg, multiple sclerosis, epilepsy), systemic medical disorders, and other psychiatric disorders (eg, mood and anxiety disorders, conversion disorder, malingering, and factitious disorder). Many patients have one or more of these illnesses comorbid with somatization disorder. Finally, somatization disorder demands creative biopsychosocial treatment planning by the neurologist, psychiatrist, and other health professionals.

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References and Recommended Reading

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  3. Cloninger CR, Sigvardsson S, von Knorring A-L, et al.: An adoption study of somatoform disorders, II: identification of two discrete somatoform disorders. Arch Gen Psychiatry 1984, 41:863–871.

    PubMed  CAS  Google Scholar 

  4. Swartz M, Landerman R, George L, et al.: Somatization disorder. In In Psychiatric Disorders in America. Edited by Robins LN, Regier D. New York: Free Press; 1990.

    Google Scholar 

  5. Smith GR: Somatization Disorder in the Medical Setting. Washington, DC: American Psychiatric Association; 1991.

    Google Scholar 

  6. Martin RL: Diagnostic issues for conversion disorder. Hosp Community Psychiatry 1992, 43:771–773.

    PubMed  CAS  Google Scholar 

  7. Cloninger CR: Somatoform and dissociative disorders. In In The Medical Basis of Psychiatry. Edited by Winokur G, Clayton, PJ. Philadelphia, PA: WB Saunders; 1986:123–151.

    Google Scholar 

  8. Johnson SK, DeLuca J, Natelson BH: Assessing somatization disorder in the chronic fatigue syndrome. Psychosomatic Medicine 1996, 58:50–57.

    PubMed  CAS  Google Scholar 

  9. Morrison J: Childhood sexual histories of women with somatization disorder. Am J Psychiatry 1989, 146:239–241.

    PubMed  CAS  Google Scholar 

  10. Xu S, Meyer D, Yoser S, et al.: Pattern visual evoked potential in the diagnosis of functional visual loss. Ophthalmology 2000, 108:76–80.

    Article  Google Scholar 

  11. Marshall JC, Halligan PW, Fink GR, et al.: The functional anatomy of a hysterical paralysis. Cognition 1997, 64:B1-B8.

    Article  PubMed  CAS  Google Scholar 

  12. Zheng Y, Lin K, Takeuchi D, et al.: An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles. Compr Psychiatry 1997, 38:249–259.

    Article  PubMed  CAS  Google Scholar 

  13. Escobar JI: Pharmacologic treatment of somatization/ hypochondriasis. Psychopharm Bull 1996, 32:589–96.

    CAS  Google Scholar 

  14. France RD, Houpt JL, Ellinwood EH: Therapeutic effects of antidepressants in chronic pain. Gen Hosp Psychiatry 1984, 6:55–63.

    Article  PubMed  CAS  Google Scholar 

  15. Richlin DM: Nonnarcotic analgesics and tricyclic antidepressants for the treatment of chronic nonmalignant pain. Mt. Sinai J Med 1991, 58:221–228.

    PubMed  CAS  Google Scholar 

  16. Benjamin S: Psychological treatment of chronic pain: a selective review. J Psychosomatic Res 1989, 33:121–131.

    Article  CAS  Google Scholar 

  17. Malone MD, Strube MJ: Meta-analysis of non-medical treatments for chronic pain. Pain 1988, 34:231–244.

    Article  PubMed  CAS  Google Scholar 

  18. Chaturvedi SK: Prevalence of chronic pain in psychiatric patients. Pain 1987, 29:231–237.

    Article  PubMed  CAS  Google Scholar 

  19. Krishnan KRR, France RD, Pelton S, et al.: Chronic pain and depression, I. Classification of depression in chronic low back pain patients. Pain 1985, 22:279–287.

    Article  PubMed  CAS  Google Scholar 

  20. Krishnan KRR, France RD, Pelton S, et al.: Chronic pain and depression, II. Symptoms of anxiety in chronic low back pain patients and their relationship to subtypes of depression. Pain 1985, 22:289–294.

    Article  PubMed  CAS  Google Scholar 

  21. Large RG: DSM-III diagnoses in chronic pain. J Nerv Ment Dis 1986, 174:295–303.

    Article  PubMed  CAS  Google Scholar 

  22. Kirmayer LJ, Robbins JM: Introduction: concepts of somatization. In Current Concepts of Somatization: Research and Clinical Perspectives. Edited by Kirmayer LJ, Robbins JM. Washington, DC: American Psychiatric Press; 1991:1–19.

    Google Scholar 

  23. Ford CV: The Somatizing Disorders: Illness as a Way of Life. New York: Elsevier; 1983.

    Google Scholar 

  24. Toone BK: Disorders of hysterical conversion. In Physical Symptoms and Psychological Illness. Edited by Bass C. London: Blackwell Scientific; 1990:207–234.

    Google Scholar 

  25. Stefansson JH, Messina JA, Meyerowitz S: Hysterical neurosis, conversion type: clinical and epidemiological considerations. Acta Psychiatr Scand 1976, 59:119–138.

    Google Scholar 

  26. Raskin M, Talbott JA, Meyerson AT: Diagnosis of conversion reactions: predictive value of psychiatric criteria. JAMA 1966, 197:530–534.

    Article  PubMed  CAS  Google Scholar 

  27. Slater ETO, Glithero C: A follow-up of patients diagnosed as suffering from ‘hysteria.’ J Psychosom Res 1965, 9:9–13.

    Article  PubMed  CAS  Google Scholar 

  28. Binzer M, Kullgren G: Motor conversion disorder: a prospective 2-to 5-year follow-up study. Psychosomatics 1998, 39:519–527. This article provided an authoritative update on outcomes of patients diagnosed with conversion disorder, in that very few are subsequently diagnosed with a neurologic disorder.

    PubMed  CAS  Google Scholar 

  29. Crimlisk HL, Bhatia K, Cope H, et al.: Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ 1998, 316:582–586.

    PubMed  CAS  Google Scholar 

  30. Couprie W, Wijdicks EFM, Rooijimans HGM, et al.: Outcome in conversion disorder: a follow-up study. J Neurol Neurosurg Psychiatry 1995, 58:750–2.

    Article  PubMed  CAS  Google Scholar 

  31. Mace CJ, Trimble MR: Ten-year prognosis of conversion disorder. Br J Psychiatry 1996, 169:282–288.

    PubMed  CAS  Google Scholar 

  32. Folks DG, Ford CV, Regan WM: Conversion symptoms in a general hospital. Psychosomatics 1984, 25:285–295.

    PubMed  CAS  Google Scholar 

  33. Barsky AJ, Wyshak G, Klerman GL: Psychiatric comorbidity in DSM-III-R hypochondriasis. Arch Gen Psychiatry 1992, 49:101–108.

    PubMed  CAS  Google Scholar 

  34. Barsky AJ, Klerman GL: Overview: hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry 1983, 140:273–283.

    PubMed  CAS  Google Scholar 

  35. Hollifield M, Tuttle L, Paine S, et al.: Hypochondriasis and somatization related to personality and attitudes toward self. Psychosomatics 1999, 40:387–395.

    PubMed  CAS  Google Scholar 

  36. Ball RA, Clare AW: Symptoms and social adjustment in Jewish depressives. Brit J Psychiatry 1990, 156:379–383.

    Article  CAS  Google Scholar 

  37. Kellner R: Psychological measurements in somatization and abnormal illness behavior. Adv Psychosom Med 1986, 17:101–118.

    Google Scholar 

  38. Kellner R: Hypochondriasis and somatization. JAMA 1987, 258:2718–2722.

    Article  PubMed  CAS  Google Scholar 

  39. Hilty DM, Gill M, Biegler KA: Hypochondriasis. In eMedicine Textbook of Medicine, Surgery, OB/GYN and Psychiatry. Edited by Zevitz M. St. Petersburg, FL: eMedicine Inc.; 2001.

    Google Scholar 

  40. Barsky AJ: Hypochondriasis: medical management and psychiatric treatment. Psychosomatics 1996, 37:48–56. This is a brief summary of the epidemiology, diagnosis, and practical management of hypochondriasis, serving as a compilation of his many articles and books on the disorder.

    PubMed  CAS  Google Scholar 

  41. Ochoa JL: Truths, errors, and lies around “reflex sympathetic dystrophyrd and ”complex regional pain syndromerd. J Neurol 1999, 246:875–879.

    Article  PubMed  CAS  Google Scholar 

  42. Brown FW, Golding JM, Smith GR: Psychiatric comorbidity in primary care somatization disorder. Psychosom Med 1990, 52:445–451.

    PubMed  CAS  Google Scholar 

  43. Katon W, Ries RK, Kleinman A: A prospective DSM-II study of 100 consecutive somatization patients (part II). Compr Psychiatry 1984, 25:305–314.

    Article  PubMed  CAS  Google Scholar 

  44. Liskow B, Othmer E, Penick EC, et al.: Is Briquet’s syndrome a heterogeneous disorder? Am J Psychiatry 1986, 143:626–629.

    PubMed  CAS  Google Scholar 

  45. Liskow B, Penick EC, Powell BJ, et al.: Inpatients with Briquet’s syndrome: presence of additional psychiatric syndromes and MMPI results. Compr Psychiatry 1986, 27:461–470.

    Article  PubMed  CAS  Google Scholar 

  46. Kroenke K, Spitzer RL, Williams JBW, et al.: Physical symptoms in primary care: predictors of psychiatric disorders and functional impairment. Arch Fam Med 1994, 3:774–779.

    Article  PubMed  CAS  Google Scholar 

  47. Rost K, Akins RN, Brown FW, et al.: The comorbidity of DSM-III-R personality disorders in somatization disorder. Gen Hosp Psychiatry 1992, 14:322–326.

    Article  PubMed  CAS  Google Scholar 

  48. Bridges KW, Goldberg DP: Somatic presentation of DSM-III psychiatric disorders in primary care. J Psychosom Res 1985, 29:563–569.

    Article  PubMed  CAS  Google Scholar 

  49. Kirmayer LJ, Robbins JM, Dworkind M, et al.: Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry 1993, 150:734–741.

    PubMed  CAS  Google Scholar 

  50. Smith GR, Monson RA, Ray DC: Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med 1986, 314:1407–1413.

    Article  PubMed  Google Scholar 

  51. Murphy GE: The clinical management of hysteria. JAMA 1982, 247:2559–2564.

    Article  PubMed  CAS  Google Scholar 

  52. Quill TE: Somatization disorder: one of medicine’s blind spots. JAMA 1985, 254:3075–3079.

    Article  PubMed  CAS  Google Scholar 

  53. Dunner D, Myers J, Khan A, et al.: Adinazolam-a new antidepressant: findings of a placebo controlled, double-blind study in outpatients with major depression. J Clin Psychopharmacol 1987, 7:170–172.

    Article  PubMed  CAS  Google Scholar 

  54. Broderick PA, Hope O, Jeannot P: Mechanism of triazolo-benzodiazepine and benzodiazepine action in anxiety and depression: behavioral studies with concomitant in vivo CA1 hippocampal norepinephrine and serotonin release detection in the behaving animal. Progress Neuro-Psychopharm Biol Psychiatry 1998, 22:353–386.

    Article  CAS  Google Scholar 

  55. Singh AN, Nair NP, Suranyi-Cadotte B, et al.: A double blind comparison of alprazolam and amitriptyline hydrochloride in the treatment of nonpsychotic depression. Can J Psychiatry 1988, 33:218–222.

    PubMed  CAS  Google Scholar 

  56. Hales RE, Hilty DM, Wise MG: A treatment algorithm for the management of anxiety in primary care practice. J Clin Psychiatry 1997, 58:76–80.

    PubMed  CAS  Google Scholar 

  57. Hilty DM, Hales RE, Wise MG, Kunkel EJS: A rational selection of antidepressants for the treatment of depression in primary care practice. Primary Psychiatry 1999, 6:56–74.

    Google Scholar 

  58. Gelenberg AJ, Lydiard RB, Rudolph RL, et al.: Efficacy of venlafaxine extended-release capsules in nondepressed outpatients with general anxiety disorder. JAMA 2000, 283:3082–3088.

    Article  PubMed  CAS  Google Scholar 

  59. Rocca P, Fonzo V, Scotta M, et al.: Paroxetine efficacy in the treatment of generalized anxiety disorder. Acta Psych Scand 1997, 95:444–450.

    CAS  Google Scholar 

  60. Schatzberg AF: New indications for antidepressants. J Clin Psychiatry 2000, 61(suppl) 11:9–17.

    Article  PubMed  CAS  Google Scholar 

  61. Drossman DA: Evaluation and care of medical patients with psychosocial disturbances. Ann Intern Med 1978, 88:366–372.

    PubMed  CAS  Google Scholar 

  62. Goldberg DP, Steele J, Smith C: Teaching psychiatric interview techniques to general practitioners. Acta Psychiat Scand 1979, 62:41–47.

    Google Scholar 

  63. Goldberg DP, Gask L, O’Dowd T: The treatment of somatization: teaching techniques of reattribution. J Psychosom Res 1989, 33:689–695.

    Article  PubMed  CAS  Google Scholar 

  64. Bursztajn H, Barsky AJ: Facilitating patient acceptance of a psychiatric referral. Arch Intern Med 1985, 145:73–75.

    Article  PubMed  CAS  Google Scholar 

  65. Kashner TM, Rost K, Smith GR, et al.: An analysis of panel data, the impact of a psychiatric consultation letter on the expenditures and outcomes of care for patients with somatization disorder. Med Care 1992, 30:811–821.

    Article  PubMed  CAS  Google Scholar 

  66. Rost K, Kashner TM, Smith GR: Effectiveness of psychiatric intervention with somatization disorder patients: improved outcomes at reduced costs. Gen Hosp Psychiatry 1994, 16:381–387.

    Article  PubMed  CAS  Google Scholar 

  67. Smith GR, Rost K, Kashner TM: A trial of standardized psychiatric consultation on health outcomes and costs in somatizing patients. Arch Gen Psychiatry 1995, 52:238–243.

    PubMed  Google Scholar 

  68. Katon W, Kleinman A, Rosen G: Depression and somatization: a review, part I. Am J Med 1982, 72:127–135.

    Article  PubMed  CAS  Google Scholar 

  69. Katon W, Kleinman A, Rosen G: Depression and somatization: a review, part II. Am J Med 1982, 72:241–247.

    Article  PubMed  CAS  Google Scholar 

  70. Kashner TM, Rost K, Cohen B, et al.: Enhancing the health of somatization disorder patients: effectiveness of short-term group therapy. Psychosomatics 1995, 36:462–470.

    PubMed  CAS  Google Scholar 

  71. Goodwin DW, Guze SB: Psychiatric Diagnosis, edn 4. New York: Oxford University Press; 1989.

    Google Scholar 

  72. Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale. Psychopharm Bull 1973, 1:13–28.

    Google Scholar 

  73. Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988, 8:77–100.

    Article  Google Scholar 

  74. Radloff LS: The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977, 1:385–401.

    Article  Google Scholar 

  75. Zung WWK: A rating instrument for anxiety disorders. Psychosomatics 1971, 12:371–379.

    PubMed  CAS  Google Scholar 

  76. Beck AT, Steer RA. The Beck Anxiety Inventory. San Antonio, TX, The Psychological Corporation, 1990.

    Google Scholar 

  77. Pilowsky I, Spence ND: Manual for the Illness Behavior Questionnaire (IBQ). Adelaide, South Australia: University of Adelaide Press; 1981.

    Google Scholar 

  78. Pilowsky I, Murrell PGC, Gordon A: The development of a screening method for abnormal illness behavior. J Psychosom Res 1979, 23:203–207.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of California, Davis, 2230 Stockton Boulevard, 95817, Sacramento, CA, USA

    Donald M. Hilty MD, James A. Bourgeois MD, Celia H. Chang MD & Mark E. Servis MD

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  1. Donald M. Hilty MD
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  2. James A. Bourgeois MD
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  3. Celia H. Chang MD
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  4. Mark E. Servis MD
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Hilty, D.M., Bourgeois, J.A., Chang, C.H. et al. Somatization disorder. Curr Treat Options Neurol 3, 305–320 (2001). https://doi.org/10.1007/s11940-001-0036-3

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