Somatization disorder and the somatoform spectrum

What it is

Somatoform disorders are those in which the patients have no conscious control over their unexplained somatic symptoms. There are five types.

• Somatization disorder: multiple chronic complaints from a variety of organ systems.
• Conversion disorder: motor or sensory losses that are incompatible with a neurologic process and are closely related to a stressful event.
• Hypochondriasis: preoccupation with a specific disease.
• Body dysmorphic disorder: preoccupation with an imagined physical defect, typically seen in dermatology and plastic surgery offices.
• Pain disorder: pain symptoms inconsistent with a physiologic process, frequently associated with depression.

Undifferentiated somatoform disorder is also grouped in this class. Somatization disorder itself is characterized by numerous physical complaints that cannot be explained by any medical condition and that involve most of the organ systems, and it affects mostly women.

How it is diagnosed

According to the DSM-IV-TR, the complaints must consist of four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom. These somatic complaints begin before the age of 30, must occur over a period of several years, and result in medical treatment or cause significant impairment in areas of functioning. There cannot be any evidence that the symptoms are feigned or intentionally produced; where there is, the patient would more appropriately be diagnosed with factitious disorder or malingering.

Hypochondriasis is the one to keep apart from it. It is marked by an overreaction to minor physical symptoms or sensations. These patients usually do not complain of disabling pain and are more focused on the development of one severe condition rather than multiple conditions, as is the case in somatization disorder.