Somatization is the expression of psychological or emotional factors as physical (somatic) symptoms. For example, stress can cause some people to develop headaches, chest pain, back pain, nausea or fatigue. Disorders where somatization manifests range from somatic symptom disorder (previously called somatization disorder) to malingering.

People with these disorders always focus on their physical problems, meaning they often seek medical advice and treatment, as opposed to seeking psychiatric care.

Somatic Symptom Disorder and Related Disorders

With somatization disorders, patients experience ongoing physical symptoms that are linked to excessive or poorly adapted thinking, feeling and behavior in response to the physical problems. Patients are often distressed and have difficulty functioning socially, at work, or academically. These disorders include the following:

• Somatic symptom disorder
• Illness anxiety disorder
• Conversion disorder
• Factitious disorder
• Psychological factors affecting other medical conditions

Of these conditions, the two most common are somatic symptom disorder and illness anxiety disorder.

Somatic Symptom Disorder

Somatic symptom disorder is characterized by ongoing physical problems that are associated with unhealthy thinking, feeling and behavior as a response to those physical complaints. The symptoms are genuinely experienced, although a medical condition may or may not be present. Doctors generally diagnose the condition based on the patient’s history and the focus of treatment is a supportive and ongoing doctor−patient relationship, with avoidance of exposure to any treatments or tests that are not needed.

Illness Anxiety Disorder

Illness anxiety disorder describes when a person is preoccupied and scared of becoming seriously ill. The condition is diagnosed when the fears and symptoms (if present) continue for 6 months or more, even after the patient has been medically evaluated and has received reassurance as to the absence of any physical illness. Treatment is focused on a strong doctor−patient relationship, possibly accompanied by the use of behavioral therapy and selective serotonin reuptake inhibitors.

Conversion Disorder

Conversion disorder refers to nervous system symptoms that typically involve motor or sensory function such as poor coordination or balance, limb paralysis, weakness, blindness, deafness, loss of sensation, unresponsiveness, difficulty swallowing or urinary retention.

Symptom onset typically occurs in response to a stressful event. Diagnosis is based on the exclusion of any underlying medical condition that could cause the symptoms. The condition tends to develop during late childhood or early adulthood and it is more common among women than men. Conversion disorder can develop as a result of psychological conflict. Someone who feels an urge to strike someone, but does not believe in violence, for example, may suddenly experience numbness in the arms.

Factitious Disorder

This refers to the falsification of mental or physical symptoms by appearing ill or by inflicting self-injury in the absence of any clear motive to falsify symptoms. Such motives might include avoiding a lawsuit, getting time away from work, or obtaining disability benefit. As well as falsifying symptoms, the person may also interfere with tests in order to persuade others that medical intervention such as surgery is required. A person with this disorder may be aware that they are falsifying symptoms but not know why they are behaving this way, or may not see the behavior as a problem. This disorder is difficult to identify and treat, but intervention is crucial to prevent any serious injury caused by the behavior.

Psychological Factors Affecting Other Medical Conditions

This is diagnosed when mental or behavioral factors have a negative impact on the outcome of an existing medical problem such as diabetes or heart disease, thus increasing the risk of suffering, death, disability and hospitalization. Examples of such factors include denial of the severity or significance of symptoms, failing to adhere to treatments or unwillingness to undergo testing. Features of this condition include treatment failure and the exacerbation of medical conditions. Intervention approaches include psychotherapy and patient education.

Malingering

This is the intentional falsification of mental or physical complaints in the presence of an incentive, such as obtaining drugs of abuse, getting time away from work, or avoiding military service, thereby differentiating it from factitious disorder. This condition is challenging for clinicians to manage since the conventional model of patient care is based on a doctor−patient relationship that assumes patients are being genuine. Clinicians can therefore feel uneasy about evaluating a patient for malingering.

A diagnosis of malingering is made based on the exclusion of any medical problem after a thorough evaluation of the patient’s history, psychological status and appropriate laboratory investigations.