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A proportion
of those symptoms that are medically unexplained will be associated
with psychological factors, with depressive, anxiety and somatoform
disorders being the most common. Indeed, most patients with these
common mental disorders present with physical rather than emotional
complaints (Kroenke
et al.,1997a; Simon
et al.,1999) -- a characteristic which defines somatization.
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Definition
of Somatization
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Somatization
is the presentation of physical symptoms as a manifestation
of psychological distress.
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Even when
psychiatric comorbidity is present, one cannot automatically conclude
that the symptom is caused by the psychiatric disorder. The individual
with persistent back pain or chronic fatigue may become depressed
or anxious, just as depression or anxiety may heighten the experience
and reporting of multiple physical symptoms.
Thus, unless
the temporal relationship of the physical symptoms and
psychological distress is clear (i.e. which came first), it is
often preferable to remain "etiologically neutral".
In other words, it may be better to consider the pain and anxiety,
or the fatigue and depression, as comorbid conditions rather
than presume that one is causal.
However, not
all medically unexplained symptoms are linked to psychological
factors. Symptoms such as fatigue, headache, musculoskeletal pains,
sleep disturbances, and gastrointestinal symptoms are nearly ubiquitous
in the general population, and most symptomatic persons do not
seek health care (Green
et al., 2001).
Many factors
may precipitate illness worry, symptom reporting, and health care
visits, including:
- Symptom
severity and persistence;
- Patient
concerns about the meaning and prognosis of the symptom;
- Excessive
attention to or amplification of the symptom;
- Personal
and family experiences; and
- Other cognitive
and behavioral factors.
Thus, somatization
can also be considered in a broader, more etiologically neutral
definition, namely, the experiencing and reporting of physical
symptoms not clearly explicable in terms of a precise medical
diagnosis or disorder.
Lipowski offers
a useful definition of somatization which comprises four key criteria
as illustrated in Figure 2.1 (Lipowski,1988).
| Figure
2.1: Somatization Criteria
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