Somatization Disorder, Essays (university) of Medicine

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Somatization Disorder

CHAPTER I

INTRODUCTION

Somatoform disorders are a group of psychiatric disorders, in which patients present with a large number of unexplained physical symptoms. These disorders include somatization disorder, hypochondriasis, conversion disorder and other unspecified somatoform disorders. These disturbances cause emotional distress to the patient and are a challenge for the family doctor.^1 There are three clinical criteria required to meet a somatoform disorder: (1) clinical symptoms that cannot be fully explained by a medical condition, other mental disorder, or the effects of a substance; (2) not caused by a factitious disorder or malingering disorder; (3) and causes significant impairment in social, occupational and other functions. In patients with somatization disorder, unexplained physical symptoms begin before age 30 and persist for several years and include at least two gastrointestinal complaints, four painful symptoms, one pseudoneurologic symptom, and one sexual symptom.^1 This reference is made to increase knowledge regarding the definition, causes, prevalence, diagnosis, differential diagnosis and management of somatization disorder.

somatic symptoms that they believe to be evidence of disease. In some individuals, this belief persists despite negative laboratory results and doctors reassuring them that there is nothing wrong with them. Patients with somatic symptom disorder often experience symptoms of depression and anxiety.7, The following are the diagnostic criteria for somatic symptom disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V):7,

1. One or more somatic symptoms causing distress or interference with daily life.
2. Excessive thoughts, feelings or behaviors related to somatic symptoms, or associated with a feeling of concern for health as reflected by at least one of: a. Persistent thoughts about the seriousness of the symptoms. b. Persistent severe anxiety about your health or symptoms. c. Excessive time and energy devoted to worrying about symptoms or health.
3. Although one of the somatic symptoms may not last until recently, the symptomatic state is persistent (usually longer than 6 months). C. Somatization Disorder in DSM-IV TR The hallmark of somatization disorder is a clinically significant, recurrent, and multiple pattern of somatic complaints. Somatic complaints are considered clinically significant if they warrant medical attention or cause significant

impairment in social, occupational, or other important areas of functioning. The following are the diagnostic criteria for somatization disorder in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM- IV TR):^10

1. Many had a history of physical complaints beginning before the age of 30 years that persisted for several years and led to treatment seeking or significant impairment in social, occupational, or other important areas of functioning.
2. Each of the following criteria must be present, with individual symptoms occurring at any time during the disturbance: a. Four pain symptoms: history of pain in four different sites or functions (eg, head, abdomen, back, joints, extremities, chest, rectum, during menstruation or during urination). b. Two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (eg, nausea, bloating, vomiting not caused by pregnancy, diarrhea, or intolerance to some foods). c. One sexual symptom: at least one history of sexual or reproductive symptoms other than pain (eg, erectile or ejaculatory disorders, irregular menstrual cycles, heavy periods). d. One pseudoneurological symptom: at least one history of neurologic symptom or deficit other than pain (conversion symptoms such as impaired coordination or balance, paralysis, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or

that teaching from parents and culture teaches children to use somatization. Social, cultural and ethnic factors are also involved in the development of somatization symptoms.

2. Biological factors Genetic data indicate the presence of genetic transmission in somatization disorder. Occurs in 10-20% of women, while their brothers tend to be substance abusers and antisocial personality disorder. In monozygotic twins occurs 29% and 10% dizygotic. E. Prevalence The prevalence of somatic symptom disorder in the general population is estimated at 5-7%, which makes it the most common category that occurs in patients in primary health care facilities. It is estimated that about 20-25% of patients who present with acute somatic symptoms will develop chronic somatic disease. This disorder can begin in childhood, adolescence or adulthood. Women more often experience somatic symptom disorder than men, with a ratio of 10:1.^12 F. Differential Diagnosis If the somatic symptoms are consistent with those of another mental disorder (eg, panic disorder), and the diagnostic criteria are met, then that mental disorder should be considered as an alternative or additional diagnosis.7,

1. Other medical conditions The presence of somatic symptoms of unclear etiology is not sufficient to establish the diagnosis of somatic symptom disorder. The symptoms in many individuals with disorders such as irritable bowel syndrome or fibromyalgia will not meet the criteria necessary to diagnose somatic symptom disorder. Conversely, the presence of somatic symptoms of an established medical disorder (eg diabetes or heart disease) does not rule out the diagnosis of somatic symptom disorder if the criteria are met.
2. Panic disorder In panic disorder, somatic symptoms and anxiety about one's health tend to be present in acute episodes, whereas in somatic symptom disorder, the anxiety and somatic symptoms are more persistent.
3. Generalized anxiety disorder Individuals with generalized anxiety disorder worry about events, situations, or activities and have little anxiety about their health. The primary focus is usually not somatic symptoms or fear of illness, as is the case with somatic symptom disorder.
4. Depressive disorder Depressive disorders are usually accompanied by somatic symptoms. However, depressive disorders are distinguished from somatic symptom

In somatic symptom disorder, recurrent thoughts about somatic symptoms or illness are less intrusive, and individuals with this disorder do not show an association with repetitive behaviors aimed at reducing anxiety, as occurs in obsessive-compulsive disorder. G. Governance Treatment should be done by one doctor, because if it is done by more than one doctor, the patient will have more opportunities to express his somatic complaints. The meeting interval is once a month. Although a physical examination should be performed for any new somatic complaints, the doctor or therapist should listen to somatic complaints as an emotional expression and not as a medical complaint.11, Psychotherapy both individually and in groups will reduce spending on health care funds, especially for hospitalization. Psychotherapy helps patients deal with their symptoms, express underlying emotions and develop alternative strategies for expressing their feelings.11, Pharmacotherapy therapy is recommended if there are other disorders (comorbid). Strict supervision of drug administration must be carried out because patients with somatization disorder tend to use drugs alternately and irrationally.11,

CHAPTER III

CONCLUSION

Somatization disorder first appeared as a diagnostic criterion in the Diagnostic and Statistical Manual of Mental Disorders Third Edition (DMS-III), survivingn in DSM-IV, and changed to somatic symptom disorders(somatic symptom disorder) in the DSM-V. The diagnosis of somatic symptom disorder can be made by meeting the diagnostic criteria of the DSM-V. The etiology of somatic symptom disorder is not known with certainty but there are two theories, namely psychosocial factors and biological factors. The prevalence of somatic symptom disorder in the general population is estimated at 5-7%, approximately 20-25% of patients presenting to primary facilities will have chronic somatic disease. This disorder is more common in women than men with a ratio of 10:1. Somatic symptom disorder must be differentiated from the differential diagnosis because of the different management. Management of somatic symptom disorder centers on the physician listening to somatic symptoms as a medical symptom. Treatment centered on psychotherapy

Association. Washington DC: American Psychiatric Publishing;2013.

10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. Fourth Tex. Vol. 1, Psychiatry: Third Edition. Arlington: American Psychiatric Association; 2000.
11. SD Elvira, Hadisukando G. Textbook of Psychiatry. Key Edition. Jakarta: Publishing Board of the Faculty of Medicine, University of Indonesia; 2017.
12. Kurlansik SL, Maffei MS. Somatic Symptom Disorder. Am Acad Fam Psysicians. 2016;211–4.
13. Dimsdale J.E. Research on Somatization and Somatic Symptom Disorders.pdf. Psychosom Med. 2017;79(9):971–3.
14. Henningsen P. Management of Somatic Symptom Disorder. In: Dialogues in Clinical Neuroscience. 2018. p.m. 23–31.