Somatization disorder - Tips from Other Journals

Date: Sept, 1991

Patients with somatization disorder have numerous physical complaints without an identifiable organic disease. These patients may represent as many as 40 percent of an outpatient family practice population and are among the most challenging patients seen in primary care. Smith reviews the diagnosis and management of patients with somatization disorder.

Once a patient with multiple somatic symptoms is found to have no organic disease to explain the symptoms, a diagnosis of somatization disorder may be considered. A widely used classification for somatization disorder is given in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). This classification requires the presence of at least 13 different somatic symptoms to establish the diagnosis. However, the majority of patients have multiple somatic symptoms but do not have all of the symptoms in the criteria.

Management Guidelines for Somatization Disorder

1. Development of realistic goals

2. Establishment and maintenance of a healthy relationship

3. Confident communication to the patients regarding information about the evaluation in somatic terms

4. Negotiation of a care plan

5. Prescription of indicated nonaddicting agents and physical measures on a time-contingent basis

6. Regular, brief follow-up by one physician that includes pertinent physical examination(*)

7. Supportive and behavioral treatment

8. Selected referral with adequate preparation of the patient

Most patients with somatization disorder are women, and the disorder generally begins before 30 years of age. Additional psychiatric disorders, such as depression and anxiety, are common.

The author points out that there is no specific cure for somatization disorder. However, most patients can be treated successfully. The table lists management guidlines that have been found to be useful. (Journal of General Internal Medicine, March/April 1991, vol. 6, p. 168.)

(*) Follow-up has been shown to be effective in several prospective studies of somatization disorder.

From Smith RC. Somatization disorder: defining its role in clinical medicine. J Gen Intern Med 1991;6:168-75. Used with permission.

COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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