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. 2002 Aug;110(Suppl 4):637–640. doi: 10.1289/ehp.02110s4637

Somatization in survivors of catastrophic trauma: a methodological review.

Carol S North 1
PMCID: PMC1241218  PMID: 12194899

Abstract

The literature on mental health effects of catastrophic trauma such as community disasters focuses on posttraumatic stress disorder. Somatization disorder is not listed among the classic responses to disaster, nor have other somatoform disorders been described in this literature. Nondiagnostic "somatization," "somatization symptoms," and "somatic symptoms" form the basis of most information about somatization in the literature. However, these concepts have not been validated, and therefore this work suffers from multiple methodological problems of ascertainment and interpretation. Future research is encouraged to consider many methodological issues in obtaining adequate data to address questions about the association of somatization with traumatic events, including a) appropriate comparison groups, b) satisfactory definition and measurement of somatization, c) exclusion of medical explanations for the symptoms, d) recognition of somatizers' spurious attribution of symptoms to medical causes, e) collection of data from additional sources beyond single-subject interviews, f) validation of diagnosis-unrelated symptom reporting or reconsideration of symptoms within diagnostic frameworks, g) separation of somatization after an event into new (incident) and preexisting categories, h) development of research models that include sufficient variables to examine the broader scope of potential relationships, and i) novel consideration of alternative causal directionalities.

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Selected References

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  1. Bravo M., Rubio-Stipec M., Canino G. J., Woodbury M. A., Ribera J. C. The psychological sequelae of disaster stress prospectively and retrospectively evaluated. Am J Community Psychol. 1990 Oct;18(5):661–680. doi: 10.1007/BF00931236. [DOI] [PubMed] [Google Scholar]
  2. Brophy C. J., Norvell N. K., Kiluk D. J. An examination of the factor structure and convergent and discriminant validity of the SCL-90R in an outpatient clinic population. J Pers Assess. 1988 Summer;52(2):334–340. doi: 10.1207/s15327752jpa5202_14. [DOI] [PubMed] [Google Scholar]
  3. Brown F. W., Golding J. M., Smith G. R., Jr Psychiatric comorbidity in primary care somatization disorder. Psychosom Med. 1990 Jul-Aug;52(4):445–451. doi: 10.1097/00006842-199007000-00006. [DOI] [PubMed] [Google Scholar]
  4. CROWNE D. P., MARLOWE D. A new scale of social desirability independent of psychopathology. J Consult Psychol. 1960 Aug;24:349–354. doi: 10.1037/h0047358. [DOI] [PubMed] [Google Scholar]
  5. Cloninger C. R., Martin R. L., Guze S. B., Clayton P. J. A prospective follow-up and family study of somatization in men and women. Am J Psychiatry. 1986 Jul;143(7):873–878. doi: 10.1176/ajp.143.7.873. [DOI] [PubMed] [Google Scholar]
  6. Deighton C. M., Nicol A. R. Abnormal illness behaviour in young women in a primary care setting: is Briquet's syndrome a useful category? Psychol Med. 1985 Aug;15(3):515–520. doi: 10.1017/s003329170003138x. [DOI] [PubMed] [Google Scholar]
  7. Dinning W. D., Evans R. G. Discriminant and convergent validity of the SCL-90 in psychiatric inpatients. J Pers Assess. 1977 Jun;41(3):304–310. doi: 10.1207/s15327752jpa4103_13. [DOI] [PubMed] [Google Scholar]
  8. Escobar J. I., Burnam M. A., Karno M., Forsythe A., Golding J. M. Somatization in the community. Arch Gen Psychiatry. 1987 Aug;44(8):713–718. doi: 10.1001/archpsyc.1987.01800200039006. [DOI] [PubMed] [Google Scholar]
  9. Escobar J. I., Canino G., Rubio-Stipec M., Bravo M. Somatic symptoms after a natural disaster: a prospective study. Am J Psychiatry. 1992 Jul;149(7):965–967. doi: 10.1176/ajp.149.7.965. [DOI] [PubMed] [Google Scholar]
  10. Escobar J. I., Gara M., Silver R. C., Waitzkin H., Holman A., Compton W. Somatisation disorder in primary care. Br J Psychiatry. 1998 Sep;173:262–266. doi: 10.1192/bjp.173.3.262. [DOI] [PubMed] [Google Scholar]
  11. Escobar J. I., Rubio-Stipec M., Canino G., Karno M. Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis. 1989 Mar;177(3):140–146. doi: 10.1097/00005053-198903000-00003. [DOI] [PubMed] [Google Scholar]
  12. Escobar J. I., Waitzkin H., Silver R. C., Gara M., Holman A. Abridged somatization: a study in primary care. Psychosom Med. 1998 Jul-Aug;60(4):466–472. doi: 10.1097/00006842-199807000-00012. [DOI] [PubMed] [Google Scholar]
  13. Farley J., Woodruff R. A., Jr, Guze S. B. The prevalence of hysteria and conversion symptoms. Br J Psychiatry. 1968 Sep;114(514):1121–1125. doi: 10.1192/bjp.114.514.1121. [DOI] [PubMed] [Google Scholar]
  14. Fink P., Ewald H., Jensen J., Sørensen L., Engberg M., Holm M., Munk-Jørgensen P. Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. J Psychosom Res. 1999 Mar;46(3):261–273. doi: 10.1016/s0022-3999(98)00092-0. [DOI] [PubMed] [Google Scholar]
  15. Guze S. B. Genetics of Briquet's syndrome and somatization disorder. A review of family, adoption, and twin studies. Ann Clin Psychiatry. 1993 Dec;5(4):225–230. doi: 10.3109/10401239309148821. [DOI] [PubMed] [Google Scholar]
  16. Helzer J. E., Robins L. N., McEvoy L. T., Spitznagel E. L., Stoltzman R. K., Farmer A., Brockington I. F. A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population. Arch Gen Psychiatry. 1985 Jul;42(7):657–666. doi: 10.1001/archpsyc.1985.01790300019003. [DOI] [PubMed] [Google Scholar]
  17. Kaplan C. P., Miner M. E., Mervis L., Newton H., McGregor J. M., Goodman J. H. Interpretive risks: the use of the Hopkins Symptom Checklist 90-Revised (SCL 90-R) with brain tumour patients. Brain Inj. 1998 Mar;12(3):199–205. doi: 10.1080/026990598122674. [DOI] [PubMed] [Google Scholar]
  18. Kaplan C. P. SCL 90-R interpretation and brain tumour: a correction factor? Brain Inj. 1998 Nov;12(11):977–985. doi: 10.1080/026990598122025. [DOI] [PubMed] [Google Scholar]
  19. Kass F., Charles E., Klein D. F., Cohen P. Discordance between the SCL-90 and therapists' psychopathology ratings. Arch Gen Psychiatry. 1983 Apr;40(4):389–393. doi: 10.1001/archpsyc.1983.01790040043006. [DOI] [PubMed] [Google Scholar]
  20. Katon W., Lin E., Von Korff M., Russo J., Lipscomb P., Bush T. Somatization: a spectrum of severity. Am J Psychiatry. 1991 Jan;148(1):34–40. doi: 10.1176/ajp.148.7.A34. [DOI] [PubMed] [Google Scholar]
  21. Kroenke K., Spitzer R. L., deGruy F. V., 3rd, Swindle R. A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics. 1998 May-Jun;39(3):263–272. doi: 10.1016/S0033-3182(98)71343-X. [DOI] [PubMed] [Google Scholar]
  22. Lenze E. J., Miller A. R., Munir Z. B., Pornnoppadol C., North C. S. Psychiatric symptoms endorsed by somatization disorder patients in a psychiatric clinic. Ann Clin Psychiatry. 1999 Jun;11(2):73–79. doi: 10.1023/a:1022342431514. [DOI] [PubMed] [Google Scholar]
  23. Liskow B., Penick E. C., Powell B. J., Haefele W. F., Campbell J. L. Inpatients with Briquet's syndrome: presence of additional psychiatric syndromes and MMPI results. Compr Psychiatry. 1986 Sep-Oct;27(5):461–470. doi: 10.1016/0010-440x(86)90034-9. [DOI] [PubMed] [Google Scholar]
  24. Miller A. R., North C. S., Clouse R. E., Wetzel R. D., Spitznagel E. L., Alpers D. H. The association of irritable bowel syndrome and somatization disorder. Ann Clin Psychiatry. 2001 Mar;13(1):25–30. doi: 10.1023/a:1009060731057. [DOI] [PubMed] [Google Scholar]
  25. Mojtabai R., Rieder R. O. Limitations of the symptom-oriented approach to psychiatric research. Br J Psychiatry. 1998 Sep;173:198–202. doi: 10.1192/bjp.173.3.198. [DOI] [PubMed] [Google Scholar]
  26. Murphy G. E. The clinical management of hysteria. JAMA. 1982 May 14;247(18):2559–2564. [PubMed] [Google Scholar]
  27. Orenstein H. Briquet's syndrome in association with depression and panic: a reconceptualization of Briquet's syndrome. Am J Psychiatry. 1989 Mar;146(3):334–338. doi: 10.1176/ajp.146.3.334. [DOI] [PubMed] [Google Scholar]
  28. Rief W., Heuser J., Mayrhuber E., Stelzer I., Hiller W., Fichter M. M. The classification of multiple somatoform symptoms. J Nerv Ment Dis. 1996 Nov;184(11):680–687. doi: 10.1097/00005053-199611000-00005. [DOI] [PubMed] [Google Scholar]
  29. Swartz M., Blazer D., George L., Landerman R. Somatization disorder in a community population. Am J Psychiatry. 1986 Nov;143(11):1403–1408. doi: 10.1176/ajp.143.11.1403. [DOI] [PubMed] [Google Scholar]
  30. Swartz M., Blazer D., George L., Landerman R. Somatization disorder in a community population. Am J Psychiatry. 1986 Nov;143(11):1403–1408. doi: 10.1176/ajp.143.11.1403. [DOI] [PubMed] [Google Scholar]
  31. Tomasson K., Kent D., Coryell W. Somatization and conversion disorders: comorbidity and demographics at presentation. Acta Psychiatr Scand. 1991 Sep;84(3):288–293. doi: 10.1111/j.1600-0447.1991.tb03146.x. [DOI] [PubMed] [Google Scholar]
  32. Verhaak P. F., Tijhuis M. A. The somatizing patient in general practice. Int J Psychiatry Med. 1994;24(2):157–177. doi: 10.2190/45H7-H8XF-T636-UB0X. [DOI] [PubMed] [Google Scholar]
  33. Wetzel R. D., Guze S. B., Cloninger C. R., Martin R. L., Clayton P. J. Briquet's syndrome (hysteria) is both a somatoform and a "psychoform" illness: a Minnesota Multiphasic Personality Inventory study. Psychosom Med. 1994 Nov-Dec;56(6):564–569. doi: 10.1097/00006842-199411000-00013. [DOI] [PubMed] [Google Scholar]
  34. Widom C. S. Child abuse, neglect, and adult behavior: research design and findings on criminality, violence, and child abuse. Am J Orthopsychiatry. 1989 Jul;59(3):355–367. doi: 10.1111/j.1939-0025.1989.tb01671.x. [DOI] [PubMed] [Google Scholar]
  35. deGruy F., Columbia L., Dickinson P. Somatization disorder in a family practice. J Fam Pract. 1987 Jul;25(1):45–51. [PubMed] [Google Scholar]
  36. deGruy F., Crider J., Hashimi D. K., Dickinson P., Mullins H. C., Troncale J. Somatization disorder in a university hospital. J Fam Pract. 1987 Dec;25(6):579–584. [PubMed] [Google Scholar]

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