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. 1986 Sep 15;135(6):609–614.

Somatization: a borderland between medicine and psychiatry.

Z J Lipowski
PMCID: PMC1491312  PMID: 3489512

Abstract

Somatization is the tendency to experience and communicate psychologic distress in the form of somatic symptoms that the patient misinterprets as signifying serious physical illness. Patients with persistent somatization relentlessly seek medical diagnosis and treatment despite repeated reassurance that physical illness is either absent or insufficient to account for their symptoms and disability. Such abnormal illness behaviour leads to overuse of health care facilities and contributes to the high cost of health care. Somatization may occur transiently in response to stressful life events or it may be persistent and result in chronic partial or total disability. Diagnostic and therapeutic guidelines that may help physicians identify and manage such patients more effectively are discussed.

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Selected References

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  1. Andersen R., Francis A., Lion J., Daughety V. S. Psychologically related illness and health services utilization. Med Care. 1977 May;15(5 Suppl):59–73. doi: 10.1097/00005650-197705001-00007. [DOI] [PubMed] [Google Scholar]
  2. Atkinson J. H., Jr, Kremer E. F., Garfin S. R. Psychopharmacological agents in the treatment of pain. J Bone Joint Surg Am. 1985 Feb;67(2):337–342. [PubMed] [Google Scholar]
  3. Bain S. T., Spaulding W. B. The importance of coding presenting symptoms. Can Med Assoc J. 1967 Oct 14;97(16):953–959. [PMC free article] [PubMed] [Google Scholar]
  4. Baker B., Merskey H. Classification and associations of hyprochondriasis in patients from a psychiatric hospital. Can J Psychiatry. 1983 Dec;28(8):629–634. doi: 10.1177/070674378302800807. [DOI] [PubMed] [Google Scholar]
  5. Barsky A. J., Klerman G. L. Overview: hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry. 1983 Mar;140(3):273–283. doi: 10.1176/ajp.140.3.273. [DOI] [PubMed] [Google Scholar]
  6. Barsky A. J., Wyshak G., Klerman G. L. Hypochondriasis. An evaluation of the DSM-III criteria in medical outpatients. Arch Gen Psychiatry. 1986 May;43(5):493–500. doi: 10.1001/archpsyc.1986.01800050099013. [DOI] [PubMed] [Google Scholar]
  7. Barsky A. J., Wyshak G., Klerman G. L. Medical and psychiatric determinants of outpatient medical utilization. Med Care. 1986 Jun;24(6):548–560. doi: 10.1097/00005650-198606000-00009. [DOI] [PubMed] [Google Scholar]
  8. Beaber R. J., Rodney W. M. Underdiagnosis of hypochondriasis in family practice. Psychosomatics. 1984 Jan;25(1):39–46. doi: 10.1016/S0033-3182(84)73095-7. [DOI] [PubMed] [Google Scholar]
  9. Bishop E. R., Jr Monosymptomatic hypochondriasis. Psychosomatics. 1980 Sep;21(9):731–747. doi: 10.1016/S0033-3182(80)73618-6. [DOI] [PubMed] [Google Scholar]
  10. Blackwell B., Galbraith J. R., Dahl D. S. Chronic pain management. Hosp Community Psychiatry. 1984 Oct;35(10):999–1008. doi: 10.1176/ps.35.10.999. [DOI] [PubMed] [Google Scholar]
  11. Bridges K. W., Goldberg D. P. Somatic presentation of DSM III psychiatric disorders in primary care. J Psychosom Res. 1985;29(6):563–569. doi: 10.1016/0022-3999(85)90064-9. [DOI] [PubMed] [Google Scholar]
  12. Brink T. L., Capri D., DeNeeve V., Janakes C., Oliveira C. Hypochondriasis and paranoia: similar delusional systems in an institutionalized geriatric population. J Nerv Ment Dis. 1979 Apr;167(4):224–228. [PubMed] [Google Scholar]
  13. Catalan J., Gath D. H. Benzodiazepines in general practice: time for a decision. Br Med J (Clin Res Ed) 1985 May 11;290(6479):1374–1376. doi: 10.1136/bmj.290.6479.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Cooke A. Hypochondria: the layman's specialty. The Lloyd-Roberts Lecture 1972. J R Coll Physicians Lond. 1973 Jul;7(4):277–290. [PMC free article] [PubMed] [Google Scholar]
  15. Costa P. T., Jr, McCrae R. R. Hypochondriasis, neuroticism, and aging. When are somatic complaints unfounded? Am Psychol. 1985 Jan;40(1):19–28. doi: 10.1037//0003-066x.40.1.19. [DOI] [PubMed] [Google Scholar]
  16. Fine S. Adolescent somatic symptoms: masks for individual and family psychopathology. Compr Psychiatry. 1977 Mar-Apr;18(2):135–140. doi: 10.1016/0010-440x(77)90056-6. [DOI] [PubMed] [Google Scholar]
  17. Goodwin J. M., Goodwin J. S., Kellner R. Psychiatric symptoms in disliked medical patients. JAMA. 1979 Mar 16;241(11):1117–1120. [PubMed] [Google Scholar]
  18. Groves J. E. Taking care of the hateful patient. N Engl J Med. 1978 Apr 20;298(16):883–887. doi: 10.1056/NEJM197804202981605. [DOI] [PubMed] [Google Scholar]
  19. Hartvig P., Sterner G. Childhood psychologic environmental exposure in women with diagnosed somatoform disorders. A case-control study. Scand J Soc Med. 1985;13(4):153–157. doi: 10.1177/140349488501300405. [DOI] [PubMed] [Google Scholar]
  20. Higgitt A. C., Lader M. H., Fonagy P. Clinical management of benzodiazepine dependence. Br Med J (Clin Res Ed) 1985 Sep 14;291(6497):688–690. doi: 10.1136/bmj.291.6497.688. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Huey S. R., West S. G. Hyperventilation: its relation to symptom experience and to anxiety. J Abnorm Psychol. 1983 Nov;92(4):422–432. doi: 10.1037//0021-843x.92.4.422. [DOI] [PubMed] [Google Scholar]
  22. Katon W. Depression: relationship to somatization and chronic medical illness. J Clin Psychiatry. 1984 Mar;45(3 Pt 2):4–12. [PubMed] [Google Scholar]
  23. Katon W. Panic disorder and somatization. Review of 55 cases. Am J Med. 1984 Jul;77(1):101–106. doi: 10.1016/0002-9343(84)90443-1. [DOI] [PubMed] [Google Scholar]
  24. Katon W., Ries R. K., Kleinman A. A prospective DSM-III study of 100 consecutive somatization patients. Compr Psychiatry. 1984 May-Jun;25(3):305–314. doi: 10.1016/0010-440x(84)90063-4. [DOI] [PubMed] [Google Scholar]
  25. Katon W., Ries R. K., Kleinman A. The prevalence of somatization in primary care. Compr Psychiatry. 1984 Mar-Apr;25(2):208–215. doi: 10.1016/0010-440x(84)90009-9. [DOI] [PubMed] [Google Scholar]
  26. Kellner R. Functional somatic symptoms and hypochondriasis. A survey of empirical studies. Arch Gen Psychiatry. 1985 Aug;42(8):821–833. doi: 10.1001/archpsyc.1985.01790310089012. [DOI] [PubMed] [Google Scholar]
  27. Kellner R. Psychotherapeutic strategies in hypochondriasis: a clinical study. Am J Psychother. 1982 Apr;36(2):146–157. doi: 10.1176/appi.psychotherapy.1982.36.2.146. [DOI] [PubMed] [Google Scholar]
  28. Kenyon F. E. Hypochondriacal states. Br J Psychiatry. 1976 Jul;129:1–14. doi: 10.1192/bjp.129.1.1. [DOI] [PubMed] [Google Scholar]
  29. Kessler L. G., Cleary P. D., Burke J. D., Jr Psychiatric disorders in primary care. Results of a follow-up study. Arch Gen Psychiatry. 1985 Jun;42(6):583–587. doi: 10.1001/archpsyc.1985.01790290065007. [DOI] [PubMed] [Google Scholar]
  30. Kessler L. G., Tessler R. C., Nycz G. R. Co-occurrence of psychiatric and medical morbidity in primary care. J Fam Pract. 1983 Feb;16(2):319–324. [PubMed] [Google Scholar]
  31. Lichstein P. R. Caring for the patient with multiple somatic complaints. South Med J. 1986 Mar;79(3):310–314. [PubMed] [Google Scholar]
  32. Linton S. J. Behavioral remediation of chronic pain: a status report. Pain. 1986 Feb;24(2):125–141. doi: 10.1016/0304-3959(86)90036-9. [DOI] [PubMed] [Google Scholar]
  33. Lipowski Z. J. Review of consultation psychiatry and psychosomatic medicine. 3. Theoretical issues. Psychosom Med. 1968 Jul-Aug;30(4):395–422. doi: 10.1097/00006842-196807000-00005. [DOI] [PubMed] [Google Scholar]
  34. Little J. C. The athlete's neurosis--a deprivation crisis. Acta Psychiatr Scand. 1969;45(2):187–197. doi: 10.1111/j.1600-0447.1969.tb10373.x. [DOI] [PubMed] [Google Scholar]
  35. Livingston R., Martin-Cannici C. Multiple somatic complaints and possible somatization disorder in prepubertal children. J Am Acad Child Psychiatry. 1985 Sep;24(5):603–607. doi: 10.1016/s0002-7138(09)60062-5. [DOI] [PubMed] [Google Scholar]
  36. MECHANIC D. The concept of illness behavior. J Chronic Dis. 1962 Feb;15:189–194. doi: 10.1016/0021-9681(62)90068-1. [DOI] [PubMed] [Google Scholar]
  37. Magarian G. J. Hyperventilation syndromes: infrequently recognized common expressions of anxiety and stress. Medicine (Baltimore) 1982 Jul;61(4):219–236. [PubMed] [Google Scholar]
  38. McFarland B. H., Freeborn D. K., Mullooly J. P., Pope C. R. Utilization patterns among long-term enrollees in a prepaid group practice health maintenance organization. Med Care. 1985 Nov;23(11):1221–1233. doi: 10.1097/00005650-198511000-00001. [DOI] [PubMed] [Google Scholar]
  39. McGaghie W. C., Whitenack D. C. A scale for measurement of the problem patient labeling process. J Nerv Ment Dis. 1982 Oct;170(10):598–604. doi: 10.1097/00005053-198210000-00003. [DOI] [PubMed] [Google Scholar]
  40. Mechanic D. Development of psychological distress among young adults. Arch Gen Psychiatry. 1979 Oct;36(11):1233–1239. doi: 10.1001/archpsyc.1979.01780110087011. [DOI] [PubMed] [Google Scholar]
  41. Melson S. J., Rynearson E. K., Dortzbach J., Clark R. D., Jr, Snyder A. L. Short-term intensive group psychotherapy for patients with 'functional' complaints. Psychosomatics. 1982 Jul;23(7):689–695. doi: 10.1016/s0033-3182(82)73343-2. [DOI] [PubMed] [Google Scholar]
  42. Ockene I. S., Shay M. J., Alpert J. S., Weiner B. H., Dalen J. E. Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med. 1980 Nov 27;303(22):1249–1252. doi: 10.1056/NEJM198011273032201. [DOI] [PubMed] [Google Scholar]
  43. Parker G., Abeshouse B., Morey E., Holmes S., Manicavasagar V. Depression in general practice. Med J Aust. 1984 Aug 4;141(3):154–158. [PubMed] [Google Scholar]
  44. Pilowsky I. Abnormal illness behaviour. Br J Med Psychol. 1969 Dec;42(4):347–351. doi: 10.1111/j.2044-8341.1969.tb02089.x. [DOI] [PubMed] [Google Scholar]
  45. Quill T. E. Somatization disorder. One of medicine's blind spots. JAMA. 1985 Dec 6;254(21):3075–3079. doi: 10.1001/jama.254.21.3075. [DOI] [PubMed] [Google Scholar]
  46. Rosenblatt R. M., Reich J., Dehring D. Tricyclic antidepressants in treatment of depression and chronic pain: analysis of the supporting evidence. Anesth Analg. 1984 Nov;63(11):1025–1032. [PubMed] [Google Scholar]
  47. Salit I. E. Sporadic postinfectious neuromyasthenia. CMAJ. 1985 Oct 1;133(7):659–663. [PMC free article] [PubMed] [Google Scholar]
  48. Schurman R. A., Kramer P. D., Mitchell J. B. The hidden mental health network. Treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiatry. 1985 Jan;42(1):89–94. doi: 10.1001/archpsyc.1985.01790240091010. [DOI] [PubMed] [Google Scholar]
  49. Sigvardsson S., von Knorring A. L., Bohman M., Cloninger C. R. An adoption study of somatoform disorders. I. The relationship of somatization to psychiatric disability. Arch Gen Psychiatry. 1984 Sep;41(9):853–859. doi: 10.1001/archpsyc.1984.01790200035005. [DOI] [PubMed] [Google Scholar]
  50. Slavney P. R., Teitelbaum M. L. Patients with medically unexplained symptoms: DSM-III diagnoses and demographic characteristics. Gen Hosp Psychiatry. 1985 Jan;7(1):21–25. doi: 10.1016/0163-8343(85)90006-4. [DOI] [PubMed] [Google Scholar]
  51. Smith G. R., Jr, Monson R. A., Ray D. C. Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Arch Intern Med. 1986 Jan;146(1):69–72. [PubMed] [Google Scholar]
  52. Smith R. C. A clinical approach to the somatizing patient. J Fam Pract. 1985 Oct;21(4):294–301. [PubMed] [Google Scholar]
  53. Stewart D. E., Raskin J. Psychiatric assessment of patients with "20th-century disease" ("total allergy syndrome"). CMAJ. 1985 Nov 15;133(10):1001–1006. [PMC free article] [PubMed] [Google Scholar]
  54. Widmer R. B., Cadoret R. J. Depression in primary care: changes in pattern of patient visits and complaints during a developing depression. J Fam Pract. 1978 Aug;7(2):293–302. [PubMed] [Google Scholar]
  55. Wilson D. R., Widmer R. B., Cadoret R. J., Judiesch K. Somatic symptoms. A major feature of depression in a family practice. J Affect Disord. 1983 Aug;5(3):199–207. doi: 10.1016/0165-0327(83)90042-3. [DOI] [PubMed] [Google Scholar]
  56. Wooley S. C., Blackwell B., Winget C. A learning theory model of chronic illness behavior: theory, treatment, and research. Psychosom Med. 1978 Aug;40(5):379–401. doi: 10.1097/00006842-197808000-00003. [DOI] [PubMed] [Google Scholar]

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