Definition of Somatization
What is somatization? Somatization disorder is one of the specific somatoform disorder characterized by the several of physical symptoms / somatic symptoms on many organ systems and can not be explained by strong based on physical examination and laboratory.

Somatization disorders are distinguished from other somatoform disorders because of the many complaints and involve multiple organ systems (for example, gastrointestinal and neurological). This disorder is chronic with symptoms that was found for several years and began before the age of 30 years. Somatization disorder is accompanied by significant psychological suffering, impaired social functioning and employment, and medical help-seeking behavior is excessive.

Epidemiology
The prevalence of somatization disorder in the general population is estimated to 0.1 to 0.2%, although several research groups believe that the real figure may be closer to 0.5%. The prevalence of somatization disorders in women in the general population is 1-2%. The ratio of female patients than for men is 5 to 1 and usually disturbance began at the age of young adults (before age 30 years).

Some researchers have found somatization disorder often in conjunction with other mental disorders. The nature of personality or personality disorder that often accompanies is marked by a characteristic avoidance, paranoid, self-defeating, and obsessive compulsive.

somatization disorder

 

Etiology
cause of somatization is not known, but there are factors that contribute to the emergence of somatization disorder:

Psychosocial Factors
There are psychosocial factors in the form below conscious psychic conflicts that have a particular purpose. The psychosocial formulation about the cause of somatization involving the interpretation of symptoms as a type of social communication, the result is to avoid obligations (not doing work that is not preferred), express emotions (anger at the partner), or to symbolism a feeling or belief (pain in one’s intestines).

Some patients with somatization disorder, especially children, are usually raised in an environment with parents who also have a history of high somatization. In addition, a history of torture and sexual harassment could increase the risk of somatization in children. This is one form of environmental influences as the cause of somatization.

Biological Factors
Research has found that genetics also has large part to contribute in the causing of this disease. This genetic factor is influencing the transmission of a particular substance in the frontal lobes and hemispheres non dominant. This causes a decrease in metabolism (hypo metabolism). Patients with family history had suffered from somatoform disorders has 10-20 times greater risk than no history.

In addition, on patients with somatization disorder also found abnormal regulation of cytokine system that may cause some symptoms of these types of somatoform disorder. This biological factor was also demonstrated by people with somatization who often have reduced ability to express emotions (alexithymia).

Somatization Disorder Symptoms
Variety (multiple) of physical symptoms, repeated and frequent changes, which usually lasts several years before patients come to psychiatrists are the main characteristics of somatization disorder symptoms. Other somatization symptoms that suffering by patient also make long and very complex history of treatment, both to basic health services, as well as specialist, with the results of operations or even negative.

Physical symptoms in patients with somatization can be affected any system or any body part, but patients often feel physical symptoms in the gastrointestinal (pain, bloating, nausea, vomiting), difficulty swallowing, pain in arms and legs, complaints about sex, breathing short unrelated to physical activity and complaints due to abnormal feeling on the skin (feeling of itching, burning, tingling, numbness, pain, etc..), menstrual problems and as well as spots on the skin.

Patients with somatization have suffered chronic psychological and interpersonal skills. This often led to severe of mental disorders such as anxiety and depression and thus requires special treatment. This makes the patient’s psychological suffering to be excessive in describing the complaints, emotional and dramatic. An outlet for this suffering on women makes exhibitionistic style dress, like the excessive praise and flattery always self-centered.

As disclosed above, somatization symptoms are often creates another type of mental disorder such as anxiety, depression, personality disorders, anxiety and phobias. Dissociative disorders and post traumatic stress disorder (PTSD) is also associated with somatization disorder

DIAGNOSIS
Criteria for diagnosis of somatization disorder according to DSM IV or also called somatization disorder dsm:

A. History of many physical complaints with onset before age 30 that occurred over a period of several years and cause significant disruption in social functioning, work or other important functions.

B. Each of the following criteria must be found, with individual symptoms occurring at any time during the trip interruption.

1. Four pain symptoms: history of pain that occurs in at least four parts of the body or different functions (head, abdomen, back, joints, limbs, chest, and rectum, during menstruation, during sexual intercourse).

2. Two gastrointestinal symptoms: history of at least two gastrointestinal symptoms other than pain (e.g. nausea, bloating, vomiting other than pregnancy, diarrhea, or intolerance towards various types of food).

3. One sexual symptom: History at least one sexual or reproductive symptom other than pain (e.g. sexual indifference, erectile dysfunction, or ejaculation, irregular periods, excessive bleeding menstrual, vomiting throughout pregnancy).

4. One symptom pseudoneurologis: History at least one symptom or deficit that leads to a neurological condition not limited to pain (Conversion Disordersymptoms such as coordination or balance disorder, paralysis or local weakness, difficulty swallowing or lump in red lane, urinary retention, loss of touch or pain sensation, the views Double, blindness, deafness, seizures, dissociative symptoms such as amnesia or loss of consciousness other than fainting).

    C. Symptoms are not caused deliberately or contrived (as in artificial interruption or pretend to).

    Other Diagnosis of somatisazation disorders are:

    1. There are a variety of physical symptoms that can not be explained. Existence of these physical symptoms must be lasted for about 2 years.

    2. Always patient would not accept advice or explanation from some doctors that there are no physical abnormalities that could explain his complaints.

    3. There is a disability in its function in society and family, relating to the nature of his complaints and impact from behavior.

       

      Prognosis
      Somatization disorders is a disturbance that lasted chronic, fluctuating, causing disability and is often accompanied by the incompatibility of social behavior, interpersonal and extended family.

      Episode increase in severity of symptoms and the development of new symptoms is expected to last 6-9 months and can be separated from the less symptomatic period that lasted 9-12 months. But it’s rarely if a patient with somatization disorder walk more than a year without seeking any medical attention.

      There is a relationship between periods of increased stress or new stress and exacerbation of somatic symptoms.

       

      Somatization Disorder Treatment
      Like on treatment of somatoform disorders , Somatization disorder treatment incorporates several treatment methods include, among others by the use of psychosocial support, psychotherapy and medicine. Somatization disorder treatment aims to prevent the adoption of the pain, invalid (not justify thinking / convinced that the phenomenon exists only in the mind is not for real life, minimize costs and avoid complications with diagnosis tests, treatments, and drugs are not necessary and also pharmacological control of comorbid syndromes (aggravating the condition.)

       

      Therapy
      Patients with somatization disorder will be better if it had one single physician as their health nurses. It aims to provide a more precise diagnosis of physical symptoms faced by patients.

      If you have been diagnosed with somatization disorder, doctors who treat patients must be listen somatic complaints as emotional expression, rather than as a medical complaint. However, patients with somatization disorder can also have a physical illness, because symptoms that doctors should consider what needs to be checked in advance and to what extent.

      A good broad strategy for primary care physicians is to increase patient awareness about the possibility that psychological factors involved in their disease symptoms. Psychotherapy is both individual and group. In psychotherapy environment, patients are helped to overcome the symptoms, to express the underlying emotion and to develop alternative strategies to express their feelings.

      Psychotherapy and psychosocial services that are used in the treatment of somatization disorder using the strategies and techniques such as:

      1. Treatment consistent, handled by the same physician

      2. Make a regular schedule with time intervals of adequate patient visits

      3. Focus on treatment of symptoms gradually to the personal and social problems

        However, patients with somatization disorder often refuse to follow the advice of individual psychotherapy or group because they view their illness is one medical problem. Patients who received psychotherapy may be able to reduce utilization of health services. Psychosocial interventions are focus on maintaining social functioning and work despite symptoms of chronic medical help.

        Medication
        medication approach was rarely showed significant results for patients with somatization. Treatment of somatization disorder especially psychopharmacologies is given when accompanied by comorbid disorders (mood disorders, depressive disorders are real, anxiety disorders). Successful medication of severe depression or anxiety disorders, such as panic disorder, also can produce a significant reduction in somatization disorder

        Medications must be monitored because patients with somatization disorder tends to use drugs excessively and can not be trusted.

        Strategies and techniques and physical pharmacological performed on patients somatization are:

        1. Given only when a clear indication

        2. Avoid drugs that are addiction

        3.  Anti-anxiety and antidepressant