Somatisation disorder in a British teaching hospital

We describe 33 patients (31 women, 2 men; mean age 47 years) who satisfied research criteria for somatization disorder (SD), a disorder characterised by persistent or recurrent unexplained somatic symptoms beginning before the age of 30. The mean duration of symptoms was 30 years (range 12-57). Twenty patients had co-existing physical disease: seven (21%) had histories of chronic physical disease in childhood, whereas in 13 (39%) the physical disorders began in adult life, after many years of somatic complaints, and were largely coincidental. All had been repeatedly investigated for their symptoms. Twenty-one patients (64%) were receiving medication for spurious physical disorders, most commonly 'angina' and 'asthma'. Hysterectomies had been performed in 16 (52%) of the 31 women at a mean age of 37 years, but pathology was detected in only two. Twenty-nine patients (88%) had received previous treatment for psychiatric illness, and 20 (61%) were receiving invalidity benefits. British psychiatrists do not usually diagnose SD, but focus selectively on symptoms that suggest more familiar psychiatric syndromes. Similarly, medical specialists often diagnose 'functional syndromes' affecting the system that interests them. Over time these patients acquire spurious organic diagnoses and develop physical disorders that make the assessment of new symptoms more difficult. Disability is invariably in excess of what might be predicted from physical findings. We conclude that a diagnosis of SD draws attention to a group of patients who are chronically ill and unresponsive to conventional medical and psychiatric treatment. They use a lot of resources to little avail and thus merit more research.