Somatization. Diagnosis and management

Somatization, the somatic expression of psychological distress, occurs in a large proportion of primary care patients. It is associated with substantial distress and impairment and with increased health care utilization. Some somatizing patients have a history of multiple unexplained complaints (somatization disorder), others are excessively worried about serious illness (hypochondriasis), and still others have psychiatric disorders that present with somatic symptoms (depression and anxiety). In general, somatizing patients are characterized by abnormal illness behavior (eg, failure to respond to treatment, excessive utilization of care) and psychological distress (eg, depressive symptoms, psychosocial stressors). Recognition requires alertness to characteristic features and skillful interview technique. Successful management begins by legitimizing symptoms. Restraint should be used in performing workups and assigning diagnoses to somatizing patients. Treatment goals should be clarified and regular visits scheduled. Also, behaviors that threaten the physician-patient relationship should be dealt with. Depression and anxiety should be treated when present. Pharmacologic and psychological treatments for somatizing patients have been described, although none has proven efficacy.