Somatisation, which falls under Somatic Symptom and Related Disorders (SSRD) in the DSM-V, refers to the condition in which an individual experiences psychological distress via somatic (physical) symptoms that are not otherwise explained through an alternative medical condition. Individuals who suffer from somatisation dedicate a lot of time, energy and focus to their symptoms and health.
Somatisation differs from factitious disorder imposed on self (previously known as Munchausen syndrome) as they are not trying to intentionally deceive anyone or themselves. However, in factitious disorder the individual makes themselves appear ill to gain sympathy or attention.
Functional neurological symptom disorder (previously known as conversion disorder) differs from somatisation in that it specifically involves neurological symptoms (e.g., weakness, paralysis, seizures, sensory loss) that are inconsistent with known medical conditions, whereas somatisation presents with varied physical symptoms across different organ systems. Conversion disorder symptoms often arise suddenly after stress or trauma, whereas somatisation tends to be chronic and persistent. Additionally, conversion disorder is characterized by la belle indifférence (French for beautiful ignorance - a lack of concern about symptoms in some cases), which is not typical in somatisation.
🏘️ Epidemiology
Somatisation is a phenomenon that is significantly more common in females. A 2001 study found a staggering 10:1 ratio in women versus men.
It may happen in all age groups from childhood to adulthood, but typically begins in adolescence or early adulthood.
Pathophysiology
The pathophysiology is not well understood, and the aetiology has not been identified, but there are some theories as to what could be going on. It is believed to involve biological, psychological and social factors altogether.
- Biological factors
- Increased pain sensitivity - patients have a heightened sensitivity with evidence of dysregulated pain pathways in the brain.
- Neurotransmitter imbalances - heightened levels of serotonin, noradrenaline and dopamine have been found.
- Altered autonomic nervous system function - increased sympathetic activity may be the cause of many somatic symptoms such as palpitations, GI upset and sweating.
- Cortisol dysregulation - the chronic stress may result in persistent activation of the hypothalamic-pituitary-adrenal axis which may amplify the symptoms.
- Psychological factors
- Somatosensory amplification - more focus on bodily sensations may lead one to believe normal sensations to be abnormal.
- Catastrophic interpretation - individuals tend to take benign symptoms as signs of serious illness.
- Social factors
- Adverse childhood events - shown to have association and predisposes one to somatisation.
- Reinforcement by family - children who receive more attention have been seen to develop a learned behaviour of somatisation.
⚠️ Risk factors
- Female sex
- Hypochondriasis
- Concurrent mental health disorder
- Adverse childhood events
- History of childhood illness
- Family history of chronic illness
😷 Criteria and presentation
⭐️ The main feature of somatisation is physical symptoms that are persistent, distressing, and medically unexplained.
Patients tend to have frequent healthcare visits, unnecessary medical tests, and procedures.
The DSM-V criteria for somatic symptoms disorder is:
- ≥1 somatic symptom.
- Excessive thoughts, feelings, or behaviors related to symptoms, with one or more of the following:
- Disproportionate concern about the severity of symptoms.
- Persistent high anxiety about health or symptoms.
- Excessive time and energy devoted to health concerns.
- Symptoms persist for ≥6 months.
🧰 Management
Management of somatic symptom disorder:
- Patient education and validation of symptoms
- Avoid unnecessary procedures and investigations
- Regular appointments with the same physician
- Cognitive behavioural therapy and management of associated anxiety/depression