Somatization disorder is a long-term (chronic) condition in which a person has physical symptoms that are caused by psychological problems, and no physical problem can be found.

The disorder usually begins before the age of 30 and occurs more often in women than in men. The disorder is more common in people with irritable bowel syndrome and chronic pain.

Physicians often dismiss patients with somatization disorder as having problems that are "all in their head." However, as researchers study the connections between the brain, the digestive system, and the immune system, somatization disorders are becoming better understood. They should not be seen as "faked" conditions.

People with this disorder have many physical complaints that last for years and can involve any body system. Most often, the complaints involve chronic pain and problems with the digestive system, nervous system, and reproductive system.

The symptoms are generally severe enough to interfere with work and relationships, and lead the person to visit the doctor and take medication. The person often has a lifelong history of "sickliness." However, even after a thorough evaluation, no physical cause is ever found to explain the symptoms. Stress often worsens the symptoms.

Some of the many symptoms that can occur with somatization disorder include:

• Abdominal pain
• Amnesia
• Back pain
• Bloating
• Chest pain
• Diarrhea
• Difficulty swallowing
• Dizziness
• Excessive menstrual bleeding
• Headaches
• Impotence
• Irregular menstruation
• Joint pain
• Nausea
• Pain during intercourse
• Pain during urination
• Painful menstruation
• Pain in the legs or arms
• Palpitations
• Paralysis or muscle weakness
• Sexual apathy
• Shortness of breath
• Vision changes
• Vomiting

It is important to note that many of these symptoms also occur in other medical and psychiatric disorders. If you experience any of these symptoms, work with your doctor to find possible causes before a diagnosis of somatization disorder is made.

• A thorough physical examination and diagnostic tests are performed to identify physical causes. The types of tests done depend on what symptoms you have.
• A psychological evaluation is performed to identify related disorders.

Once other causes have been investigated and it is likely that you have somatization disorder, the goal of treatment is to help you learn to control your symptoms. There is often a mood disorder, which may respond to antidepressant medications.

Having a supportive relationship with a sympathetic health care provider is the most important part of treatment. Regularly schedule appointments to review your symptoms and coping mechanisms. The health care provider should explain any test results.

You should not be told that your symptoms are imaginary. With the current understanding of the complex interactions between the brain and other body parts, scientists recognize that real physical symptoms can result from psychological stress.

• Complications from invasive testing and from many evaluations while looking for the cause of the symptoms
• Becoming dependant on pain relievers or sedatives
• Worsening of the condition due to a poor relationship with the health care provider and evaluation by many providers

Having a good relationship with your primary health care provider is helpful. Call for an appointment if you notice a major change in your symptoms.

Counseling or other psychological interventions may help people who are prone to somatization learn other ways of dealing with stresses. This may help reduce the intensity of the symptoms.

Moore DP, Jefferson JW. Briquet's Syndrome. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004: chap 90.

deGruy FV. The Somatic Patient. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 61.

Purcell TB. Somatoform Disorders. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 111.