In somatization disorder, the patient has unintentional multiple physical complaints from different systems, which is persistent and has onset before age 30. The patient's complaints are often dramatic but inconsistent. Mood and anxiety are common and may be the result of drug interactions of various medication regimens. The typical patient with somatization disorder usually undergoes repeated medical examinations and diagnostic testing that - unlike the symptoms themselves - can be potentially dangerous or debilitating.
In conversion disorder, the patient focuses on defects of motor or sensory function. Psychological factors initiate the condition or seem to worsen it. The defect isn't intentionally produced or simulated.
In hypochondriasis, the patient believes he has a serious medical illness despite reassurance and appropriate medical evaluation. It can be disabling and persistent with waxing and waning symptoms.
In factitious illnesses, the patient consciously produces the physical symptoms of illness. Munchausen syndrome involves dramatic, chronic, or severe factitious illness. The sick role is qualifying in these illnesses; a variety of signs, symptoms. and diseases are simulated. Diagnosis is usually not made until 5 to 10 years after onset, producing significant social and medical costs. In malingering, there is a desire for an external reward, such as narcotic medication or disability reimbursement.
CausesBoth genetic and environmental factors may contribute to the development of somatization disorder. In somatization disorder and hypochondriasis, the patient has a history of poor relationships with doctors. This is because he believes he has been evaluated and treated inappropriately.
Symptoms usually occur over many years. The person may be distressed and function poorly at work and at home. Either medical evaluation does not explain the symptoms, or the symptoms exceed what would be expected in any medical illness that is found. Symptoms include:
Behavior modification is most successful, especially if access to a doctor is tightly regulated so that repeated diagnostic testing and exploratory surgeries are limited. After diagnostic evaluation has ruled out organic causes, the patient should be told that although he has no serious illness, he will continue to receive care to ease his signs and symptoms.
Some patients may benefit from antidepressant treatment. Fluoxetine and monoamine oxidase inhibitors may help with patients' obsession with symptoms and preoccupation with multiple somatic complaints. The patient should have regularly scheduled appointments to review his signs and symptoms and the effectiveness of his coping strategies. The patient with somatization disorder seldom acknowledges any psychological aspect of his illness and rejects psychiatric treatment.
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.
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