Somatization Disorder Assessment

by Helen Farrell, MD

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    00:00 In terms of making an assessment, you want to ask your patient about pain symptoms. You want to know if they have experienced the headache, back or joint pain, or any extremity pain. You also want to ask about stomach issues or GI symptoms like nausea and vomiting and diarrhea.

    00:16 They may also pass gas or have some bloating or abdominal pain and you want to ask about cardiopulmonary symptoms, things like chest pain, shortness of breath, or heart palpitations and dizziness. Then you want to also ask about reproductive problems so whether or not there is any pain during intercourse or abnormal menstrual cycle especially with pain during it, any burning during intercourse or passing urine and this is the summary of groups of systems that you want to make sure you ask your patient about during the assessment. Neurological symptoms can include fainting, pseudoseizures, amnesia, muscle weakness, dysphagia, vision changes, gait instability, difficulty urinating, deafness, hoarseness and aphonia. So let’s go back to this case example. “Middle-aged woman who comes to her primary care doctor multiple times over the course of only 1 month with numerous vague complaints. Okay, she said she has pain in every joint, nausea, sexual dysfunction and a tremor but again you can’t actually find any physical problems with her. She’s anxious and upset when you ask her if she has been stressed out lately and maybe mention referring to a psychiatrist.” So what do you suspect? She may be presenting with a somatization disorder. So when taking a patient’s history, establishing trust is extremely key. A lot of people who have seen multiple clinicians already and trust may be an issue. They may feel embarrassed or humiliated so it’s really important to focus on a therapeutic alliance.

    01:55 Explore with your patient the medical and psychological etiology at the same time and this will help the patient feel a little bit more confident that you’re believing them and that you’re not going to discount their symptoms or not take them seriously. So pay attention to physical symptoms as well as emotions, ask the patient if there has been any stressful events lately, assess their physical problems and ask what makes it worse, what makes it better. So, don’t just discount their symptoms because you think maybe something psychiatric is happening. The patient takes their physical symptoms very seriously. They may even feel like they’re dying or they’re going to lose their organ function. So listen very carefully and take a thorough history including asking about their family history and social history. You want to know if other people have been affected and offer your patient reassurance. Make sure to ask them about medications that they’re taking including over-the-counter medications and of course screen them for substance abuse because this can be comorbid. It’s important to ask whether or not the patient has experienced physical or sexual abuse whether the patient feels safe in their current relationship, or whether or not they feel threatened in any way.

    About the Lecture

    The lecture Somatization Disorder Assessment by Helen Farrell, MD is from the course Dissociative Disorders.

    Included Quiz Questions

    1. The patients often refuse to meet the physician despite these health issues.
    2. The complaint of multiple vague symptoms involving various organ systems.
    3. There is no organic etiology.
    4. The patients attribute the distress to physical illness.
    5. They experience somatic distress in response to psychosocial stress.
    1. They believe that hysteria was caused by the uterus migrated upwards and caused discomfort.
    2. Pain and suffering are used as an intrapsychic defense and seen as deserved and used as atonement for hostile impulses.
    3. Family aggregation can be due to genetics, environment or both.
    4. Implicates patient’s ability to recall symptoms from either their own or a role model’s experience as a means of expressing distress.
    5. It is a communication asserting to doctors that one is deserving of care.
    1. Interpersonal model
    2. Biological model
    3. Genetic model
    4. Cultural stigma
    5. Learning theory

    Author of lecture Somatization Disorder Assessment

     Helen Farrell, MD

    Helen Farrell, MD

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