Somatization

00:00 We’re going to review Somatization now. So, what are somatic symptom disorders? Well, they are a constellation of physical symptoms that are distressing to an individual and they have no organic cause. Patients tend to be convinced that their symptoms are due to a medical disorder and they absolutely refused to acknowledge that there could be a psychiatric component. There are 2 types of gain that you’ll want to familiarize yourself with. Primary gain and secondary gain.

00:33 So let’s start here with primary gain. This is an expression of unacceptable feelings as physical symptoms in order to avoid facing the actual emotional disturbance and the patient here actually wants to assume the sick role so they want to be a patient and cared for. Whereas secondary gain is the use of symptoms to benefit the patient through obvious external incentives. Things like getting free housing, disability, evading criminal charges, etc. So, why can lead to being misunderstood by doctors? This is an important point because people who present with a somatic symptom disorder are often very much misunderstood by their doctors. There tends to be a clash because remember patients are presenting with physical symptoms but physical problems are ruled out by the doctor and they are left with the diagnosis of some kind of emotional disturbance but the patient doesn’t want to accept that so there’s a real struggle in forming a therapeutic alliance.

01:40 Somatic symptom disorders, again, in these disorders, patients do not intentionally create symptoms. Now, this is different from factitious disorders where patients do create physical symptoms in an effort to assume the role of the sick patient. Also in malingering, patients do consciously feign physical symptoms but here it’s an effort to avoid some kind of problem or gain some kind of external incentive. So, when it comes to somatic symptom disorders, females tend to be more affected than males and half of patients have a comorbid mental disorder, something like anxiety or depression.

02:25 The first step when you’re suspecting a somatic symptom disorder is actually to rule out an organic cause of symptoms. Now this can be very challenging to do and practice but it’s very critical that every patient receive a thorough medical work-up. So you’re going to take a thorough history, do a physical exam, some baseline blood work and maybe some imaging as well to look for central nervous system problem. You’re also going to look for endocrine abnormalities and connective tissue diseases. So again, really can’t overemphasize this point enough. Whenever it comes to a psychiatric illness, you have to rule out general medical conditions before labeling somebody with an emotional or psychological problem. When you do baseline blood work, you’re going to be checking a complete blood count, kidneys, a liver panel, you’re going to check the thyroid function, probably do a urinalysis and a urine tox screen and consider a head CT scan.