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DSM IV Criteria
Many physical complaints resulting in treatment being sought or significant functional impairment. Onset is before the age of 30.
Physical Complaints
History of pain related to at least 4 sites or functions.
Two GI symptoms.
One sexual symptom.
One symptom suggestive of a neurological condition (pseudoneurological).
Symptoms can not be explained by organic etiology or symptoms are in excess of what is expected from the medical evaluation.
Symptoms are not intentionally produced.
Clinical Features of Somatization Disorder
Somatization disorder is chronic problem, and it often causes frequent seeking of medical treatment or multiple concurrent treatments.
Patients undergo multiple procedures, surgeries, and hospitalizations. The disorder often begins during adolescence.
Frequently encountered symptoms include nausea, vomiting, extremity pain, shortness of breath, and pregnancy or menstruation associated complaints.
The frequency and severity of symptoms may vary with level of stress.
Two-thirds of patients have coexisting psychiatric diagnoses. Mood and anxiety disorders and substance-related disorders are common in somatization disorder.
Epidemiology
The lifetime prevalence is 0.1 to 0.5%.
The disorder is five to twenty times more prevalent in women. The frequency of Somatization Disorder is inversely related to social class.
15% of patients have a positive family history, and the concordance rate is higher in monozygotic somatisation
Differential Diagnosis of Somatization Disorder
Medical conditions that present varied symptoms, such as systemic lupus erythematosus, HIV or multiple sclerosis, must be excluded.
Prominent somatic complaints can also be associated with depression, anxiety, and schizophrenia.
Malingering is suspected when there are external motives (example: financial) that would be furthered by the intentional production of symptoms.
Factitious Disorder. In factitious disorder symptoms are intentionally produced to assume the sick role. In this case, the motivation is to meet a psychological need.
Treatment
The physical complaints that