Academic journal article Journal of Psychosocial Research

Somatization as a Form of Common Mental Disorder: A Hospital Based Study

Academic journal article Journal of Psychosocial Research

Somatization as a Form of Common Mental Disorder: A Hospital Based Study

Article excerpt

INTRODUCTION AND REVIEW

Somatization refers to the development of somatic symptoms for which no organic cause is found (Escalona, Achilles, Waitzkin and Yager, 2004; North, Kawasaki, Spitznagel and Hong, 2004). Anxiety, distress and depressive tendencies along with functional impairment were found to be associated with somatization (Katon, Sullivan, Walker, 2001), a set of syndromes collectively came to be referred as common mental disorders. Common Mental Disorders was a term coined by Goldberg and Huxley (1992, pp. 7-8) to describe "disorders which are commonly encountered in community settings, and whose occurrence signals a breakdown in normal functioning". Common Mental Disorders, the new incarnation of neuroses, have been classified in ICD 10 in two main categories: Neurotic, Stress-related and Somatoform Disorders with a number of subcategories and Mood Disorders (with specific reference to unipolar depression).

Several studies have described the clinical presentations of these disorders in general health care settings. Physical symptoms that are unexplained by longitudinal medical workup are common and associated with high rates of psychopathology among primary and specialty care patients (Simon, Von Korff, Piccinelli, Fullerton, and Ormel, 1999; Kroenke, Spitzer, Williams, Linzer, Hahn and deGruy, 1994; Russo, Katon, Sullivan, Clark and Buchwald, 1994; Walker, Katon and Jemelka, 1993). For example, physical complaints account for over 50% of outpatient clinic visits, yet in one third to one half of cases no medical explanation is found (Kroenke et al., 1994; Kroenke and Price, 1993). Many patients present with unexplained physical symptoms or functional somatic symptoms rather than psychological complaints, resulting in an excess number of costly clinical investigations (Becker, 2004). The commonest complaints are somatic, in particular tiredness and weakness, multiple aches and pains, dizziness, palpitations and sleep disturbances (Chaturvedi, Upadhyaya and Rao, 1988; Ebigbo, Janakiramaiah and Kumaraswamy, 1989; Patel, Pereira and Mann, 1998; Srinivasan and Suresh, 1990). However, these are distress states with non-somatic aetiology (Patel, Pereira, Coutinho and Fernandes, 1997).

High levels of somatization create high levels of distress in the patient and drain out scarce resources in society owing to health-care utilization, productivity at work and other social costs (Fink, Rosendal and Olesen, 2005). A retrospective review of more than 13,000 psychiatric consultations found that somatization disorder resulted in more disability and unemployment than any other psychiatric illness (Thomassen, van Hemert, and Huyse, 2003).

Unexplained physical symptoms also impact health service delivery. Among medical patients with depressive and anxiety disorders, high levels of somatic symptoms are associated with increased health care utilization (Walker et al., 1993; Katon, Von Korff, Lin, Lipscomb, Russo and Wagner, 1990; Pearson, Katzelnick, Simon, Manning, Helstad and Henk, 1999), and functional impairment (Kroenke et al., 1994; Walker, Gelfand, Gelfand, Creed and Katon, 1996). Patients with somatization in the primary care setting have more than twice the outpatient utilization and overall medical care cost when compared with patients without somatization (Barsky, Orav and Bates, 2005).

Currently, research on somatization and its treatment suffer from a lack of specific diagnostic classification. Diagnostic categories involving somatoform disorders tend to overlap with somatization. Patients with overlapping symptoms may be issued different diagnostic labels based on the focus of the attending physician. Patients with symptoms of short duration do not provide the opportunity for diagnosis in primary care settings wherein somatoform diagnostic categories are issued to persistent cases (Fink, Rosendal and Olesen, 2005).

It has been reported that between one-fourth to one-third of all patients who availed general medical services, did not have clear physical or organic illness but were suffering from predominantly psychological or emotional problems often expressed in somatic terms (Verma, 1988). …

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