Skip to main content
SpringerLink
Log in
Book cover

Somatization and Psychosomatic Symptoms pp 99–111Cite as

An Effective Approach to Somatization Assessment and Management

  • Chapter
  • First Online:

Abstract

Somatization is a process in which there is inappropriate focus on physical symptoms and psychosocial problems are denied [1]. Somatization is highly prevalent in primary care where 20–30 % of patients fulfill criteria for somatoform disorders [2–4] and even more patients may present with medically unexplained symptoms of shorter duration [5]. In a general medical clinic in the USA, 84 % of presentations of common physical symptoms had no identified organic cause [5], and over half of new referrals to a Dutch medical outpatient clinic had symptoms that remained medically unexplained [6]. Despite its high prevalence, somatization often goes unrecognized [3, 7]. Somatizing patients suffer distress for a long time and seek treatment that results in disappointment because a correct diagnosis is not made by physicians. They doctor shop but cannot find a willing physician so they are called “medical orphans” [8]. They often make the complaint that “My symptoms are genuine, but everything is coming back negative” [9].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Bass, C., & Benjamin, S. (1993). The management of chronic somatization. British Journal of psychiatry, 162, 472–480.

    Article  PubMed  Google Scholar 

  2. Toft, T., Fink, P., Oernboel, E., et al. (2005). Mental disorders in primary care: Prevalence and co-morbidity among disorders. Results from the functional illness in primary care (FIP) study. Psychological Medicine, 35, 1175–1184.

    Article  PubMed  Google Scholar 

  3. Fink, P., Sorensen, L., Engberg, M., et al. (1999). Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics, 40, 330–338.

    Article  PubMed  Google Scholar 

  4. Arnold, I. A., de Waal, M. W., Eekhof, J. A., et al. (2006). Somatoform disorder in primary care: Course and the need for cognitive-behavioral treatment. Psychosomatics, 47, 498–503.

    Article  PubMed  Google Scholar 

  5. Kroenke, K., & Mangelsdorff, D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy and outcome. The American Journal of Medicine, 86, 262–266.

    Article  PubMed  Google Scholar 

  6. van Hemert, A. M., Hengeveld, M. W., Bolk, J. H., et al. (1993). Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic. Psychological Medicine, 23, 167–173.

    Article  PubMed  Google Scholar 

  7. Goldberg, D., & Bridges, K. (1987). Screening for psychiatric illness in general practice: The general practitioner versus the screening questionnaire. The Journal of the Royal College of General Practitioners, 37, 15–18.

    PubMed  Google Scholar 

  8. Aronowitz, R. A. (2001). When do symptoms become a disease? Annals of Internal Medicine, 134, 803–808.

    Article  PubMed  Google Scholar 

  9. Nettleton, S., Watt, I., O’Malley, L., et al. (2005). Understanding the narratives of people who live with medically unexplained illness. Patient Education and Counseling, 56, 205–210.

    Article  PubMed  Google Scholar 

  10. Price, J. R. (2000). Managing physical symptoms: The clinical assessment as treatment. Journal of Psychosomatic Research, 48, 1–10.

    Article  PubMed  Google Scholar 

  11. Koh, K. B. (2011). Stress and psychosomatic medicine (pp. 263–285). Seoul, Korea: Ilchokak.

    Google Scholar 

  12. Rhodes, L. A., McPhillips-Tangum, C. A., Markham, C., et al. (1999). The power of the visible: The meaning of diagnostic tests in chronic back pain. Social Science & Medicine, 48, 1189–1203.

    Article  Google Scholar 

  13. Fink, P. (1992). Surgery and medical treatment in persistent somatizing patients. Journal of Psychosomatic Research, 36, 439–447.

    Article  PubMed  Google Scholar 

  14. Smith, G. R., Jr., Monson, R. A., & Ray, D. C. (1986). Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Archives of Internal Medicine, 146, 69–72.

    Article  PubMed  Google Scholar 

  15. Hahn, S. R., Thompson, K. S., Wills, T. A., et al. (1994). The difficult doctor-patient relationship: Somatization, personality and psychopathology. Journal of Clinical Epidemiology, 47, 647–657.

    Article  PubMed  Google Scholar 

  16. Sharpe, M., Mayou, R., Seagroatt, V., et al. (1994). Why do doctors find some patients difficult to help? The Quarterly Journal of Medicine, 87, 187–193.

    PubMed  Google Scholar 

  17. Henningsen, P., Zipfel, S., & Herzog, W. (2007). Management of functional somatic syndromes. Lancet, 369, 946–955.

    Article  PubMed  Google Scholar 

  18. Aragones, E., Pinol, J. L., & Labad, A. (2007). Depression and physical comorbidity in primary care. Journal of Psychosomatic Research, 63, 107–111.

    Article  PubMed  Google Scholar 

  19. de Waal, M. W., Arnold, I. A., Eekhof, J. A., et al. (2008). Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care. BMC Family Practice, 9, 5.

    Article  PubMed  Google Scholar 

  20. Gask, L., Sibbald, B., & Creed, F. (1997). Evaluating models of working at the interface between mental health services and primary care. The British Journal of Psychiatry, 170, 6–11.

    Article  PubMed  Google Scholar 

  21. Lieb, R., Meinlschmidt, G., & Araya, R. (2007). Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: An update. Psychosomatic Medicine, 69, 860–863.

    Article  PubMed  Google Scholar 

  22. Hanel, G., Henningsen, P., Herzog, W., et al. (2009). Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study. Journal of Psychosomatic Research, 67, 189–197.

    Article  PubMed  Google Scholar 

  23. Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56, 730–737.

    Article  PubMed  Google Scholar 

  24. Faraone, A., Tsuang, M. T., & Tsuang, D. W. (1999). Genetics of mental disorders. A guide for students, clinicians and researchers. New York: Gilford Press.

    Google Scholar 

  25. Hotopf, M., Wadsworth, M., & Wessely, S. (2001). Is “somatisation” a defense against the acknowledgment of psychiatric disorder? Journal of Psychosomatic Research, 50, 119–124.

    Article  PubMed  Google Scholar 

  26. Williams, S., Weinman, J., Dale, J., et al. (1995). Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Family Practice, 12, 193–201.

    Article  PubMed  Google Scholar 

  27. Matthews, D. A., Sledge, W. H., Lieberman, P. B., et al. (1987). Evaluation of intern performance by medical inpatients. The American Journal of Medicine, 35, 936–944.

    Google Scholar 

  28. Kerwick, S., Jones, R., Mann, A., et al. (1997). Mental health care training priorities in general practice. The British Journal of General Practice, 47, 225–227.

    PubMed  Google Scholar 

  29. Reid, S., Whooley, D., Crayford, T., et al. (2001). Medically unexplained symptoms – GPs’ attitudes towards their cause and management. Family Practice, 18, 519–523.

    Article  PubMed  Google Scholar 

  30. Fink, P., Rosendal, M., & Toft, T. (2002). Assessment and treatment of functional disorders in general practice: The extended reattribution and management model – an advanced educational program for nonpsychiatric doctors. Psychosomatics, 43, 93–131.

    Article  PubMed  Google Scholar 

  31. Koh, K. B., Kim, D. K., Kim, S. Y., et al. (2008). The relation between anger management style, mood, and somatic symptoms in anxiety disorders and somatoform disorders. Psychiatry Research, 160, 372–379.

    Article  PubMed  Google Scholar 

  32. Maguire, G. P., Goldberg, D. P., Hobson, R. F., et al. (1984). Evaluating the teaching of a method of psychotherapy. The British Journal of Psychiatry, 144, 575–580.

    Article  PubMed  Google Scholar 

  33. Goldberg, D. P., Smith, C., Steele, J. J., et al. (1980). Training family doctors to recognize psychiatric illness with increased accuracy. Lancet, ii, 521–523.

    Article  Google Scholar 

  34. Gask, L., Goldberg, D. P., Lesser, A. L., et al. (1988). Improving the psychiatric skills of the general practice trainee: An evaluation of a group training course. Medical Education, 22, 132–138.

    Article  PubMed  Google Scholar 

  35. Gask, L., Goldberg, D., Porter, R., et al. (1989). The treatment of somatization: Evaluation of a teaching package with general practice trainees. Journal of Psychosomatic Research, 33, 697–703.

    Article  PubMed  Google Scholar 

  36. Craig, T. K. J., & Boardman, A. P. (1990). Somatization in primary care settings. In C. Bass (Ed.), Somatization: Physical symptoms and psychological illness. Oxford: Blackwell.

    Google Scholar 

  37. Grol, R. (1988). To heal or to harm. The prevention of somatic fixation in general practice. London: Royal College of General Practitioners.

    Google Scholar 

  38. Gorlin, R., & Zucker, H. D. (1983). Physician’s reactions to patients: A key to teaching humanistic medicine. The New England Journal of Medicine, 308, 1059–1063.

    Article  PubMed  Google Scholar 

  39. Groves, J. E. (1978). Taking care of the hateful patient. The New England Journal of Medicine, 298, 883–887.

    Article  PubMed  Google Scholar 

  40. Mayou, R. A., Bass, C., & Sharpe, M. (1995). Treatment of functional somatic symptoms. Oxford: Oxford University Press.

    Google Scholar 

  41. Stewart, M., Brown, J., Weston, W., et al. (2003). Patient-centered medicine transforming the clinical method. Oxford: Radcliffe Medical Press.

    Google Scholar 

  42. Salmon, P. (2000). Patients who present with physical symptoms in the absence of physical pathology: A challenge to existing models of doctor-patient interaction. Patient Education and Counseling, 39, 105–113.

    Article  PubMed  Google Scholar 

  43. Salkovskis, P. M. (1989). Somatic problems. In K. Hawton, P. M. Salkovskis, J. Kirk, et al. (Eds.), Cognitive behavior therapy for psychiatric problems. A practical guide. Oxford: Oxford University Press.

    Google Scholar 

  44. Sharpe, M., Peveler, R., & Mayou, R. (1992). The psychological treatment of patients with functional somatic symptoms: A practical guide. Journal of Psychosomatic Research, 36, 515–529.

    Article  PubMed  Google Scholar 

  45. Thomas, K. B. (1987). General practice consultations: Is there any point in being positive? BMJ, 294, 1200–1202.

    Article  PubMed  Google Scholar 

  46. Fitzpatrick, R. M., & Hopkins, A. (1981). Referrals to neurologists for headaches not due to structural disease. Journal of Neurology, Neurosurgery, and Psychiatry, 44, 1061–1067.

    Article  PubMed  Google Scholar 

  47. van Dulmen, A., Fennis, J. F., Mokkink, H. G., et al. (1995). Doctor-dependent changes in complaint-related cognitions and anxiety during medical consultations in functional abdominal complaints. Psychological Medicine, 25, 1011–1018.

    Article  PubMed  Google Scholar 

  48. Sharpe, M., & Bass, C. (1992). Pathophysiological mechanisms in somatization. International Review of Psychiatry, 4, 81–97.

    Article  Google Scholar 

  49. Morriss, R., Gask, L., Ronalds, C., et al. (1999). Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners. The British Journal of General Practice, 49, 262–267.

    Google Scholar 

  50. Morriss, R. K., & Gask, L. (2002). Treatment of patients with somatized mental disorder: Effects of reattribution training on outcomes under the direct control of the family doctor. Psychosomatics, 43, 394–399.

    Article  PubMed  Google Scholar 

  51. Rosendal, M., Olesen, F., Fink, P., et al. (2007). A randomized controlled trial of brief training in the assessment and treatment of somatization in primary care: Effects on patient outcome. General Hospital Psychiatry, 29, 364–373.

    Article  PubMed  Google Scholar 

  52. Kroenke, K., Taylor-Vaisey, A., Dietrich, A. J., et al. (2000). Interventions to improve provider diagnosis and treatment of mental disorders in primary care. A critical review of the literature. Psychosomatics, 41, 39–52.

    Article  PubMed  Google Scholar 

  53. Kroenke, K., & Swindle, R. (2000). Cognitive-behavioral therapy for somatization and somatic symptoms: A critical review of controlled clinical trials. Psychotherapy and Psychosomatics, 69, 205–215.

    Article  PubMed  Google Scholar 

  54. Smith, G. R., Jr., Rost, K., & Kashner, T. M. (1995). A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Archives of General Psychiatry, 52, 238–243.

    Article  PubMed  Google Scholar 

  55. Speckens, A. E. M., van Hemert, A. M., Spinhoven, P., et al. (1995). Cognitive behavioral therapy for medically unexplained physical symptoms: A randomized controlled trial. BMJ, 311, 1328–1332.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Kyung Bong Koh M.D., Ph.D.

Authors
  1. Kyung Bong Koh M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyung Bong Koh M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. College of Medicine, Department of Psychiatry, Yonsei University, 50 Yonsei-ro, Seoul, 120-752, Korea, Republic of (South Korea)

    Kyung Bong Koh

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Koh, K.B. (2013). An Effective Approach to Somatization Assessment and Management. In: Koh, K. (eds) Somatization and Psychosomatic Symptoms. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7119-6_9

Download citation

Publish with us

Policies and ethics

Search

Navigation