Somatization in the population: From mild bodily misperceptions to disabling symptoms

Department of Clinical Psychology, University of Mainz, Staudingerweg 9, 55099 Mainz, Germany.
Social Psychiatry and Psychiatric Epidemiology (Impact Factor: 2.58). 10/2006; 41(9):704-12. DOI: 10.1007/s00127-006-0082-y
Source: PubMed

ABSTRACT This study investigates the prevalence of current somatization in the population by taking different levels of symptom severity into account. Somatization is described along a continuum from mild and negligible bodily misperceptions to severe and disabling somatoform symptoms.
A representative sample of 2.552 persons in Germany was examined with a screening instrument for medically unexplained physical complaints that had occurred during the past 7 days. All 53 symptoms from the ICD-10/DSM-IV sections of somatoform disorders were included.
81.6% reported at least one symptom causing at least mild impairment and 22.1% at least one symptom causing severe impairment. The entire sample had an average of 6.6 symptoms associated with at least mild distress. Somatization of any degree was associated with female gender, age above 45, lower educational level, lower household income and rural area. The most common symptoms with prevalence rates > 20% were various types of pain (back, head, joints, extremities), food intolerance, sexual indifference, painful menstruations and erectile/ejaculatory dysfunction.
This population survey demonstrates that medically unclear complaints are an everyday phenomenon. About three out of four cases are below clinical relevance with only low level of impairment. Epidemiological correlates are similar between clinical and non-clinical forms of somatization.

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Available from: Winfried Rief, Aug 31, 2015
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    • "First, we extend the diagnostic spectrum by including somatoform disorders. This addition is stimulated by a substantial amount of literature highlighting that somatoform disorders like somatization and pain disorders are particularly impairing and with a frequently chronic course with a substantially degree of help-seeking, utilization of health services and high cost burden [4] [14] [16] [15] [32]. Second, we provide a more comprehensive characterization of disability days. "
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    ABSTRACT: This paper provides nationally representative data on how current and past mental disorders are related to functional disability and health-related quality of life (QoL). Results are based on a nationally representative sample (DEGS1-MH; n=4483 aged 18-79). Respondents were examined by clinical interviewers with the DSM-IV Composite International Diagnostic Interview (DIA-X/M-CIDI). Functional disability, i.e. number of disability days in the past 4weeks, and QoL, i.e. mental (MCS) and physical (PCS) component scale of the SF-36V2, were examined in subjects with 12-month mental disorders (=active cases [AC]) and compared to (a) subjects who never met diagnostic criteria (=unaffected individuals [UAI]), and (b) those with a history of mental disorders but not meeting the diagnostic criteria in the past 12months (=non-active cases [NAC]; partially or fully remitted). In comparison to UAI (mean: 1.9), AC reveals a 2-3 fold disability days/month (5.4, P<.001) and a substantially reduced MCS (UAI: 52.1; AC: 43.3, P<.001). NAC had a similar number of disability days as UAI, but significantly reduced MCS scores (49.9; P<.001). Disability days and QoL decrements were highest in internalizing disorders including somatoform disorders and most pronounced in comorbid cases. By and large, findings of a previous study were confirmed and extended for this nationally representative German sample. 12-month mental disorders, particularly internalizing, including somatoform disorders, are associated with high levels of disability and increased health-related QoL decrements. Partial or complete remission of the mental disorders is associated with a normalization of the numbers of disability days. Copyright © 2015. Published by Elsevier Masson SAS.
    European Psychiatry 07/2015; DOI:10.1016/j.eurpsy.2015.06.003 · 3.21 Impact Factor
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    • "Lastly, ED may represent a frequent symptom in somatization disorders, especially in men of over 45 years old [61]. "
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    ABSTRACT: Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed.
    International Journal of Endocrinology 03/2014; 2014:878670. DOI:10.1155/2014/878670 · 1.52 Impact Factor
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    • "Symptom intensities of 53 physical symptoms from the somatization symptom lists of ICD-10 and DSM-IV were measured according to the Screening for Somatoform Symptoms 7-day version (SOMS-7d) [24,25], with the difference that instructions asked participants to report perceived impairment for all symptoms, without requesting participants to differentiate between MUS and MES. The SOMS-7d was designed to measures impairment by 53 typical somatization symptoms, such as “headache”, “bloating” or “back ache” on a 5-point Likert-scale within the last seven days: Scores are 0 (symptom absent or not impairing), 1 (mild), 2 (medium), 3 (severe) and 4 (very severe). "
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    ABSTRACT: The etiology of somatization is incompletely understood, but could be elucidated by models of psychosocial stress. Academic exam stress has effectively been applied as a naturalistic stress model, however its effect on somatization symptoms according to ICD-10 and DSM-IV criteria has not been reported so far. Baseline associations between somatization and personality traits, such as alexithymia, have been studied exhaustively. Nevertheless, it is largely unknown if personality traits have an explanatory value for stress induced somatization. This longitudinal, quasi-experimental study assessed the effects of university exams on somatization - and the reversal of effects after an exam-free period. Repeated-observations were obtained within 150 students, measuring symptom intensity before, during and after an exam period, according to the Screening for Somatoform Symptoms 7-day (SOMS-7d). Additionally, self-reports on health status were used to differentiate between medically explained and medically unexplained symptoms. Alexithymia, neuroticism, trait-anxiety and baseline depression were surveyed using the Toronto-Alexithymia Scale (TAS-20), the Big-Five Personality Interview (NEO-FFI), the State Trait Anxiety Inventory (STAI) and Beck's Depression Inventory (BDI-II). These traits were competitively tested for their ability to explain somatization increases under exam stress. Somatization significantly increased across a wide range of symptoms under exam stress, while health reports pointed towards a reduction in acute infections and injuries. Neuroticism, alexithymia, trait anxiety and depression explained variance in somatization at baseline, but only neuroticism was associated with symptom increases under exam stress. Exam stress is an effective psychosocial stress model inducing somatization. A comprehensive quantitative description of bodily symptoms under exam stress is supplied. The results do not support the stress-alexithymia hypothesis, but favor neuroticism as a personality trait of importance for somatization.
    PLoS ONE 12/2013; 8(12):e84911. DOI:10.1371/journal.pone.0084911 · 3.23 Impact Factor
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