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

Philipps University of Marburg, Marburg, Hesse, Germany
Social Psychiatry and Psychiatric Epidemiology (Impact Factor: 2.54). 10/2006; 41(9):704-12. DOI: 10.1007/s00127-006-0082-y
Source: PubMed


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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    • "Sleep problems , anxiety and depression have commonly been reported along with LBP and neck pain and other conditions with chronic pain [13] , and a review identified headache /migraine, respiratory disorders, cardiovascular disease, general health, and other diseases clustering with LBP in some individuals [14]. It would appear that various impact of LBP is often one element in a more diffuse sensitisation /somatization151617. Consequently, it would be useful to evaluate the total co-morbidity tendency in people who have sustained neck injuries prior to, and after, the accident. "
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    ABSTRACT: Background Previous studies suggest that a greater proportion of neck injury patients, whose injuries were sustained through whiplash accidents, become chronic due to a component of sickness-focusing. However, it is also possible that some of those with neck injuries were already more frail prior to the injury, resulting in more consequences from a certain intensity of injury. The objective of this study was to compare co-morbidity and mortality in people with a registered neck injury diagnosis, evaluated prior to and after the neck injury, to people without a registered neck injury evaluated at the same time-points. Methods From a hospital patient registry over a 12-year period, we identified those with the diagnosis ‘cervical-column distortion’ and matched four controls for each of them on sex, age, marital status and county of residence. For calculations of co-morbidity, those with an injury at year 1, who thus had no prior data, and for those at year 12 who did not have post data, were not included. The same applied to their individually matched controls. Health data for up to 3 years prior to and up to 3 years after the year of injury were recorded. Results We identified 94,224 cases and 373,341 controls. Those with registered neck injuries had 1.2-2.0 times more co-morbidities than controls after the injury, but had already had about the same (1.3-1.8 more co-morbidities) number of co-morbidities prior to the injury. Mortality up to 12 years was approximately the same in the two groups. Conclusions Those people having a registered neck injury had more co-morbidity diagnoses both before and after the injury than those without a registered neck injury. This suggests that the co-morbidities observed after the injury may be partly related to already existing general high health care-seeking and/or a low health status, rather than being entirely the consequence of the injury.
    Full-text · Article · Dec 2016 · BMC Musculoskeletal Disorders
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    • "Medically unexplained symptoms (MUS) are defined as somatic symptoms that cannot or have not been sufficiently explained by somatic causes after a thorough physical examination [1]. MUS in the sense of mild bodily misperceptions are a common phenomenon in the general population that have to be distinguished from distressing and disabling MUS [2]. Latter present core symptoms of the diagnostic category of somatoform disorders in DSM-IV [3] and ICD-10 [4], and are highly prevalent in the general population e.g. "
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    ABSTRACT: Introduction: Although cognitive behavior therapy (CBT) is the best evidenced psychological treatment for medically unexplained symptoms (MUS), effect sizes are rather moderate. Empirically evidenced deficits in emotion processing in patients with MUS make a CBT enriched with an emotion regulation training (ENCERT) a promising approach to increase treatment effects. Methods and design: This protocol describes the development and implementation of a multicenter, randomized, active-controlled study with blinded outcome assessors to compare the efficacy of ENCERT with a conventional CBT for MUS. Individuals presenting with ≥3 disabling, chronic MUS and fulfilling other predefined inclusion criteria are randomized to 20 sessions either of ENCERT or conventional CBT. Power calculations are based on the severity index of the Screening of Somatoform Disorders-7T and obtained an optimal sample size of N=244. Questionnaires on symptom severity, symptom-related psychological features, and emotion regulation skills are administered at baseline, end of therapy, and 6-months follow-up. An every-session monitoring of therapy progress, and regular patients'/therapists' ratings of quality of therapy, working alliance, outcome expectations, and adverse events are conducted. Primary statistical analysis shall verify the hypothesis of ENCERT being more efficacious than conventional CBT regarding symptom severity. Discussion: Enriching CBT with transdiagnostic therapeutic strategies addressing emotion regulation is a promising and new approach to target not only somatic symptom coping but also symptom-associated problems and comorbid mental disorders. The current trial will not only allow examining the efficacy of ENCERT but also important variables and mechanisms of the process of therapy. Trial registration: NCT01908855.
    Full-text · Article · Dec 2015 · Contemporary clinical trials
    • "These disorders are prevalent in 3.5% to 10% of the general population [3], and in up to 20% of patients in primary care settings [4] [5]. Medically unexplained symptoms and somatoform disorders substantially reduce patients' well-being and quality of life [1] [6]. Moreover, similarly to depressive and anxiety disorders, somatoform disorders are associated with high health care costs caused by frequent consultations, repeated diagnostic procedures and work incapacity [7] [8]. "
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    ABSTRACT: Objective: The successful management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for somatoform disorders, and its impact on the diagnostic process and treatment recommendations in primary care. Method: The Network for Somatoform and Functional Disorders (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and treatment recommendations were compared before and 12 months after establishing the network. Results: Out of the pre- (n=1645) and 12-months-post Sofu-Net patient samples (n=1756), 267 (16.2%) and 269 (15.3%) high-risk patientswere identified. Fromthese, 156 and 123 patientswere interviewed and information was assessed fromtheir PCP. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs. 79.2%, p < .001). PCPs prescribed more antidepressants (3.8% vs. 25.2%, p < .001) and less benzodiazepines (21.8% vs. 6.5%, p < .001). Sofu-Net did not affect PCP's diagnostic detection rates or recommendation to initiate psychotherapy. Conclusion: The study results indicate feasibility of an interdisciplinary network for somatoformdisorders. Collaborative care networks for somatoform disorders have the potential to improve doctor–patient-communication and prescription behavior.
    No preview · Article · Nov 2015 · Journal of Psychosomatic Research
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