Somatization Disorder…often confused with CFIDS
Somatization Disorder
Somatization disorder is a syndrome described by diagnostic criteria found in
DSM-IV, the current diagnostic and statistical manual published by the American
Psychiatric Association. I practiced psychiatry for 20 years and had the
opportunity to evaluate and follow over many years patients with this disorder.
Most CFS and FMS patients do not qualify for these criteria, but a few do. The
symptoms in SD must be without medical explanation. Generally patients with CFS
will have a positive quantitative EEG, neuropsychological test, or some other
objective data although it is not essential.
Somatization disorder (SD) can generally be easily distinguished from CFS and
FMS by the experienced evaluator. This situation arises in disability
evaluations where there is discrimination against psychiatric conditions. Some
evaluators will refer to patients as “somatisizing,” which has the effect of
demeaning the patient. Generally patients with SD do not bring in a list of
symptoms. In fact, this diagnosis is usually missed because the patients are
more concerned with their social problems than with their symptoms. I have never
seen a case of SD in which there was not a significant personality disorder. A
personality disorder is a marked, persistent aberration in thinking and/or
feeling that causes the individual to have difficulty in relating to others and
adapting to his environment. Generally, the personality disorder is more
disabling than the physical symptoms. Ninety-five percent of SD patients are
women. They usually have a strong attachment to a male figure, which can be a
friend, husband or even a son. When this relationship is disturbed, one or more
of their principal psychiatric symptoms such as depression, anxiety, fears,
panic disorder, etc. gets worse. The patients are very feeling oriented and
relate best on a one-to-one feeling level. Although they have a history of
numerous physical symptoms, they generally don’t reveal the majority of them
unless they are asked.
Patients with SD have the highest incidence of suicide attempts by far, but not
the highest incidence of deaths by suicide. Usually the suicide attempts are
overdoses of medications. They are often seen in emergency rooms after an
overdose associated with a disruption in the relationship with the significant
male. Patients with SD are often attractive, flirtatious, and seek male
attention. They are not likely to have an interest in mathematics, science, or
traditionally male pursuits. They frequently have difficulty relating to other
women.
If you are concerned that this issue may come up in a disability evaluation, you
should anticipate this and have your health professional address this issue in
his report. He should make a statement that SD was considered, but ruled out,
giving his reasons. You are at a strong disadvantage if you go into a disability
evaluation without good medical records.
History of Somatization Disorder
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