What Is Somatization?

Somatization is the development of physical symptoms that can be attributed to psychological factors, ultimately disrupting your daily life or causing significant distress. The physical symptoms may or may not be associated with a medical condition, but an underlying medical cause for the specific somatic symptoms and complaints cannot be identified.

Arielle Schwartz, Ph.D., a licensed clinical psychologist who practices in Boulder, Colorado, notes that while it can be common to feel symptoms—such as a tension headache—from psychological factors such as stress, somatization is when the physical response is excessive and becomes more difficult to manage.

“At times, the amount of pain or physical distress lingers long after the stressful or traumatic event has occurred,” she says. “Common types of somatization symptoms include migraines, gastrointestinal complaints and, in some cases, non-epileptic seizures.”

A 2019 article in Frontiers in Psychiatry notes that somatization is a very common comorbid condition along with other psychiatric disorders including depression, anxiety and panic disorder^[2]Fu X, Zhang F, Liu F, Yan C, Guo W. Editorial: Brain and Somatization Symptoms in Psychiatric Disorders. Front. Psychiatry, 2019;(10). .

Somatization can result in disability and high health care costs, the article adds. In fact, another article in Archives of General Psychiatry estimated that annual medical costs can be twice as much as non-somatizing patients^[3]Barsky AJ, Orav EJ, Bates DW. Somatization Increases Medical Utilization and Costs Independent of Psychiatric and Medical Comorbidity. Arch Gen Psychiatry. 2005;62(8):903–910. .

It might be easy for some to dismiss these physical symptoms as being “all in your head,” but Dr. Schwartz stresses that somatization is very real. Although these symptoms—such as stomachaches—don’t relate to a specific medical condition, it is related instead to the physical manifestation of psychological symptoms that are not well addressed or adequately treated.

“Somatization symptoms can’t be controlled and people are not faking their illness even if they cannot be explained by any medical condition,” she adds. “These symptoms still cause significant stress in social or work settings. The distress they experience is real, regardless of whether or not a physical explanation can be found.”

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the diagnostic manual used by mental health professionals—the previous disorder class of “somatoform disorders” is now classified as “Somatic Symptom and Related Disorders.” These include the following:

Somatic Symptom Disorder

Somatic symptom disorder (SSD) is characterized by a significant focus on physical symptoms—that may or may not be related to a medical diagnosis—causing excessive worries about the symptoms and their potential consequences, create significant distress or lead to impairment in important areas of functioning, according to the American Psychiatric Association (APA). This can lead to additional physical symptoms as well, explains Sanam Hafeez, Psy.D., a neuropsychologist and director of Comprehend the Mind based in New York City.

“For example, you may suffer from chest pain and therefore, harbor so much stress and anxiety over it that you then develop stomach pain as well,” she says. “You will genuinely feel the pain, but not necessarily suffer from a medical condition, if one has not been diagnosed.”

Illness Anxiety Disorder

Illness anxiety disorder involves a persistent and excessive fear of getting seriously sick, explains Dr. Hafeez, which can occur even if no physical symptoms are present. This is akin to what is commonly referred to as hypochondria. Experts note that illness anxiety disorder differs from SSD because the distress involved isn’t caused by physical symptoms, but by anxiety about possible physical symptoms arising and going to the worst case scenarios about what these physical symptoms might signify.

Conversion Disorder

Also described in the DSM-5 as functional neurological symptom disorder, conversion disorder occurs when there is a single, unexplained symptom involving voluntary or sensory functioning (such as weakness or paralysis, abnormal movement or swallowing symptoms). The DSM-5 provides the example of someone trembling, with the person believing it’s caused by a seizure disorder. But when the person is distracted, the trembling stops (which would not be the case for someone with a seizure disorder).

Experts note that the individual is not usually cognizant of how these symptoms present in odd ways that are not in line with known medical conditions.

Psychological Factors Affecting Other Medical Conditions

The DSM-5 notes this condition is more common than SSD, and defines it as distress over physical symptoms that have a confirmed or suspected diagnosis. This may actually cause harm to the patient, who may delay care or a diagnosis due to their increased anxiety about what the medical condition means for their life.

Factitious Disorder

The DSM-5 categorizes factitious disorder as a person who falsifies physical symptoms or a medical diagnosis, even in the absence of obvious, external rewards. There is an intent to deceive, as they will present to others as ill or injured. Oftentimes, they may be doing this for attention or to receive support from others, but there can be severe consequences as they may go as far as to induce pain or suffering to themselves in order to receive such attention and support.

Other Specified Somatic Symptom and Related Disorder

This category is used when a person does not meet the criteria in the DSM-5 for any of the above diagnoses. Additionally, it can also involve having the above symptoms for only a short period of time, such as having SSD for six months or less, with resolution thereafter.

There can be varying causes for somatization symptom disorders, but according to Dr. Schwartz, past stresses and experiences are often the cause for somatization symptom and related disorders. “In part, these health consequences occur because chronic stress and unresolved post-traumatic stress can lead to dysautonomia, which is a fancy word for the dysregulation of the autonomic nervous system (ANS),” she explains.

The 2019 article from Frontiers of Psychology notes that somatization symptoms can co-occur with other mental disorders, including^[2]Fu X, Zhang F, Liu F, Yan C, Guo W. Editorial: Brain and Somatization Symptoms in Psychiatric Disorders. Front. Psychiatry, 2019;(10). :

• A strong association with depressive and anxiety symptoms
• An intermediate association with symptoms of schizophrenia and mania
• A weak association with symptoms of substance use and antisocial personality

Treatment for somatization symptom disorders depends on the specific diagnosis; for example, illness anxiety disorder and factitious disorder vary and may require their own approaches. Somatization symptom disorder will typically involve treatment from both a general practitioner or other medical provider and a psychiatrist or psychologist (which in part is what leads to higher medical costs, as noted above).

“Usually, after medical tests do not reveal a medical cause, a psychiatrist or psychologist or another mental health professional will diagnose the person’s persistent physical symptom as a possible symptom of somatization,” explains Raja Selvam, Ph.D., a licensed clinical psychologist and developer of the therapy modality Integral Somatic Psychology. “If the client comes to a mental health professional, the therapy modality that the therapist is trained in is used to treat the symptom.”

A 2016 article in American Family Physician notes that on the physician side, treatment for SSD should include:

• Scheduling regular, short-interval visits to avoid the need for symptoms to get an appointment
• Establishing a collaborative, therapeutic alliance with the patient
• Acknowledging and legitimizing symptoms once the patient has been evaluated for other medical and psychiatric diseases
• Limiting diagnostic testing
• Reassuring the patient that serious medical diseases have been ruled out
• Educating patients about coping with physical symptoms
• Setting a treatment goal of functional improvement rather than cure
• Appropriately referring patients to subspecialists and mental health professionals

As Dr. Selvam notes, treatment on the mental health professional side will depend on the professional’s specific training. “In psychiatry, it is treated with a combination of medication and a therapy modality, usually cognitive behavioral therapy (CBT),” he notes.

In addition, Dr. Schwartz adds that treatment such as eye-movement rapid desensitization may even be beneficial (especially for patients who also have a trauma history). The goal is often to help the patient make the connection between stored trauma in the body and the symptoms that are present.

“Somatic psychology emphasizes body awareness as an essential part of psychotherapy and assists clients to make connections between the felt sense in the body and unfinished emotional responses related to stressful or traumatic experiences,” she notes. “We recognize that the body bears the burdens of trauma and that the body holds the keys to releasing the pain of the past so that we can reclaim a greater sense of freedom.”

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If you have visited your physician with physical symptoms that are not explained by a medical diagnosis or suspect stress or anxiety may be causing physical symptoms, you may want to reach out to a mental health professional familiar with or specializing in somatization symptoms.

Dr. Hafeez adds that the anxiety from somatization symptoms can cause reactions including but not limited to:

• Shortness of breath
• Dizziness
• Sweating
• Heart palpitations
• Restlessness
• Insomnia
• Muscle aches

“The side effects of anxiety and the symptoms it produces could cause a vicious cycle of nerves for the somatic patient,” she adds. “As long as the patient is aware of and understands the physical health problem that has been diagnosed, they need to learn to recognize and understand the physical reactions that are simply mentally related to the somatic disorder.”