GETTYSBURG MEDICAL NEWS
The Clinical View
By P. E. Hoffsten, M. D.
5 March 2008

WHAT IS SOMATIZATION DISORDER?

             Over the years, I had seen this lady a very few times.  Twice she had come in for evaluation of abdominal pain and no major abnormality was discovered.  Once she had come in because she had headaches and, again, no specific abnormality was identified.  But I hadn’t seen her now for about five years.  She came to see me bringing a letter from Mayo Clinic where she had recently gone.  She had been seeing a physician in Sioux Falls who had done a large number of tests.  She finally went to Mayo because she didn’t seem to be satisfied with the answers she was getting.  They did an additional extensive number of tests at Mayo Clinic and then explained to her that she had “Somatization Syndrome.”  She was very indignant because she felt that they “didn’t listen to her.”  They suggested a psychiatric consult which insulted her even more.

            So I inquired as to what her concerns were.  She took out a list that was headed by abdominal pain.  She explained that the pain was not related to any activity and not necessarily made better or worse by eating or by having a bowel movement or by changing position or activity.  The pain was described as constant in nature, not cramping.  It was not associated with weight loss or appetite suppression.  She was not bleeding from any place.  Then she made the challenging comment that no matter what anybody gave her, “it didn’t do any good”.  She had CT scans of her abdomen done along with an endless number of blood tests, endoscopic examinations of her stomach and her bowel, and consultations with the gastroenterologist.  She had never received a satisfying answer as to “what was wrong.”

            The second item on her list was headaches.  These were described as constant in nature, unrelated to activity, not associated with any abnormality of her neurologic function, not associated with a change in level of consciousness, and, again, the challenging comment that no one had ever found a medicine that helped them.

            After this, there came 4 more complaints including diffuse joint aching, diffuse muscle aching, shortness of breath with any exertion, and dizziness.  While at Mayo Clinic, she had been seen by the neurologist for her headaches and dizziness, the rheumatologist for her muscle and joint aches, and the pulmonary specialist for her shortness of breath, along with a cardiology consult.  There had been no identified disease process to explain the symptoms that she had.  Following all of these consultations, one of the physicians at Mayo Clinic tried to explain to her that she was not sick and that her various symptoms did not represent disease.  He suggested psychiatric consultation, at which point she decided she would leave the clinic there and come home.

            At this visit, I inquired as to what she was hoping for from her visit with me.  She said she wanted to know what was wrong causing all of these symptoms.  She wondered what tests could be done to find the cause of her symptoms.  It was certainly not music to her ears when I explained that she was not going to find a cause for her symptoms and that there was no reason to do any more tests.  I inquired as to what her concern was regarding her symptoms.  She was not really able to explain her concerns, but eventually indicated that she knew there must be something wrong causing all of her symptoms.

            I explained to her then that this assumption is not correct.  Certainly, pain is not a pleasant thing but a surprising fact is that 7 out of 10 people that seek medical attention from a physician do not have a disease to explain the pain that they are having.  She listened to me for a brief instant, cocked her head to one side, and then asked, “Well then what is causing the pain”?  I had to explain to her again that she is not going to find a cause for the pain.  I explained that not every pain represents a disease.  She said that she was sure that there must be a cancer, or an ulcer, or something wrong with her liver to explain the abdominal pain that she has had all of these years.  I pointed out to her that tests had been done for all of those various different maladies (and I promise you Mayo Clinic is very thorough) and they had not found any such disease to explain the pain that she was having.

            I then asked how the pain that she was having interfered with her life.  Did she not go places or do things because of the symptoms that she had?  She proudly stated that she was a very strong individual and was not going to let the pains interfere with her life.

            It was at that point that I explained to her that “Somatization Syndrome” is the name applied to some individuals who have multiple pains and multiple symptoms, but in spite of all of the tests that are ever done, never really have a demonstrable disease process to explain the symptoms.  The problem with care with these individuals is to avoid over medicating or over testing.  There is no point doing an increasing number of sophisticated medical examinations that become expensive and at some point even dangerous.  Some how there needs to come an understanding that the symptoms do not represent a disease and will not shorten or interfere with her life. 

            Sometimes there are medications that will change how a person focuses on their symptoms and can be helpful, but the biggest favor the medical community can do for a person with Somatization Syndrome is to recognize it and avoid inappropriate medications and tests.  This is, of course, very tricky because people with Somatization Syndrome can become victims of the “crying wolf” problem.  The best thing a person with this diagnosis can do is pick a trusted caregiver and stick with that person so that if and when dangerous disease processes do develop, they can be recognized and appropriately dealt with.  In regard to the rest of the time, the person with Somatization Syndrome can be treated with symptomatic medications that can help the symptoms, but avoid side effects, complications, and unnecessary and expensive testing and treatments.