I. Background

  1. Somatizers generate 9 times the average medical cost
  2. Despite medical attention, somatizers highly disabled
  3. Physicians report frustration in treating somatizers
    1. Lack sense of effectiveness
    2. Patient does not fit into standard diagnoses
    3. Patient does not fit into standard office schedule

II. Pathophysiology

  1. Sensory amplification
    1. Preoccupation with disease focuses on body sensations
    2. Normal variations in senses interpreted as abnormal
    3. Exacerbates anxiety and panic, as well as discomfort
  2. Identified patient within a dysfunctional family
    1. Family dysfunction transferred to the patient
    2. Patient's "illness" stabilizes family
    3. Other family member's anxiety relieved
  3. Need to be sick
    1. Patient pursues sick role to relieve stressors
    2. Not the same as Malingering or faking symptoms
      1. Somatizing Patient unaware of symptom generation
  4. Dissociation
    1. Activation of Pain Sensation without physical pain

IV. Differential Diagnosis

  1. Organic disease (exclude completely before making Somatization diagnosis)
  2. Reported symptoms adopted by patient for Secondary Gain
    1. Factitious Disorder (Adoption of physical symptoms for unconscious internal gain)
    2. Malingering (Purposeful feigning of physical symptoms for external gain)

V. Risk Factors

  1. See Somatization Risk Factors
  2. Underlying mental health condition
  3. History of physical abuse or sexual abuse

VI. Definition

  1. Emotional distress experienced as physical symptoms

VII. Symptoms

X. Precautions

  1. Reassess for underlying medical condition

XI. Management

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Ontology: Hysteria (C0020701)

Definition (MSH) Historical term for a chronic, but fluctuating, disorder beginning in early life and characterized by recurrent and multiple somatic complaints not apparently due to physical illness. This diagnosis is not used in contemporary practice.
Definition (CSP) behavior exhibiting excessive or uncontrollable emotion, such as fear or panic; mental disorder characterized by emotional excitability and sometimes by amnesia or a physical deficit, such as paralysis, or a sensory deficit, without an organic cause.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D007046
ICD9 300.10
ICD10 F44
SnomedCT 268629005, 191712003, 62448009, 191719007, 44376007, 89239005
French HYSTERIE, Hystérie, non précisée, Hystérie
English HYSTERIA, Hysteria unspecified, Hysteria, unspecified, SOMATIZATION DISORDER <HYSTERIA>, hysteria, hysteria (diagnosis), SOMATIZATION DISORDER HYSTERIA, Hysteria NOS, Hysteria [Disease/Finding], hysterical disorder, Hysteria unspecified (disorder), Hysteria (finding), Hysteria NOS (disorder), Hysterical disorder, Hysterical disorder, NOS, Hysteria
Portuguese HISTERIA, Histeria NE, Histeria
Spanish HISTERIA, Histeria no especificada, histeria (hallazgo), histeria, SAI, histeria no especificada (trastorno), histeria no especificada, histeria, SAI (trastorno), histeria, trastorno histérico, Histeria
German HYSTERIE, Hysterie, unspezifisch, Hysterie
Dutch niet-gespecificeerde hysterie, hysterie, Hysterie
Italian Isteria non specificata, Isteria
Japanese ヒステリー、詳細不明, ヒステリーショウサイフメイ, ヒステリー, ヒステリー, ヒステリー性ノイローゼ, ヒステリー反応, ヒステリー性神経症
Swedish Hysteri
Czech hysterie, Hysterie, Hysterie, blíže neurčená
Finnish Hysteria
Polish Histeria, Nerwice histeryczne
Hungarian Hysteria, Hysteria, nem meghatározott
Norwegian Hysteri

Ontology: Psychophysiologic Disorders (C0033931)

Definition (MSH) A group of disorders characterized by physical symptoms that are affected by emotional factors and involve a single organ system, usually under AUTONOMIC NERVOUS SYSTEM control. (American Psychiatric Glossary, 1988)
Definition (CSP) characterized by physical symptoms and demonstrable structural or physiological changes in which emotional factors are believed to play a major etiologic role.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D011602
ICD10 F45.9
SnomedCT 191985004, 37057007
English Psychophysiologic Disorders, Psychophysiological Disorder, Psychophysiological Disorders, Psychosomatic Disorders, Psychophysiologic Disorder, Psychosomatic Disorder, psychosomatic disorder, Psychosomatic disease, PSYCHOSOMATIC DIS, PSYCHOPHYSIOL DIS, psychophysiologic disorder, psychophysiological dysfunction, Psychosomatic disorder NOS, Psychophysiologic Disorders [Disease/Finding], illness psychosomatic, illnesses psychosomatic, diseases psychosomatic, psychophysiologic disorders, psychosomatic disease, psychosomatic illness, psychophysiological disorders, psychosomatic disorders, psychophysiological disorder, disease psychosomatics, Psychosomatic disorder NOS (disorder), Psychosomatic disorder (diagnosis), psychiatric diagnosis or condition psychosomatic disorder, Psychophysiologic disorder, Psychosomatic disorder, Psychophysiologic disorder (finding), dysfunction; psychophysiological, Psychophysiologic disorder, NOS, Psychosomatic disorder, NOS, Psychophysiologic disorder NOS
Italian Malattia psicosomatica, Disturbi psicosomatici, Disturbi psicofisiologici
Swedish Psykosomatiska sjukdomar
Japanese シンシンショウ, 心身症, 心理生理的障害, 心身相関の障害, 精神生理障害, 精神身体学的障害, 精神身体異常, 精神身体症, 精神身体的異常, 精神身体障害
Czech psychosomatické nemoci, psychofyziologické poruchy, Psychosomatické onemocnění
Finnish Psykofysiologiset häiriöt
Polish Zaburzenia psychosomatyczne, Zaburzenia psychofizjologiczne
Hungarian Psychosomatikus betegség
Norwegian Psykosomatiske sykdommer, Psykosomatiske forstyrrelser
Spanish trastorno psicosomático, SAI (trastorno), trastorno psicosomático, SAI, trastorno psicofisiológico (hallazgo), trastorno psicofisiológico, trastorno psicosomático, Enfermedad psicosomática, Trastornos Psicofisiológicos, Trastornos Psicosomáticos
Dutch functiestoornis; psychofysiologisch, psychosomatische ziekte, Psychofysiologische storing, Psychofysiologische storingen, Psychosomatische storingen, Storing, psychofysiologische
Portuguese Doença psicossomática, Transtornos Psicofisiológicos, Transtornos Psicossomáticos
French Maladie psychosomatique, Troubles psychophysiologiques, Troubles psychosomatiques
German Psychosomatische Erkrankung, Psychophysiologische Störungen, Psychosomatische Störungen