Published on 03/03/2015 by admin
Filed under Neurology
Last modified 03/03/2015
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26 Somatization Disorder
Kenneth Lakritz
At age 35 years, Barbara W. already had a 15-year career as a medical patient. When she consulted a new rheumatologist for unexplained fatigue, arthralgias, and muscle tenderness, a thorough examination revealed only an overweight, deconditioned, angry, and sullen woman demanding nonspecific relief from her suffering. She was dependent on an oral opiate and a benzodiazepine, which she simultaneously insisted were ineffective and necessary for her continued functioning. She also consumed startling quantities of nonsteroidal anti-inflammatory drugs and over-the-counter hypnotics.
A careful review revealed that she had seen at least 15 physicians in the past 5 years, had been hospitalized at four different institutions, and had undergone an appendectomy, two subsequent exploratory laparotomies for unexplained abdominal pain, and numerous steroid injections of her knees, shoulders, and lower back. She was an avid consumer of medical literature and believed herself to be suffering from fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivities, sick building syndrome, chronic lyme disease, and mercury poisoning. When gently confronted about the absence of clinical findings and her lengthy history of unresponsiveness to medical intervention, she accused the rheumatologist of labeling her “a mental patient” and left angrily.
Somatization disorder, sometimes referred to as Briquet syndrome or hysteria, is a dramatic and severely disabling illness. Its diagnostic criteria require extensive unexplained physical symptoms, including pain in at least four different sites, two gastrointestinal complaints, one sexual symptom, and one pseudo-neurologic symptom such as fainting or paraparesis. Fortunately, few patients meet this exacting standard, but somatization disorder should be understood as just the most severe of a family of somatoform disorders. These include conversion disorder (one or more unexplained neurologic or general medical symptom), hypochondriasis (excessive preoccupation and worry about illness), pain disorder (unexplained pain), and body dysmorphic disorder (preoccupation with imagined or exaggerated physical defects). When all forms of unexplained medical symptoms are lumped together, they are surprisingly common; one study found them in more than 30% of patients presenting to neurology clinics.
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