Somatization is the expression of mental phenomena as physical (somatic) symptoms. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously and nonvolitionally to those in which symptoms develop consciously and volitionally. This continuum includes
Somatic symptom and related disorders
Factitious disorders
Malingering (not a psychiatric disorder)
In all of the disorders, patients focus prominently on somatic concerns. Thus, somatization typically leads patients to seek medical evaluation and treatment rather than psychiatric care.
Somatic symptom disorder and related disorders are characterized by persistent physical symptoms that are associated with excessive or maladaptive thoughts, feelings, and behaviors in response to these symptoms and associated health concerns. These disorders are distressing and often impair social, occupational, academic, or other aspects of functioning. They include
Factitious disorders: Factitious disorder imposed on self; factitious disorder imposed on another
Functional neurological symptom disorder (conversion disorder)
Somatic symptom disorder and illness anxiety disorder are the most common.
Factitious disorders involve the falsification of physical or psychologic symptoms and/or signs in the absence of obvious external incentives (eg, obtaining time off from work, disability payments, or drugs; avoiding military service or criminal prosecution). The term Munchausen syndrome is no longer used for factitious disorders. Malingering, which is not a factitious disorder but may be confused with it, is intentional feigning of physical or psychologic symptoms motivated by an external incentive, which distinguishes malingering from factitious disorders.
Functional neurological symptom disorder consists of neurologic symptoms or deficits (typically involving motor or sensory function) that develop unconsciously and nonvolitionally and are incompatible with known pathophysiologic mechanisms or anatomic pathways.
Illness anxiety disorder is preoccupation with and fear of having or acquiring a serious disorder.
Psychological factors affecting other medical conditions is diagnosed when psychologic or behavioral factors adversely affect the course or outcome of an existing medical condition.
Somatic symptom disorder is characterized by multiple persistent physical complaints that are not feigned and are associated with excessive and maladaptive thoughts, feelings, and behaviors related to those symptoms. See table Somatic Symptom 8 Scale, which is used to determine how frequently the patient has been bothered by 8 selected symptoms during the previous 7 days.
