Clinical Features

Somatization disorder consists of multiple recurrent physical symptoms and complaints in multiple organ systems that cannot be objectively validated (e.g., by physical examinations or diagnostic studies) or cannot be fully explained on the basis of a known medical condition or the direct effect of a substance. These unexplained physical complaints must begin before age 30 and assume a chronic and fluctuating course. They must consist of at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurologic symptom. In addition, the physical symptoms and complaints are usually of sufficient severity to impair social, occupational, or other important areas of functioning (Table 1-1).

Patients with somatization disorder may present with a history of a large number of outpatient visits, frequent hospitalization, and repetitive subspecialty referrals. It is imperative that medical history not be overlooked, because the diagnosis can be missed. The medical record may reveal the use of multiple medications and a large number of diagnoses and diagnostic studies. This is a concrete manifestation of the somatically preoccupied patient's high utilization of health care resources. Patients with somatiza-tion disorder have been found to have a threefold higher use of ambulatory services, a 50% higher use of office visits, and a ninefold higher overall cost for health care than nonsomatically preoccupied patients in the United States (Hollifield et al. 1999).

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