Abnormal Psychology

Dissociative and Somatoform Disorders 355

cannot identify a medical cause for the pain; in other cases, a medical cause may

underlie the pain, but psychological factors contribute signifi cantly to the patient’s

experience of it. When the pain can be diagnosed as arising predominantly from a

medical condition, pain disorder will not be diagnosed on Axis I, but the medical

condition will be noted on Axis III, along with the specifi c location of the pain, such

as the lower back (American Psychiatric Association, 2000).

Both pain disorder and somatization disorder involve genuine—as opposed to

feigned—pain to which psychological factors are thought to contribute. However,

SD requires that the individual have a history of four different locations of signifi cant

pain (as well as other types of bodily symptoms), whereas pain disorder requires

only one location of signifi cant pain (American Psychiatric Association, 2000).

Many laboratory tests and visits to doctors may be required to rule out other

medical and psychological diagnoses, which is necessary before a diagnosis of SD

can be made. When patients have more than one physical problem, arriving at such

a diagnosis can be even more complicated and take even longer (Hilty et al., 2001).

Table 8.11 lists additional facts about SD.

Table 8.11 • Somatization Disorder Facts at a Glance

Prevalence

• An individual’s symptoms rarely meet the stringent diagnostic criteria for SD; survey studies have found that at
  most approximately 1% of people will receive this diagnosis in their lifetimes.


• Although infrequent, SD is nonetheless a serious problem in medical settings; patients with this disorder use
  three times as many outpatient medical services and cost nine times more to treat than people who do not have
  this disorder (Hollifi eld et al., 1999).

Comorbidity

• People with SD often have other psychological disorders, most frequently an anxiety disorder (particularly panic
  disorder), depression, or borderline personality disorder (to be discussed in Chapter 13).


• Patients with SD who take benzodiazepines or narcotics for relief of bodily symptoms are at increased risk for
  developing a substance-related disorder (Holder-Perkins & Wise, 2001).

Onset

• Initial symptoms of SD usually emerge between adolescence and age 30; menstrual diffi culties may be the earli-
  est symptom in women.

Course

• The symptoms are chronic; they may fl uctuate in location or in intensity (so that the criteria for SD are no longer
  met), but symptoms usually never completely disappear.


• Patients with SD often take many medications and receive numerous medical tests and diagnoses (Holder-Perkins
  & Wise, 2001).


• One study found that people in the United States who had this disorder spent, on average, 7 days in bed each month
  (Smith, Monson, & Ray, 1986).


• Over the course of a year, 50% of patients improve at least enough so that their symptoms no longer meet the full diagnos-
  tic criteria (Creed & Barsky, 2004).

Gender Differences

• Survey results differ: This disorder may occur equally often in women and men or may be as much as ten times
  more common among women as among men, depending on the survey (American Psychiatric Association, 2000;
  Toft et al., 2005).

Cultural Differences

• The specifi c symptoms of patients with SD vary across cultures, and some ethnic groups have a higher prevalence of
  this disorder than others.
  Source: Unless otherwise noted, the source is American Psychiatric Association, 2000.