Abnormal Psychology

354 CHAPTER 8

Somatization Disorder

The hallmark of somatization disorder (SD) is multiple physical symptoms that are

medically unexplained and impair an individual’s ability to function (American Psy-

chiatric Association, 2000). For example, Anna O.’s eye problems and her cough

were both physical symptoms that impaired her daily life and that doctors could not

explain. In this section we examine what somatization disorder is, and the various

factors that are known to contribute to the disorder.

What Is Somatization Disorder?

To be diagnosed with SD according to DSM-IV-TR criteria, the individual must have

had each of four different types of medically unexplained symptoms: pain symptoms,

gastrointestinal symptoms, sexual symptoms, and pseudoneurological symptoms

(the prefi x pseudo—is used to indicate that the symptoms are similar to those of

neurological disorders, but they do not have a neurological or other medical cause).

Table 8.10 lists the DSM-IV-TR diagnostic criteria for SD.

As noted in Criterion C(2), sometimes people with SD do have a medical

problem. In those cases, the clinician diagnoses SD only if the symptoms are more

extreme than what would be expected based on the medical assessment. SD must be

distinguished from neurological disorders, such as multiple sclerosis, other medical

problems, and various other psychiatric disorders, including anxiety disorders and

pain disorder.

According to DSM-IV-TR, pain disorder occurs when psychological factors sig-

nifi cantly affect the onset, severity, or maintenance of signifi cant pain (American

Psychiatric Association, 2000). For a clinician to arrive at a diagnosis of pain disor-

der, the pain must cause signifi cant distress or impair functioning, and malingering

or factitious disorder must be ruled out. In some cases of pain disorder, examiners

Table 8.10 • DSM-IV-TR Diagnostic Criteria for Somatization Disorder

A. A history of many physical complaints beginning before age 30 years that occur over a period of several years

and result in treatment being sought or signifi cant impairment in social, occupational, or other important areas of

functioning.

B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the

course of the disturbance:

(1) four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen,

back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)

(2) two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea,

bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)

(3)one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indif-

ference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout

pregnancy)

(4)one pseudoneurological symptom: a history of at least one symptom or defi cit suggesting a neurological condi-

tion not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized

weakness, diffi culty swallowing or lump in throat, aphonia [loss of voice], urinary retention, hallucinations, loss of

touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or

loss of consciousness other than fainting)

C. Either (1) or (2):

(1) after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general

medical condition or [as] the direct effects of a substance (e.g., a drug of abuse, a medication)

(2) when there is a related general medical condition, the physical complaints or resulting social or occupational im-

pairment are in excess of what would be expected from the history, physical examination, or laboratory fi ndings.

D. The symptoms are not intentionally feigned or produced (as in Factitious Disorder or Malingering).

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition, (Copyright

2000) American Psychiatric Association.

Somatization disorder (SD)
A somatoform disorder characterized
by multiple physical symptoms that are
medically unexplained and impair an
individual’s ability to function.

Pain disorder
A somatoform disorder that occurs when
psychological factors signifi cantly affect
the onset, severity, or maintenance of
signifi cant pain.