Somatization is when emotional pain or psychological distress manifests in the body as physical pain or symptoms. People who experience somatization may have a variety of non-specific physical symptoms and complaints that they’ve been unable to resolve.1 Once diagnosed, somatization can be treated by addressing the underlying psychological problem using therapies like cognitive behavioral therapy (CBT) or with a combination of therapy and medication.2,3,4
What Is Somatization?
Somatization describes physical and medical symptoms that have an emotional or psychological cause. Somatization is a symptom of a group of disorders known as somatoform disorders. Somatoform disorders include physical complaints like pain, G.I. problems, heart problems, neurological problems, and sexual or reproductive problems that cannot be traced to a medical problem.1,2,5
The person experiencing these symptoms often attributes them to a medical problem, and will spend a lot of time, energy, and money on medical appointments, diagnostic tests, and treatments.5 Most are either oblivious or resistant to the idea that their symptoms could be related to stress, trauma, or emotional pain, and may go for several years without getting an accurate diagnosis or treatment recommendation.4,5
Somatoform disorders are often unrecognized and undiagnosed by medical professionals, who are trained to find medical causes for symptoms, as opposed to psychological causes. It is not until somatization is accurately diagnosed as being psychological in nature that people with this problem will be able to get the treatment needed to improve their symptoms.1,3
3 Examples of Somatization
Somatization can cause a range of physical and medical symptoms, and these symptoms may worsen, change, or resolve over time.
Here are three examples of somatization:
1. Job Stress
A person who experiences significant stomach pain, cramping, and also sometimes tingling sensations and dizziness throughout the day has been seeing his doctor, a G.I. specialist, and working with a nutritionist for months. He has made several dietary changes, tried different medications, and even had many expensive tests to try to figure out what is wrong. All of the diagnostics, bloodwork, and imaging have come back normal, but the symptoms have persisted. His symptoms began around the same time as he began a new job, which is high-pressure and adds a lot of stress. He does not think to mention this to his healthcare team because he believes that his symptoms have a medical cause. It is only when he quits his job and starts a new, less stressful job that his symptoms resolve on their own, causing him to realize his symptoms were stress-related.
2. Child of Divorce
An 8-year-old is living at home with his parents who frequently fight and are considering divorce. He recently began complaining of frequent headaches, heart palpitations, and chest pain when in school. His symptoms tend to happen towards the end of the day, right before dismissal. His parents are concerned and have taken him to see the pediatrician as well as several specialists, who are unable to find a medical reason for his symptoms. The child is sent for a psychological evaluation, where it is determined that he is experiencing somatic symptoms as a result of increased stress and conflict in the home.
3. Hypochondriac
An adult female has been to the emergency room several times in the past six months, each time reporting different symptoms including shortness of breath, unexplained tingling and nerve pain, and intense stabbing pain in her abdomen. Each time, she has received a full work-up as well as being recommended to a specialist for additional testing and diagnostic work, but shows up to follow-up appointments reporting different symptoms. She is highly anxious and concerned about her health, fearing that she has cancer or another terminal illness, despite her labs and tests coming back normal. She spends several hours per day researching early signs of terminal diseases, and often finds that new symptoms arise that match what she has been researching.
What Causes Somatization?
Somatization is caused by underlying emotional distress or mental health conditions. In some cases, the root cause is another mental health condition (e.g., mood disorders, anxiety disorders, personality disorders, dissociative, and substance use disorders).2 Sometimes, the person isn’t aware that they have a mental health condition or if they do, they don’t realize that their physical symptoms may be related to this condition.
Often, people who experience somatization have a lot of anxiety about their physical health. Because of their anxiety and preoccupation with their health, they are often on “high alert” and may misinterpret or overreact to normal bodily functions or minor aches and pains, seeing these as signs of a serious illness.2,5,6 Spending a lot of time, money, and mental energy worrying about, researching, or seeking treatment for their symptoms can actually make them more anxious, worsening their symptoms.2
Genetic, psychological, and different personality traits also can predispose someone to the condition, as well as certain social, cultural, and environmental factors.2 For example, children growing up in homes where there was special attention paid to physical complaints are more likely to report somatization as adults.6 Women and people between the ages of 20-30 are also most likely to develop somatic symptom disorder.2
Some psychologists believe that somatization is an unconscious defense mechanism that is learned or developed, often in response to trauma that occurs in childhood.6,7,8 The idea is that emotional pain and trauma that is repressed can manifest in the body, creating pain, discomfort, or other symptoms.6 Because the actual emotions and memories are repressed, the person is more likely to attribute their symptoms to a medical problem, rather than considering an emotional cause.
Types of Somatoform Disorders
There are several different types of somatoform disorders; the experience of psychosomatic symptoms is common to all of them.
Here are the most common types of somatoform disorders and their symptoms:2,7
Somatic Symptom Disorder
The symptoms of somatic symptom disorder (formerly called somatization disorder) differ between people, making the condition hard to detect. People with this condition may experience a range of non-specific symptoms that include pain or perceived problems with different organs or parts of the body.1,3 These unexplained symptoms are a source of stress and anxiety, causing the person to seek out answers from different health and medical professionals.2,7
Illness Anxiety Disorder
Illness anxiety disorder is another somatoform disorder that describes a person who has high anxiety about getting sick or who believes they are sick, despite having few to no actual symptoms. People with this condition often have a tendency to overreact to even minor aches, pains, or physical abnormalities, and often engage in compulsive checking, avoidance, or controlling behaviors. For example, someone with illness anxiety disorder may schedule and attend unnecessary medical appointments.
Conversion Disorder
Conversion disorder is another somatoform disorder that involves a person wrongly believing that they have a neurological condition or problem. People with this condition report neurological abnormalities that they believe indicate a disease or problem with their brain like blurred vision, tics or seizures, or even paralysis and blindness. The symptoms of conversion disorder tend to come on suddenly and may be severe in nature, but don’t line up with any neurological disorder.2,7
Factitious Disorder
Factitious disorder is the only somatoform disorder that involves a patient knowingly and intentionally lying or exaggerating their symptoms. This condition involves providing false information to medical providers or intentionally harming or injuring oneself in ways that appear unintentional.2,7 People with factitious disorders may use false medical complaints or problems as a way to get attention, pity, or empathy from others.
How Therapy Can Help With Somatization
A licensed psychologist, psychiatrist, or therapist is often needed in order to effectively diagnose and treat symptoms of somatization. Once a patient is accurately diagnosed with a somatoform disorder, a licensed and trained provider can help them by providing therapy or a combination of medication and therapy.4,5,6
Therapy for somatization can help improve a person’s physical symptoms, as well as treat the underlying emotional cause. The most effective form of treatment is cognitive behavioral therapy (CBT), a specific kind of evidence-based practice that helps people make targeted changes to their thoughts and behaviors to improve symptoms.4,5,6
According to research, therapy for somatoform disorders can help in the following ways:2,4,5,6
- Provides accurate diagnosis of the condition and informed treatment recommendations
- Provides education to the patient about their diagnosis and symptoms
- Improves the person’s self-awareness and insight into their emotions and thoughts
- Explores root causes like childhood trauma or untreated mental health conditions
- Provides tips on how to manage stress, relax, and improve symptoms of anxiety
- Offers empathy, support, and validation to the person suffering
- Corresponds with the person’s primary care doctor and/or medical specialists about the person’s diagnosis and treatment
- Teaches new, more adaptive methods of coping with stress, anxiety, and other difficult thoughts and feelings
- Encourages less anxiety-driven health behaviors (i.e., not seeking emergency medical treatment for minor symptoms, less research of diseases, etc.)
- Improves the person’s communication and encouraging them to rely on their natural support systems
- Uses problem-solving and solution-focused approaches to help address sources of stress and anxiety within the person’s life
- Encourages the person to adopt healthy lifestyle habits that enhance their physical and mental wellbeing
Getting Help For Somatization
If you or someone you care about is struggling with unexplained physical symptoms, consider making an appointment with a licensed therapist. Choosing a therapist who has experience in somatoform disorders can help determine whether or not your physical symptoms are related to an underlying mental health condition, previous trauma, or current stressor.
Most insurance plans will cover at least some of the costs of therapy, making it an affordable way to rule out a psychological explanation for your symptoms. If you are struggling with a somatoform disorder, therapy is a proven way to improve your symptoms and begin feeling better both physically and emotionally. In one study, people with somatic symptoms experienced significant improvements after just 10 sessions of CBT.
It is always a good idea to consult with your primary care physician (PCP) and healthcare team about concerns with your physical health. Mental health professionals should not be used as a substitute for medical care, as they are unable to diagnose, treat, or advise patients on medical issues.
Final Thoughts on Somatization
If you have unexplained physical symptoms, making an appointment with a licensed therapist can help you rule out a psychological cause. If the cause is psychological in nature, therapy (sometimes in combination with medication) is the most effective method of treatment, and may offer the relief you’ve been searching for from doctors.4,5,6
