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Somatization disorder: causes, symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 07.07.2025
Somatization disorder is characterized by multiple somatic complaints (which include pain and gastrointestinal, sexual, and neurological symptoms) over a period of years that cannot be fully explained by a somatic illness.
Symptoms usually manifest before age 30, are not intentionally induced, and are not simulated. Diagnosis is based on anamnestic information after excluding somatic diseases. Treatment focuses on establishing a stable, supportive relationship between the doctor and the patient, which will free the patient from unnecessary and potentially harmful diagnostic tests and treatments.
Somatization disorder is usually a familial disorder, although the etiology is unknown. The disorder is more common in women. Male relatives of a woman with the disorder are at risk for antisocial personality disorder and substance use disorders.
[ Symptoms of somatization disorder
Recurrent and multiple somatic complaints usually begin before the age of 30. The severity varies, but the symptoms persist. Complete resolution of symptoms for any length of time is rare. Some patients become markedly depressed, and the possibility of suicide becomes threatening.
Any part of the body may be involved, and specific symptoms and their frequency vary across cultures. In the United States, typical symptoms include headache, nausea and vomiting, bloating, abdominal pain, diarrhea or constipation, dysuria, dysmenorrhea, dyspareunia, and loss of sexual desire. Men often complain of erectile or ejaculatory dysfunction. Neurological symptoms are common. Anxiety and depression may also develop. The patient is usually very vocal about their symptoms, often describing them as “unbearable,” “indescribable,” or “the worst that can happen.”
The patient may become extremely dependent. They increasingly demand help and emotional support and may become enraged if they feel their needs are not being met. Such patients are sometimes viewed as demonstrative and attention-seeking. They may also threaten or attempt suicide. Often dissatisfied with the medical care they receive, they move from one physician to another in search of treatment or see several physicians at the same time. The intensity and persistence of symptoms reflect the patient's strong desire to be cared for. The presence of symptoms helps the patient avoid responsibility, but they may also interfere with pleasure and act as a punishment, reflecting underlying feelings of inadequacy and guilt.
Diagnosis and treatment of somatization disorder
The patient is unaware of the underlying mental health issues and believes that he or she has a somatic illness, so he or she demands examinations and treatment from the physician. Physicians usually perform a variety of examinations and tests to rule out a somatic illness as the cause. Since such patients may develop a concomitant somatic illness, appropriate examinations and tests are necessary if symptoms change significantly or objective signs develop. Patients are usually referred to a psychiatrist, even those who have a trusting relationship with their family physician.
Specific diagnostic criteria include the onset of multiple somatic symptoms before age 30, treatment seeking or impairment of function, history of pain in at least 4 body parts, 2 or more gastrointestinal symptoms, at least 1 sexual or reproductive symptom, and at least 1 neurological symptom (excluding pain). The diagnosis is confirmed by dramatization of complaints and sometimes demonstrative, dependent, and suicidal behavior of the patient.
Somatization disorder differs from generalized anxiety disorder, conversion disorder, and major depression by the predominance, multiplicity, and persistence of somatic symptoms. Patients who complain of at least one somatic symptom for about 6 months that is not explained by a somatic disease and whose condition does not fully meet the specific diagnostic criteria for somatization disorder should be considered as patients with undifferentiated somatoform disorder.
Treatment is difficult. Patients tend to become irritated and frustrated by the suggestion that their symptoms are mental. Medication may help treat co-existing mental disorders (eg, depression). Psychotherapy, especially cognitive behavioral therapy, emphasizes self-help for the disorder. It is important for the patient to have a supportive relationship with a therapist who offers symptomatic treatment, sees the patient regularly, and prevents unnecessary tests and procedures.