Bodily discomfort of one kind or another is a relatively common experience.
These experiences are usually transient in nature and associated with either
reactive stress, illness, or an obvious injury. Somatization however is not the
same as mere bodily discomfort. Somatization is an episodic or ongoing
interaction with the body, mind and anxiety. Somatization may involve medical or
other distinct physical symptoms. It is highly associated with the dynamic
presence of anxiety and the psychological capacity to change, shift or convert
this anxiety into physical symptoms.
Some of the more common examples of somatization
include three of six different kinds of headache; muscle contraction, the two
varieties of migraine headache, and the mixed headaches. They are not generally
associated with sinus, cluster or neurological headaches. Some are psychosomatic
in origin while others are medical in origin but greatly exasperated by anxiety.
Various annoying gastrointestinal disorders are highly associated with the
process of somatization. These include the symptoms of irritable bowel syndrome,
colitis, esophageal reflex syndrome, and various sites of GI tract ulcers. In
the area of respiratory disorders, somatization is associated with the symptoms
of both asthma and rhinitis. This is not to say that all asthma is a result of
somatization. Some asthmas are the result of either environmental toxic
reactions and in some cases congenital respiratory sensitivities. However, there
is a clear association in a large percent of asthmatic situations with stress
and respiratory distress.
In adults, genitourinary problems are expressed
primarily in the areas of sexual dysfunction. In particular, the difficulties
men experience with either premature or retarded ejaculation or various other
erectile functions (ED) but not associated with a primary medical problem are
highly correlated with the phenomena of anxiety and somatization. In women, the
symptoms of vaginismus, dyspareunia, and various forms of what has been know
historically as "frigidity" are associated with anxiety, somatization and in
some cases trauma. In physically healthy men, both primary and secondary
impotence are highly associated with anxiety and somatization, particularly
performance anxiety. These sexual issues are deeply infused with familial and
interpersonal dilemmas as well as social-political dynamics. Therefore, one must
proceed with caution in working with a clinician in these areas to get an
In the area of dermatological complications,
somatization can express itself in the phenomena of hyperhidrosis, or excessive
sweating, dry skin or psoriasis, or even hives. In the area of cardiovascular
problems, somatization is most expressive in the various forms of arrhythmias or
irregular heartbeats, Raynauds disease and Raynauds phenomena, which is
decreased blood flow to the hands and feet, and Burgers disease. The two
varieties of migraine headache are cardiovascular disorders highly associated
with phenomenon of somatization.
From ancient times until now, the phenomena of
somatization has been associated with the experience of prolonged and acute
anxiety. Clinicians have noticed an increase in somatic symptoms concomitant
with the increase in anxiety. However, it has also been observed that chronic
depression and a sense of hopelessness can either greatly exacerbate existing
symptoms or actually create various forms of somatization. The dynamics of
somatization very often are parallel to other psychological events, especially
the experience of dreaming. By this is meant that both somatization and dream
phenomena emerge from the unconscious and involve the dynamic process of
displacement, localization, and symbolization. This is not such a striking
notion when we consider that both dream life and most of our physical and
somatic life, of necessity, is lived in the regions of the unconscious. It is
also in the regions of the unconscious that our shared family dynamics have
their deepest roots. This is why family oriented clinicians have noticed that
symptoms of a somatic variety seem to be learned and unconsciously modeled
within the family context.
Many benefits do accompany various forms of
somatization. "Secondary gains" for being ill can exercise control or
influence in the family, relationship or work situation. Also there are
emotional and sometimes financial benefits for malingering and hypochodriasis.
Hypochondriasis however should not be identified with a hysterical neurosis or
fictitious disorder. Hypochondriasis is that constant preoccupation with usually
minor physical complaints and shape-shifting medical disorders. Often in
hypochondriasis there is not a clearly identified or stable medical disorder. In
the case of hysterical neurosis, a powerful emotional conflict is expressed in a
bodily symptom. One of the most dramatic, of course, being an hysterical
pregnancy. One can also actually be physically pregnant but in psychotic denial
despite the obvious medical situation. Finally, in the case of fictitious
disorder, a person actually creates a medical problem that may require
medication or even surgery for the secondary gains attended to it.
Various "vague symptoms" are also associated with
somatization. These vague symptoms many times do have a medical basis, however
there is not always a one-to-one correspondence between the intensity or
severity of the symptoms and the person's life context. An example is the
Epstein-Barr phenomena. Another is chronic fatigue syndrome. Both of these have
some root in physical medical causes but are greatly exacerbated by
What is generally helpful in these conditions is not
intense medical intervention, sometimes this can actually make things worse.
Rather it may be other sound, tried and true remedies. For instance a sound,
regulated diet can be extremely helpful. This includes a decrease or a moderate
intake of "junk food", and moderate to light alcohol use. Many healthy
distractions will decrease stress and anxiety. Meditation and prayer are also
helpful. Moderate exercise can not be out done, nor can mini-relaxations during
the day. A regulated satisfying sleep life is of great value in moderating and
influencing one's metabolism and emotional state, which has a profound effect on
decreasing the tendencies towards somatization. Many diseases are born in the "dis-ease"
of emotional and sleep life. Finally, real emotional contact with friends and
confidants helps us feel grounded and connected. This will very often decrease
There are times however, when the above remedies are
not as useful and it is warranted to seek a professional consultation. This is
especially the case when there are specific, recurrent somatic complaints over
at least a 2-3 week period. The sudden onset of unusual symptoms warrant contact
with a healthcare provider. Bleeding or other bodily discharges should be a
source of immediate concern and a healthcare practitioner sought out. In all of
these circumstances, it is best to see a physician or nurse practitioner first.
Consultation with the University Health Services is the fastest and easiest way
to go. Based upon their evaluation and your experience, it may then be helpful
to see a clinician in the Mental Health division Health Services. This clinician
at the Health Services may first recommend a classical and purely medical
intervention. This may be diet, moderate exercise, decrease in alcohol and other
substances, and regulated sleep. They may also recommend the above and also some
brief counseling and therapy for anxiety decrease. In certain specialized
situations they may refer you to the behavioral medicine and biofeedback clinic,
where the possibility for learning self-regulation strategies and/or clinical
hypnosis may be the treatment of choice.
Ader, R. (ed) 1981. Psychoneuroimmunology. New York: Academic Press.
Bynum, E.B. 1994. Transcending Psychoneurotic Disturbances. Ithaca, NY:
Minuchin, S., Rosman, B.L., and Baker, L. 1978. Psychosomatic Families.
Cambridge, MA: Harvard University Press.
The information provided in this column is for educational/information
purposes only. The intention is not to provide medical advice or replace the
services of a trained healthcare professional. Please take specific issues or
medical concern to your healthcare provider. For further information please
visit the UHS Mental Health web page at www.umass.edu/uhs/mentalheath.