Understanding the Course of Somatization Disorder and Undifferentiated Somatoform Disorder and Assessing Patients’ Symptoms

Understanding the course of somatization disorder and undifferentiated somatoform disorder and carefully assessing patients who present with symptoms of these disorders are both critical to their appropriate treatment.

Course of Somatization Disorder
Somatization disorder is a chronic relapsing condition with an unknown etiology. The disorder has no known cure. It usually begins in middle to late adolescence but may start as late as the 30s. Patients also often develop new symptoms during times of emotional distress. No research data are available concerning how long an episode of illness lasts; however, clinical experience indicates that a typical episode lasts 6-9 months. Remission periods may last 9-12 months. However, patients with somatization disorder likely will not continue for a year without developing a new symptom or seeking some type of health care. For example, authors of the ECA study found that 95% of the patients with somatization disorder had visited a health care provider in the previous 6 months, compared with only 56% of other community residents.

Periods of distress seem to coincide with either the onset of new symptoms or increased health care-seeking behavior associated with some preexisting symptom. Although no data exist on whether stress precipitates relapse, an association seems likely. This association with stress is problematic because patients with somatization disorder are noted for their chaotic social lives, reflected in their multiple divorces and remarriages, work disabilities, and marked interpersonal difficulties. Accordingly, they are involved in an inordinate number of distressing situations.

These patients typically report very poor health status. When standard measures for health status assessment are used with these patients, all aspects of their health - physical, social, and mental - as well as general health perceptions are severely impaired. When compared with patients with chronic medical conditions (e.g., hypertension, rheumatoid arthritis, chronic obstructive pulmonary disease, or type 1 diabetes mellitus), the health of patients with somatization disorder is worse. In other words, patients with somatization disorder perceive themselves as “sicker than the sick.”

As a part of this pattern of unexplained somatic complaints, these patients repeatedly return to their physicians for care. If the correct diagnosis is not recognized, the physician often undertakes various diagnostic and therapeutic actions, all of which prove negative and do not identify the true origin of the symptom. A vicious cycle then develops. The patient again consults the physician, and the physician orders more tests that do not prove helpful. Both the physician and the patient then become frustrated. Typically, at this point, the patient is referred to another physician, usually a specialist or subspecialist, for evaluation of the presenting complaint. This specialist then undertakes even more complicated tests to determine the origin of the symptom, all to no avail. The patient, now even more frustrated, seeks care from other physicians, and the saga begins anew. As is readily apparent, this cycle results in not only inappropriate diagnosis and treatment but also excessive use of the health care system.

Course of Undifferentiated Somatoform Disorder
No data are available on the course of undifferentiated somatoform disorder. It is presumed to be similar to that of somatization disorder but less intense with fewer episodes of unexplained somatic complaints and less impairment in functioning.