Somatization

Somatization, or the conversion of emotional problems into physical symptoms, is a well-documented phenomena that accounts for a large proportion of office visits to physicians, primary care doctors, specialists, and emergency room visits. These disorders are often referred to as “unexplained medical symptoms”, “psychosomatic disorders”, or “somataform disorders.” Regardless of the name, the financial and emotional costs of these disorders are high. These disorders often go undiagnosed for years, resulting in a burden on the system and the patient alike due to unnecessary treatments, testing, hospitalizations, disability, and “revolving door” failed treatments.

Characteristics of the disorder

These disorders can be broadly classified into either pain or non-pain related symptoms.  Pain-related symptoms would include lower back pains, chest pains, headaches, joint pains, body aches, and stomach/reflux issues. Non-pain-related symptoms include dizziness, chronic fatigue, heart palpitations, weakness, loss of movement, and sexual dysfunctions.

Common disorders that fall under these two categories include:

•    Headaches
•    Migraine Headaches
•    Chronic Pain
•    Irritable Bowl Syndrome
•    Fibromyalgia

•    Erectile Disorder
•    Chronic Fatigue
•    Nausea
•    GERD
•    Allergies and other immune system difficulties
•    Impotence and other sexual dysfunctions

What causes these disorders?

Although the actual cause is unclear, there seems to be an emotional component to these disorders and the expression of symptoms. For example, somatic symptoms are increased 2-to-3-fold in patients with depression or anxiety, and it is well known that stress and anxiety can either exacerbate symptoms or trigger acute outburst of dormant symptoms. When emotions are intense, frightening, or conflicted, they create anxiety and are avoided by somatization or other defense mechanisms. The anxiety that is generated by these unconscious emotions is often expressed by one or more physiological pathways (see table 1 below). Blocking and inhibiting painful or conflicted emotions is a common finding in somatizing patients.

To better understand this how this process works, years of cased-based videotaped research by Dr. Allan Abbass of patients suffering from somatoform disorders demonstrates 4 main patterns of bodily discharge of anxiety/tension and the corresponding expression of psychosomatic symptoms:

             Examples of diagnosable somatization patterns

 

Pathway of Anxiety Discharge Observation during emotion-focused diagnostic assessment Examples of related health complaints or health problems
Striated muscle tension Progression from hand clenching, arm tension, neck tension, sighing respirations to whole-body tension Fibromyalgia, headache, muscle spasm, backache, chest pain, shortness of breath, abdominal (wall) pain, fatigue
Smooth muscle tension Relative absence of striated muscle tension. Activation of smooth muscle causes, for example, cramps in the abdomen or heartburn Irritable bowel symptoms, abdominal pain, nausea, bladder spasm bronchospasm, coronary artery spasm, hypertension, migraine
Cognitive-perceptual disruption Relative absence of striated muscle tension. Instead patient loses track of thoughts, becomes confused, gets blurry vision Visual blurring, blindness, mental confusion, memory loss, dizziness, weakness, pseudo-seizures, paresthesias, fainting, conversion
Conversion Relative absence of striated muscle tension. Instead patient goes weak in some or all voluntary muscle Falling, aphonia, paralysis, weakness

Treatment

The experience of emotions overcomes somatization: research has show that if you can experience true feelings (unconscious warded-off emotions) in the moment, the process of somatization is weakened or overcome. The experience of mixed feelings about present and past event removes the anxiety and somatization symptoms. This process is diagnostic. IF we see a drop in symptoms after the experience of feelings, then we have evidence there was a somatization process at work. What we look for in the session:

•    Observation: Note any signs of unconscious tension, somatic distress, or defensiveness from the start of the session.
•    Ask about emotions: “Can you describe a situation where the symptoms get worse? What feelings do you have when you talk about that?”
•    Distinguish feeling from anxiety or defense: “The tension you had was anxiety, but how did the anger feel?”
•    Observe the physical and behavioral responses in the client when the emotional system is activated.