 | Somatization
disorder |
Incorrect
Somatization
is a powerful marker for co-existing psychological disorders,
particularly depressive and anxiety disorders. At least one-third
of the time, patients who present with physical symptoms lack
an adequate medical explanation for their symptoms (Kroenke,
2003). In such cases, a depressive disorder can be
diagnosed 60% or more of the time, and an anxiety disorder 40-50%
of the time.
There are
at least three indicators that physical symptoms may be associated
with psychiatric comorbidity.
First, as
in the case of the 30-year-old woman described previously, the
type of symptom doesn't matter. Whether it is fatigue, insomnia,
chest pain, abdominal pain, headache, back pain, dizziness, or
any another physical symptom, it is the fact it is medically
unexplained (rather than the specific type of symptom) that
carries the strong association with depressive and anxiety disorders.
Second, the
total number of physical symptoms (both medically explained
and unexplained) is also strongly correlated with psychiatric
comorbidity. As shown in Figure 6.3 below, there is a powerful
"dose-response" relationship between the number of physical
symptoms endorsed on the PHQ-15 and the likelihood of a comorbid
depressive or anxiety disorder.
| Figure
6.3: Relationship between Somatic Symptom Count and
Likelihood of a Depressive or Anxiety Disorder in Primary
Care Patients
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A
third characteristic of physical symptoms associated with psychiatric
comorbidity is chronicity. Up to 75% of patients presenting
with physical complaints report improvement within several weeks
of seeking health care for their symptoms. Conversely, 20-25%
of the patients will have chronic or recurrent symptoms when followed
up for one or more years.
In summary,
three factors that should raise the suspicion of a coexisting
and potentially treatable depressive or anxiety disorder include:
- Medically
unexplained symptoms;
- High total
symptom counts; and
- Chronicity.
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