Key Words: somatization, conversion disorder, narcoanalysis, depression, somatoform disorder
S omatization is the tendency of individuals to experience
and communicate psychological distress in the form of so-
matic symptoms and to seek medical help for them (1,2). This
psychological process gives rise to somatoform disorders,
which are typically first seen in nonpsychiatric settings. Their
core features comprise somatic symptoms and signs that can-
not be explained by known disease and that result in social and
occupational impairment. Table 1 lists the clinical criteria.
Symptoms are typically multiple and vague and may refer to
single or multiple body systems or functions. Presentations
include cardiopulmonary, gastrointestinal, genitourinary,
musculoskeletal, and neurologic complaints, as well as pain
and fatigue (3,4). The DSM-IV-TR diagnostic categories that
incorporate the concept of somatization include body
dysmorphic disorder, conversion disorder, hypochondriasis,
somatization disorder, pain disorder, undifferentiated
somatoform disorder, and somatoform disorder not otherwise
specified (5).
In clinical practice, somatoform disorders overlap and most
commonly present with multifocal symptoms and signs (6).
The spectrum of presentations varies from mild to severe and
may be mostly symptom-based (hypochondriasis) or mostly
sign-based (conversion disorder).
Sickness
Somatoform disorders are best understood within the context of
sickness, because patients present as physically sick, which ini-
tially masks the underlying psychiatric disorder. Sickness com-
prises 3 components: disease, illness behaviour, and
predicaments (7,8). Disease is the physical basis of sickness
caused by tissue abnormality or malfunction. Clinically, dis-
ease manifests by observable signs (what the physician sees),
such as edema, hemorrhage, or inflammation, and organ and
system compromise, such as heart failure and paralysis. Illness
behaviour refers to the subjective experiences and behavioural
consequences of disease (what the patient complains of).
Illness behaviour presents as symptoms. These may be nonspe-
cific symptoms, such as fatigue or nausea. Symptoms may also
be referable to specific systems or physical functions, such as
shortness of breath or an inability to move; to specific mental
dysfunctions, such as problems with concentration or sadness;
172 � Can J Psychiatry, Vol 49, No 3, March 2004
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