Functional Somatic Symptoms and Somatization: Person-centered Approach to Understanding their Relationships
AbstractBackground: Despite the visible points of overlapping between the psychopathologic concepts of "somatization" and "somatoform disorders" with those of "functional symptoms" and "somatic syndromes" of general medicine, there is little literature which clarifies their relationships, making it difficult to formulate common grounds for work between psychiatry and the rest of medicine. Objectives: The purpose of this article is to review and critically analyze current knowledge on the subject, in search for conceptual links between different paradigms involving the underlying phenomena, proposing present and future lines of work according to the basic concepts of the Person Centered Medicine. Methodology: A wide ranging review and critical analysis of the literature on these subjects was conducted, trying to explore the relationship and integration of different paradigms according to the MCP framework and an outline of the author´s current research. Results: A need was found to establish transdisciplinary concepts which leave aside the particular visions of each paradigm, in search for links which may integrate different insights, considering the person as a whole. Therefore, it is essential to analyze carefully the phenomenon from various points of view to elucidate wider conceptualizations so as to reformulate this spectrum of phenomena from an integrative perspective. The possibility of the existence of a “general factor”, both present in the so-called “functional” disorder of general medicine, and in those that in psychopathology are grouped as somatization, is suggested. This general factor could be represented by certain personality dimensions and psychic representations encompassed by complex context variables. Conclusions: It would be valuable to continue with research of this phenomena structure as well as to look for strategies to benefit from the theoretical findings in the health care field, according to the proposals of Person Centered Medicine.
Creed, F H "Should general psychiatry ignore somatization and hypochondriasis?." World Psychiatry 2006; 4 (3): 146-150.
Mezzich, J E "Repensando el Centro de la Medicina: De la enfermedad a la persona". Acta Médica Peruana, 2010; 27(2): 148-150.
Asociación Americana de Psiquiatría, Guía de consulta de los criterios diagnósticos del DSM 5. Arlington, VA, Asociación Americana de Psiquiatría, 2013.
World Health Organization. "The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines". Geneva: World Health Organization, 1992.
American Psychiatric Association (APA) DSM-IV. Manual Diagnóstico y Estadístico de los Trastornos Mentales. 1995. Barcelona: Masson.
Klaus, K., Rief, W. , Brähler, E., Martin A. , Glaesmer H. , Mewes R. : "The Distinction Between Medically Unexplained and Medically Explained in the Context of Somatoform Disorders Int.J. Behav. Med. (2013) 20:161–171
Burton, C. (2003). Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). British Journal of General Practice, 53(488): 231-239.
Ascensión Godoy C, Martín Ortíz R, Moro López A, Hernández Monsalve M : "Pacientes somatizadores en Atención Primaria. Del reconocimiento del síntoma a la intervención sin iatrogenia" SEMERGEN - Medicina de Familia. 2003; 29 (6): 311-317
Granel A: “Pacientes con síntomas somáticos no explicables”. Evid. Actual. Pract. Ambul. 9(6); (2006) 176-180
Caballero Martínez, L., & Caballero Martínez, F. . (2008). Trastornos somatomorfos y síndromes somáticos funcionales en atención primaria. Jano: Medicina y Humanidades, (1714), 15-30.
Wessely S, Nimnuan C, Sharpe M." Functional somatic syndromes: one or many?" Lancet 1999; 354:936–969.
Strassnig, M., Stowell, K. R., First, M. B., Pincus, H. A. (2006): " General medical and psychiatric perspectives on somatoform disorders: separated by an uncommon language". Current opinion in psychiatry, 19(2): 194-200.
Mezzich, J. E., Salloum, I. M., Robert Cloninger, C. R, Salvador-Carulla, L., Kirmayer, L. J., Banzato, C. E., ... & Botbol, M. (2010). Person-centered integrative diagnosis: conceptual bases and structural model. Canadian Journal of Psychiatry/Revue Canadienne de Psychiatrie, 55(11), 701-708
Lipowski, ZJ. Somatization: the experience and communication of psychological distress as somatic symptoms. Psychother Psychosom 1987; 47:160-7
Ford, CV, 1983 “The Somatizing Disorders: Illness as a Way of Life”, Elsevier Biomedical, Nueva York.
Taylor, G T, “Somatization and Conversion: Distinct or Overlapping Contructs?” 2003. Journal of The American Academy of Psychoanalysis and Dynamic Psychiatry, 31(3), 487-508
Mayou, R., Kirmayer, L. J., Simon, G., Kroenke, K., & Sharpe, M. (2005). Somatoform disorders: time for a new approach in DSM-V. American Journal of Psychiatry, 162(5), 847-855
Escobar, J. I., Rubio-Stipec, M., Canino, G., & Karno, M. (1989). Somatic Symptom Index (SSI): A new and abridged somatization construct: Prevalence and epidemiological correlates in two large community samples. The Journal of nervous and mental disease, 177(3), 140-146.
Escobar, J. I., Waitzkin, H., Silver, R. C., Gara, M., & Holman, A. (1998). Abridged somatization: a study in primary care. Psychosomatic Medicine, 60(4), 466-472.
Kirmayer, LJ, Robbins, JM. “Three forms of somatization in primary care: prevalence, cooccurrence and sociodemographic characteristics”. J Nerv Ment Dis 1991; 179:647-655
Witthöft, M., Hiller, W., Loch, N., & Jasper, F. (2013). The latent structure of medically unexplained symptoms and its relation to functional somatic syndromes. International journal of behavioral medicine, 20(2), 172-183.
Casullo, M. (1999) El Inventario de Síntomas SCL-90-R de L. Derogatis. Adaptación. Buenos Aires: UBA.CONICET
Greene RL. The MMPI-2/MMPI: An Interpretive Manual. Boston, Mass: Allyn and Bacon; 1991.