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What is somatization?

Also known as somatization disorder, conversion disorder or Functional Neurological Symptom Disorder, somatization is a condition where a person experiences serious physical symptoms that can’t be explained by illness or injury. Instead, these symptoms are a way of expressing stress, trauma and difficult feelings through the body. Some somatic (that is, physical) complaints are common, and we all experience them, as I’ll explain below. But somatization becomes a diagnosis when these symptoms start to impede our day-to-day functioning. Symptoms can be mild, moderate or severe, and range from pains, movement difficultly to non-epileptic episodes. In these cases, your body is trying to tell you something, but you often need professional help to determine what it’s saying.  (For more basic information on somatization, please see my earlier post about somatization here.)

Understanding the mind-body connection and somatization

For those not familiar with it, the concept of somatization can be challenging, but there are numerous examples of involuntary mind-body connections. For example, blushing is a physical response to emotional events, usually being embarrassed. It happens instantly, and there’s literally no way to prevent it. But it’s also one way we process the feelings of embarrassment, and it helps us calm down. This kind of mild somatization is a near-universal part of the human experience.

Similarly, when working with someone who has serious somatization symptoms, I try to find out what these symptoms are trying to express. Their symptoms are a metaphor for what’s going on in that person’s mind. Sometimes it’s fairly straightforward: a child getting stomach pains before school might have been punched there by a bully, sometime in the past. And I once saw a kid who got sick every time he visited a certain place, and it turns out he’d once experienced trauma or stress there.

But it’s not always so easy. As a therapist offering social anxiety treatment and cognitive behavioural therapy, I need to pay very close attention to the nature of the symptoms, the language the client uses to describe them, and the context in which these symptoms show up. And I’ll look for triggers such as abuse, intimidation, stress or trauma. I once saw a young person who was having non-epileptic episodes and, oddly, they happened during a favourite TV show. Tellingly, the main character’s father had had a stroke and was in hospital. And then I learned that this young client had, in recent years, lost four family members. Seeing the hospital scenes, he experienced such intense distress from remembering those losses that he couldn’t express it verbally, so it came out physically.

How does somatization happen? 

Like many mental-health issues, somatization crosses all boundaries of age, gender and social status. However, there are certain traits we see. One of the principal ones is that those with somatization are often the kind of people who don’t generally talk about their problems or share them with others. They keep these feelings and worries to themselves. This approach has worked for them, too—until it doesn’t any more. At some point, the emotions involved get too big to keep in, and they come out in physical ways. 

Treatments for somatization 

After thoroughly assessing the symptoms of somatization, and trying to understand reasons behind them, we often turn to talk therapy. Through talk therapy, my young client triggered by the hospital scenes was able to open up about his family members who had passed away. This helped him process his intense and overwhelming feelings, so his reactions didn’t have to be physical.  

Another key aspect of recovery is working with the client to develop a plan for returning to their normal daily activities. We focus on taking small, regular steps toward rebuilding a routine that may have stopped due to the physical symptoms. Although somatization is distressing and disruptive, the good news is that treatment is usually successful, allowing people to recover, and get back to their day-to-day work school and social lives.

Thanks for reading, and please feel free to reach out with questions about somatization  or other mental health issues.

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