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Understanding and Treating Somatization (aka Conversion Disorder)


conversion disorder treatmentOf all the people I see in my practice, few are more distressed and discouraged than those dealing with somatization disorders. There are many factors making this condition difficult to deal with, including  the fact that it’s not well known to the general public, and that it’s often an afterthought to medical practitioners.



Somatization – An Overview

Simply put, somatization occurs when psychological concerns are converted into physical symptoms. By contrast, most mental health disorders are characterized by mental symptoms. That is, people have unusual or disturbing thoughts, moods and/or behaviors.

However, with somatization, mental factors and stress present as pain, weakness, fatigue, nausea, heart palpitations, seizures, or any number of other bodily sensations.

I developed an interest in this condition while working at Toronto’s renowned Hospital for Sick Children (aka SickKids). I worked with a young person who was experiencing non-epileptic seizures, with no medical cause, which was a real lesson in just what the mind can do. Over the years, I saw many people who suffered like this or with other distressing symptoms. With support and education, I learned how to treat this condition and, with my colleagues, developed a group treatment that has been helpful. Since then, many patients have been referred to us, and we continue to run several treatment programs for youth and families dealing with somatization.

What Makes Somatization Disorder So Challenging?

One of the most lasting impressions from all this work, is that somatization is a high-cost condition. It takes a real toll on people and their families: missing school/work, loss of socializing, constant pain. And it consumes substantial health-care resources, as well.

The fact is, we’ve all experienced somatization in mild forms, such as a headache after a stressful day at work, or nausea when we’re extremely anxious about something. Whether they know it or not, somatization is also a favored device of movie and TV screenwriters, often used to show a character’s secret or suppressed mental distress. The most famous example may be the Tom Hanks character in Saving Private Ryan, who strives to conceal a hand tremor that appears in moments of great stress. It’s never explicitly addressed, but it clearly suggests a person struggling with trauma and the weight of life-or-death responsibilities. Very recently, the Netflix teen comedy-drama Never Have I Ever also portrays a young woman dealing with a conversion disorder after a traumatic event.

However, when the physical symptoms take on a life of their own, and interfere in day to day activities, the condition becomes a somatization disorder. For those unfamiliar with somatization, the crucial thing to understand is that people are not “faking” their symptoms. Just as stress headaches and pre-exam nausea are real, the pain and other problems experienced from a somatization disorder are also very real, regardless of whether doctors can find a physical explanation or not. In addition, sometimes somatization can occur along with a medical condition.

Somatization, a.k.a.

Before I go any further, I should also note that somatization is known by a wide variety of names, including:

  • Somatic Symptom Disorder
  • Conversion Disorder
  • Functional Neurological SymptomDisorder
  • Functional Abdomen Pain (often any diagnosis with the word “functional”)
  • Medically Unexplained Symptoms
  • Factitious Disorder Imposed on Self/OnAnother
  • Malingering
  • Psychosomatic Disorders
  • Hypochondria
  • Non-Epileptic Seizure Disorder
  • Anxiety Disorders
  • Depressive Disorders

“Medically Unexplained Symptoms” Still Need Diagnosis and Treatment!

This long list of terms describing what is, in reality, a single condition, highlights some of the difficulties in understanding and treating somatization. It shows the inconsistent way in which the medical community responds and, I think, demonstrates a subtle but lingering prejudice or stigma toward mental illnesses. Of all those terms, by the way, my least favorite is “Medically Unexplained Symptoms” because that makes it sound like we don’t know what’s going on with the person suffering when, of course, we do—at least those of us working in the field of mental health!

Somatic symptoms may be quite extreme. This makes it hard for patients (not to mention family members) to wrap their heads around the idea that this degree of discomfort is resulting from psychological stress and difficulties. In addition, the diagnosis of somatization can create a lot of stress and frustration for patients, since doctors need to perform many tests to rule out other possible causes first.

Although 21st century physicians do understand there is a mind-body connection, their training (and instincts) almost always lead them to look at the body first. Usually, doctors only consider the possibility that physical symptoms might have a mental cause, after eliminating everything else. Often, the stress of this lengthy process leads patients to become even more worried about their health, creating a feedback loop. When somatization occurs in children and youth, the family is disrupted as parents focus on the physical symptoms, and worry that doctors have missed a medical problem. It is, to say the least, a very challenging situation for everyone involved. That said, a clear diagnosis is critical to the healing process, as is on going collaboration between medical and mental health professionals. Of course, physical illness must be always considered and ruled out.

When I see patients, who’ve been through all of this, they are understandably distressed. Even when they’ve finally received a diagnosis of somatization, patients often despair of ever getting better. But they can, and they will, with proper care and support.

Help is Available for Somatization Disorder

When somatization patients work with a mental health professional, the goal of treatment is to improve their symptoms and ability to function in daily life. This begins with a thorough assessment. That allows both client and caregivers to understand the narrative of the illness, and validate the severity of the symptoms, which is an important step towards recovery. Simply learning more about somatization and its causes is also important, and often quite reassuring for clients and their families. Creating a successful treatment plan then requires collaboration between a patient’s medical and mental health care professionals.

Proven treatments include various kinds of talk therapy, which help people understand their symptoms, and what triggers them.

Understanding what the symptoms are trying to tell us is an important component of psychotherapy exploration. In addition, therapists such as myself will validate the patient’s symptoms, and teach strategies to lessen their impact, while maintaining a parallel focus on helping the patient resume a regular routine. The longer a patient has struggled with symptoms of somatization, the more time it will take to get better. But I want to emphasize that the prognosis for recovery is good.

In fact, if there’s one thing I hope readers will take away from this post, it’s that although somatization is a distressing and disruptive condition, treatment is usually successful. With expert care and good support, most people recover and resume their normal work, school and social lives. They are also able to gain a better understanding of how stress impacts them and their bodies.

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

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