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-

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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