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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Somatization Disorders

Contrary to what many of you may think, the phenomena of somatization is not simply a malingering patient. Somatization is an individual=s conscious or unconscious use of the body or bodily symptoms for psychological purposes or personal gain. According to the AMA Guides Newsletter, ASomatization is characterized by the propensity to experience and report somatic symptoms that have no pathophysiologic explanation, to misattribute them to disease, and to seek medical attention for them.@

There are two main forms of somatization. The first is when there is no medical comorbidity and the symptoms are purely psychogenic. The second exists when there is a lesion but the symptoms are inappropriate or exaggerated. While somatization is not a mental disorder the process does have several clinical presentations. These include somatiform disorders, factitious disorders and malingering.

Diagnosis	Symptoms for Gain	Deceptive State of Mind	Ratable Per AMA Guides
Somatoform	Yes	No	Yes
Factitious	No	Yes	Yes
Malingering	Yes	Yes	No

The somatization process may have numerous contributing factors. These include manipulation of interpersonal relationships, privileges of the sick role, sanctioned dependency, financial gain, interpsychic defense mechanisms. Many of these are rooted in developmental and cultural origins.

An interesting concept is that of Amedicalization@. This is the process of applying a medical diagnosis to explain physical discomfort not caused by disease and applying medical intervention to treat it. It is speculated that some of the new Adiseases@ such as Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia and Candida Hyperensitivity Syndrome may be of a somatic origin. The result may be iatrogenic disease (resulting from medical intervention).

Somatoform disorders are those which lack organic basis in the presence of factors judged to be important in the initiation, exacerbation or maintenance of the disorder. The complaints of the somatoform patient are not intentionally produced or feigned. The somatoform disorders have classifications which include conversion disorder, pain disorder and hypochondriasis.

Patients with conversion symptoms present with a loss or alteration of physical function without known physiologic basis. Conversion symptoms may include paralysis, blindness, deafness, abnormal movements or regional sensory loss. The symptoms usually conform to the patient concept of the disease.

Pain disorders are associated with a preoccupation with pain in the absence of physical findings but in the presence of significant psychologic factors. The pain somatoform disorders are difficult to differentiate from organic pain disorders since there are no clinical findings to indicate that the pain does not originate from organic disease..

Factitious disorders are those which are intentionally produced specifically to assume the patient role. Factitious illness is not real and is associated with symptoms which are voluntarily controlled. When the patients objective is to obtain drugs, avoid work or prosecution, evade undesirable duties or gain financial benefit the patient is considered a malingerer. The malingering patient is motivated by external incentives.

Why is this information important? Perhaps because the majority of injured patients are considered to be malingerers if they don=t get better quickly or return to work immediately. In addition to the complexities of wound repair which may explain prolonged healing one must consider the psychological factors which are facing the patients.

Many patients with chronic pain develop dependencies with family, friends, doctors, attorneys, adjusters, co-workers etc. The post-traumatic chronic pain patient, when associated with other psychologic contributions, may develop some of the somatoform presentations described earlier. The labeling of these patients as a malingerer may magnify the psychologic component and further reduce the probability of favorable outcome. Chronic pain patients, with or without somatoform disorders, may develop depressive states which can be life threatening.

An awareness of these disorders may lead to improved diagnosis, treatment and documentation for your clients. For more information please contact us at 800-232-6824.