Somatization

Objectives

1. In patients with recurrent unexplained or confusing symptoms:
   • Do not attribute symptoms to somatization unless an adequate workup rules out any medical or psychiatric condition (e.g., depression)
   • Reassess the symptoms periodically as they may evolve into diagnosable medical conditions/mental health diagnoses or remain unexplained
2. When a patient presents with symptoms that may be somatoform (e.g., caused by emotional distress) clearly distinguish between the stressed individual with somatoform traits and somatic symptom disorder by using established diagnostic criteria.
3. In patients with a previously diagnosed somatic symptom disorder do not assume that somatization is the cause of new or ongoing symptoms.
4. In patients who somatize acknowledge the illness experience and strive to find common ground with them concerning their diagnosis and management, including investigations.
5. When a patient presents frequently with medically inconsistent or confusing symptoms that are not worrisome:
   • Order investigations judiciously
   • Educate the patient about the connection between physical symptoms and psychological distress
6. In a patient with existing mental health conditions do not dismiss new physical symptoms as somatization without appropriate assessment.
7. When caring for a patient with somatization identify and manage your own emotional responses.
8. When somatic symptom disorder has been established as the most likely diagnosis recommend and discuss evidence-informed psychotherapy and refer when appropriate, ensuring appropriate ongoing care and follow-up.
9. In patients who have somatic symptoms inquire about the use of and suggest therapies that may provide symptomatic relief and/or help them cope with their symptoms.