Maria was raped by a group of men at age 15. She developed symptoms of post-traumatic stress disorder, including intrusive memories, nightmares, anxiety, and avoidance of places related to the attack. A 77-year-old woman presented with a long history of multiple somatic complaints and preoccupation with physical symptoms. Somatization disorder is characterized by physical symptoms that cause distress and cannot be fully explained by a medical condition. Treatment for somatization focuses on coping and functioning rather than eliminating symptoms, using a conservative diagnostic approach, validating the patient's distress, providing a diagnosis emphasizing dysfunction over pathology, and involving psychiatric consultation when appropriate.

1. Post-Traumatic Stress Disorder
and Somatization
Hena Jawaid

2. PTSD Somatization
• Story
• Clinical features
• Management
Pharmacological
Non-pharmacological
• Story
• Clinical features
• Management
Non-pharmacological

3. PO

4. Maria was only 15 when she was attacked by a group of men on
the way home from school. They took turns screaming abuse at
her and then they each raped her. Finally, they tried to stab her
to death and would almost certainly have succeeded had the
police not arrived on the scene. For months after this horrifying
event, Maria was not herself. She was unable to keep the
memories of the attack out of her mind. At night she would have
terrible dreams of rape, and would wake up screaming. She had
difficulty walking back from school because the route took her
past the site of the attack, so she would have to go the long way
home. She felt as though her emotions were numbed, and as
though she had no real future. At home she was anxious, tense,
and easily startled. She felt “dirty” and somehow shamed by the
event, and she resolved not to tell close friends about the event,
in case they too rejected her.

9. Somatization

10. • A 77yo woman is healthy except for mild
hypertension and a history of chronic multiple
somatic complaints, for 6m, preoccupied with
a “heavy head”. Ongoing complaints of
anxiety, decreased energy and insomnia for
the past several months or years (hx is vague).
• Screening neuro exam is unremarkable.
Routine labs done two months ago are also
noncontributory.

12. A. One or more somatic sx’s that are distressing
or disruptive of daily life
B. Excessive thoughts, feelings, or behaviors
related to the symptoms or concerns:
– Disproportionate and persistent thoughts about
seriousness
– Persistent high levels of anxiety about health
– Excessive time and energy devoted to
•symptoms and concerns
•C. Symptoms state is persistent (> 6mo)
•Specify if: With predominant pain

13. • May include some individuals previously
• diagnosed with hypochondria or
• somatization d/o…
• …And may ALSO include those
• individuals with major medical illness
• (e.g. IDDM testing blood sugar 20 times
• daily)
• • Usually based on a misinterpretation
• of bodily sensations

14. Management of Somatization
1) Care Rather Than Cure
Don’t try to eliminate symptoms completely
Focus on coping and functioning as goals of
treatment
2) Diagnostic and Therapeutic Conservatism
Review old records before ordering tests
Respond to requests just as for patient who
does not somatize
Frequent visits and physical examinations
•Benign remedies

15. Management (cont.)
3) Validation of Distress
•Don’t refute or negate symptoms
•Patient-physician relationship not
•predicated on symptoms
•Focus on social history
•Regular visits (not prn) – consider scheduled
telephone contacts
•Once set, try not to alter the frequency of visits

16. Management (cont.)
4) Providing a Diagnosis
•Emphasize dysfunction rather than structural
•pathology
•Describe amplification process and provide
specific example
•Cautious reassurance
•Introduce stress model of disease, if
appropriate

17. Management (cont.)
5) Psychiatric Consultation
•To diagnose psychiatric comorbidity
•For recommendations about pharmacotherapy
•For cognitive-behavioral therapy to improve
coping or psychotherapy

18. Thank you