Introduction

Although somatic forms of distress are of considerable epidemiological significance, impact adversely on health care utilization, and result in considerable economic, social, and personal burden, they occupy a rather minor place in much clinical psychiatry research and teaching (Hickie, Scott & Davenport, 1998). There is ongoing debate about appropriate nomenclature, the role of genetic, psychosocial, cultural and neurobiological factors in etiology, and the efficacy of specific pharmacological and behavioral interventions (Bass, 1990; Escobar, 1997; Hickie, Hadzi-Pavlovic & Ricci, 1997; Hickie et al., 1998; Kleinman, 1987; Mayou, 1993; Pilowsky, 1991). Despite these difficulties, the most striking feature of many of these disorders in medical settings is their impact on patterns of health care utilization and doctor–patient interactions (Clements, Sharpe, Simkin, Borrill & Hawton, 1997; Gureje, Simon, Üstün & Goldberg, 1997; Kroenke et al., 1997). As long as doctors remain ill-informed about the significance of somatoform disorders and appropriate forms of intervention, they will continue to result in high levels of disability. In this chapter the nature of somatization will be explored, the epidemiology described, and research and clinical issues outlined.

Medical assessment processes

When patients present with common or unusual somatic symptoms, the immediate response of general medical practitioners is to determine whether such symptoms may be readily explained by a ‘physical’ pathology. While this approach is understandable, it tends to be associated with a premature narrowing of the medical practitioner's perspective. An overly medical approach, particularly towards non specific symptoms such as tiredness, headaches, sleep disturbance and aches and pains, tends to exclude the possibility that psychological distress may give rise to these phenomena.