Abstract

The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fourth Edition, notes that individuals may consciously exaggerate the symptoms of a disorder in the clinical or impairment evaluation setting, an activity that is associated with the process of somatization. This article reviews the phenomena of somatization, its magnitude, factors that contribute, and somatizing disorders themselves. Somatization 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. Reported symptoms could result from organic disease—which is precisely the point because somatizing patients choose symptoms, consciously or not, that will be taken as evidence of real, physical disease. The prevalence of somatization reportedly ranges from 5% to 60% and varies with the medical specialty and the clinical setting. Studies have reported that in 25% to 50% of all primary care encounters, physicians found no significant objective cause to explain the presenting symptoms. The somatization process contributes to somatoform disorders, which are mental disorders and are not intentionally produced or feigned. A table compares three types of somatizing disorders: somatoform disorders, factitious disorders, and malingering. The presence of somatization distorts symptom presentation and can confound assessment methodologies, but the AMA Guides instructs that impairment is rated on the basis of objective findings, not solely on subjective complaints.

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