Somatization Across Populations

Somatization Across Populations


A young girl lies in bed while an adult hand checks her forehead for fever.People of all ages, genders, and ethnicities can experience somatization. Regardless of one’s background, somatic symptoms are a valid concern. They deserve to be taken seriously.

Somatization in Children

Somatic symptoms often develop when a person is unable to verbally express their distress. Children are more likely than adults to struggle with expressing emotions. Young children may lack the verbal skills to vocalize their feelings. Older children may fear judgment from adults or peers. So instead of expressing these emotions, the body manifests them as physical ailments. 

A child might, for example, feel homesick at sleepaway camp. If the child cannot address their feelings openly, their stress may manifest as stomach aches or headaches. Other common somatic symptoms in children include fatigue and dizziness. As with adults experiencing somatization, the child is not consciously faking the symptom. Yet medical exams will reveal that nothing is physically wrong with the child. 

Somatization in children is common. It does not necessarily point to a serious mental health issue or family problem. However, research shows some children are more likely to experience somatization. Risk factors include: 

  • A family history of illness, especially if a parent models illness behavior. 
  • The presence of childhood anxiety or depression.
  • Parental reinforcement of physical symptoms. A child who gets additional attention and support for physical symptoms is more likely to continue expressing their emotions through physical ailments—especially if the child doesn’t get the same level of support for emotional distress. 
  • Cultural influences. Children within certain cultures may be more likely to develop somatic symptoms. 

Somatization and Culture

A person’s culture can heavily influence their beliefs about illness, emotions, and vulnerability. These beliefs can alter how a person expresses their distress. For example, a person may live in a culture that decries intense emotions as a sign of weakness. This person might be less likely to verbally express their feelings and more likely to experience somatization.

A 2007 study suggests social norms around discussing emotions may play a role in somatization. The study gathered data on 60 people seeking psychiatric care at a clinic in South India. Researchers found most participants reported physical symptoms first, even when they also had psychological symptoms. People who reported concern about stigma were especially likely to focus on somatic symptoms. Participants who embraced more Western values of self-expression, however, were more likely to discuss their psychological symptoms. These results point to the role of cultural values in the manifestation of psychological distress. 

A 1997 cross-national study found that Latin American participants had the highest rate of somatization symptoms. A 1998 study provides more context. That study followed a multi-ethnic sample in the United States. Researchers found higher rates of somatization among Central American immigrants. They found that the most significant predictor of somatization was exposure to war. So cultural differences in somatization may be due in part to exposure to traumatic events

A 2009 study of children with asthma found higher rates of somatization among Latinx children living in Rhode Island. Latinx children living in Puerto Rico reported fewer somatoform symptoms than their Rhode Island-dwelling counterparts. This suggests that ethnicity alone cannot explain differences in somatization. Environment plays a role as well.

Somatization and Gender Bias

Women are more likely to be diagnosed with somatization issues. Women are three times as likely as men to have a conversion diagnosis. They are 10 times as likely to have SSD. Some theorists argue women are more likely to be diagnosed with these issues because their health problems are not taken as seriously. 

Women are often stereotyped as “sensitive” and “emotional”, so many doctors assume women are exaggerating their pain. Medical issues are often attributed to menstrual cycles or somaticized stress. This bias is compounded if the woman is a racial or ethnic minority.

Making matters worse, there is less research on how physical illness manifests in women’s bodies. In the past, many illnesses in women were dismissed as “hysteria.” Researchers did not routinely include women in their studies until the early 1990s. Women may be misdiagnosed because their symptoms don’t match the male criteria. 

These misdiagnoses can delay women from getting necessary care. A 1965 study looked at 85 women who had been diagnosed with hysteria in the 1950s. Researchers found 60% of the women actually had a physical issue such as a brain tumor. Twelve of the women had died, most likely due to lack of treatment. Research from the United Kingdom shows many women with brain tumors still wait over 10 months to get the right diagnosis.

Due to sexism in the medical sphere, it is vital for clinicians to rule out physical ailments before diagnosing a woman with somatization issues. Women who do have somatization issues may be reluctant to see a mental health specialist. They may assume their worries are being dismissed due to their gender. Therapists treating women should communicate respect and take all complaints seriously.

If you or a loved one is experiencing somatic symptoms, you can find a therapist here.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Campo, J. V., & Fritsch, S. L. (1994). Somatization in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 33(9), 1223-1235. Retrieved from http://psycnet.apa.org/record/1995-18070-001
  3. Dusenbery, M. (2018, May 28). ‘Everybody was telling me there was nothing wrong.’ BBC. Retrieved from http://www.bbc.com/future/story/20180523-how-gender-bias-affects-your-healthcare?ocid=twfut
  4. Escobar, J. I. (2004, April 15). Transcultural aspects of dissociative and somatoform disorders. Psychiatric Times, 21(5). Retrieved from http://www.psychiatrictimes.com/somatoform-disorder/transcultural-aspects-dissociative-and-somatoform-disorders
  5. Rao, D., Young, M., & Raguram, R. (2007). Culture, somatization, and psychological distress: Symptom presentation in South Indian patients from a public psychiatric hospital. Psychopathology, 40(5), 349-355. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17657134
  6. The surprising reason we lack so much knowledge about women’s health. (2018, August 24). Forbes. Retrieved from https://www.forbes.com/sites/quora/2018/08/24/the-surprising-reason-we-lack-so-much-knowledge-about-womens-health/#3d2df2e1298f
  7. Vasquez, J. C., Fritz, G. K., Kopel, S. J., Seifer, R., McQuaid, E. L., & Canino, G. (2009). Ethnic differences in somatic symptom reporting in children with asthma and their parents. Journal of the American Academy of Child & Adolescent Psychiatry, 48(8), 855-863. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278967
 

Last updated: 10-12-2018

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