Somatization occurs when a person’s emotional distress is converted into physical symptoms. Often, a person first goes to a physician, believing their symptoms have a bodily cause. Once the physician confirms that the person is somaticizing, they will likely refer the person to a licensed therapist.
Although the source of the symptoms is psychological, the person’s pain is real. Effective treatment typically focuses on alleviating distress rather than “proving the person wrong.” Treatment for somatization may involve collaboration between physical and mental health care providers.
Somatization Treatment Journey
Many individuals doubt at first that their somatic symptoms are psychological. They may not believe doctors who say they have no physical condition. They may misinterpret a psychological explanation as a dismissal of their pain.
They may need to hear the same diagnosis from multiple physicians before consenting to see a therapist. Therapy can help a person address the underlying emotions contributing to somatization. A therapist may also treat comorbid conditions such as depression.
Even while a person is in therapy, they may still need physical care. For example, someone who has difficulty talking may benefit from seeing a speech pathologist, even though their speech issues do not have physical causes. Treating physical symptoms can help relieve the person’s distress. It may also convince the individual that their care team is taking their issues seriously.
Once it’s established that there is no underlying physical ailment, a strong therapeutic relationship is critical to the success of therapy. People experiencing somatization may feel overwhelmed by anxiety around their symptoms. They may also worry that their therapist thinks they are faking.
Therapy can offer a safe space to discuss these fears. These conversations in turn can lay the foundation for deeper exploration. A therapist can help the person address the feelings and memories that cause somatization.
Numerous studies have found that cognitive behavioral therapy (CBT) is highly effective at treating somatization. CBT focuses on helping people identify automatic negative thoughts. It then teaches people how to combat these thoughts with less self-defeating messages. Over time, these skills can help resolve emotional distress and reduce somatic symptoms. A 2006 study found people who did CBT reported significantly milder somatic symptoms by the study’s end (The study lasted 15 months.). They were much more likely to show improvement than participants who only had medical care.
Depending on the cause of somatization, other types of therapy might also be appropriate. Someone who develops somatic symptoms because of trauma might need a trauma-informed approach such as eye movement desensitization and reprocessing (EMDR) therapy. When somatization is due to family or relationship stress, family or couples counseling may help. Family counseling can be particularly important when loved ones have trouble understanding the true nature of somatic symptoms.
Helping Loved Ones With Somatization
When a loved one develops somatic symptoms, it may be tempting to tell them that their symptoms are “all in their head.” This approach is unlikely to help. It may even make the symptoms worse by making the person feel stigmatized. Even if a person’s symptoms have a psychological source, their pain is still real.
A more effective approach is to get the person to talk about their underlying feelings. Try to create an environment where they feel safe voicing negative emotions is key. Don’t judge or argue with the other person’s emotions. Those feelings exist whether you approve of them or not. Instead, listen with empathy and offer support for coping with those feelings. If the person can express their emotions verbally, they will likely have less need to express them physically.
It may help to encourage a loved one to seek therapy—not for the somatization, but for the feelings that cause it. Some people are anxious about therapy or overwhelmed by the process of finding a therapist. You may offer to help the person find a therapist or consider going with them to the first appointment.
Case Examples of Therapy for Somatization
- Somaticized pain after reminders of sexual assault: Tameka, 32, was sexually abused in childhood. In college, she was raped at a party. She never told anyone except her wife about the abuse and never sought therapy. Sometimes she worries the assault was her fault or that it was punishment for bad decisions she made. After seeing a number of high-profile news stories about sexual assault and abuse, Tameka begins complaining of headaches and back pain. Three doctors have told her that there is no underlying medical issue and have instead suggested relaxation exercises and yoga. Tameka feels unheard by her doctors. She also felt unheard after experiencing abuse. At the urging of her wife, Tameka agrees to see a therapist to discuss her emotions. At first, Tameka insists that her headaches are real and worries that the therapist thinks she is faking. Over time, the therapist helps her understand that the tension in her body is a physical manifestation of the tension Tameka feels about her abuse and the tension triggered by stories of other people’s abuse. With the help of trauma-informed CBT, Tameka is able to process her emotions and get relief from her pain.
- Child has somatization after divorce: Jackson, 7, often stays home from school because of headaches and nausea. His parents recently divorced. Prior to the divorce, they often stayed up all night fighting loudly. Jackson’s father hit his mother in front of him several times. Jackson’s parents think he didn’t know about the fights or was too young to be affected by them. At the urging of the school counselor, Jackson and his mother enter family therapy. The therapist also independently works with Jackson, using a CBT-informed variety of play therapy. Over time, Jackson is able to talk about the fear he felt when he saw his parents fight. He indicates that he doesn’t want to go to school because he’s afraid to be away from his mother. In family therapy, Jackson and his mother develop a plan for helping Jackson express his emotions and feel safe at school. Jackson has begun experiencing fewer headaches and is no longer reluctant to go to school.
- Allen, L. A., Woolfolk, R. L., Escobar, J. I., Gara, M. A., & Hamer, R. M. (2006). Cognitive-behavioral therapy for somatization disorder: A randomized controlled trial. Archives of Internal Medicine, 166(14), 1512-1518. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16864762
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Functional neurologic disorders/conversion disorder. (n.d.) Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/conversion-disorder/diagnosis-treatment/drc-20355202
- Hurwitz, T. A. (2004). Somatization and Conversion Disorder. The Canadian Journal of Psychiatry, 49(3), 172-178. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/070674370404900304
- Isaac, A., & Wise, T. (2003). A low-frustration strategy for treating somatization. Current Psychiatry, 2(8), 32-51. Retrieved from https://www.mdedge.com/psychiatry/article/66166/somatic-disorders/low-frustration-strategy-treating-somatization