LETTER
Rethinking Somatization
Donald M. Loveman, MD
15 December 1997 | Volume 127 Issue 12 | Page 1132
TO THE EDITOR:
McWhinney and colleagues' article on rethinking somatization [1] is troubling because it discusses terminology and an approach to therapy while deemphasizing cause. The authors do not point out that evidence links childhood physical; emotional; and, especially, sexual abuse with the development of subsequent somatization syndromes in adulthood. To cite a few examples: In a nonclinical sample of college-age women, Briere and Runtz [2] showed higher levels of somatization in those who reported childhood sexual abuse. Walker and colleagues [3] found a significantly higher prevalence of both somatization and history of childhood and adult sexual abuse in a group of women with chronic pelvic pain. Drossman and coworkers [4] demonstrated that a history of childhood sexual abuse is associated with a greater risk for symptom reporting and lifetime surgeries in relation to gastrointestinal disease. Finally, Morrison [5] reviewed a group of women with psychiatric disorders and found that significantly more women with somatization disorder had been molested as children.
If, as this and other evidence suggests, childhood sexual abuse is associated with somatization, the omission of any mention of this issue greatly distorts McWhinney and colleagues' conclusions. The subject of somatization cannot be meaningfully advanced by discussing its nomenclature while neglecting its cause. The authors emphasize the relief of symptoms over the search for and understanding of the cause. Many patients with somatization focus excessively on physical symptoms, at least in part because they cannot see or effectively come to grips with the causes of these symptoms. The medical profession should not do the same.
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Author and Article Information
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Texas Tech University Health Sciences Center; Odessa, TX 79763
1. McWhinney IR, Epstein RM, Freeman TR. Rethinking somatization. Ann Intern Med. 1997; 126:747-50.
2. Briere J, Runtz M. Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse and Neglect. 1988; 12:51-9.
3. Walker EA, Katon W, Hansom J, Harrop-Griffiths J, Holm L, Jones L, et al. Medical and psychiatric symptoms in women with childhood sexual abuse. Psychosom Med. 1992; 54:658-64.
4. Drossman DA, Leserman J, Nachman G, Zhiming Le M, Gluck H, Tooney TC, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990; 113:828-33.
5. Morrison J. Childhood sexual histories of women with somatization disorder. Am J Psychiatry. 1989; 146:239-41.
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