Controvérsias sobre a somatização

Abstract

ResumoContexto: A somatização é freqüentemente encontrada nos diversos serviços de saúde e apresenta controvérsias quanto a sua abordagem, diagnóstico e encaminhamentos para tratamento. Objetivos: Realizar uma revisão sistemática sobre o tema somatização, caracterizando como vem sendo discutido na literatura científica e empregado indiscriminadamente em diversos campos de atuação clínica. Pretendemos delimitar o conceito, demonstrando a necessidade de uma definição unívoca dessa classificação. Métodos: Uma revisão da literatura foi conduzida nos indexadores Medline e Lilacs, entre os anos 2001 e 2004, com os termos somatização, transtornos somatoformes e medicina psicossomática. Propusemos categorias de conteúdo, de acordo com o tema principal associado ao conceito de somatização, priorizando questões sobre classificação. Resultados: Encontramos contradições nas definições, usos e classificação da somatização. A maioria dos artigos do período (191) enfocava a somatização na psiquiatria, seguida por outras especialidades médicas (139), observando-se grande dispersão dos contextos e situações clínicas em que ela é empregada. Conclusões: Há premente necessidade de melhor entendimento dessa condição, muito freqüente em diferentes áreas médicas, que gera altos custos para os sistemas de saúde. Mais estudos sobre classificação são necessários no sentido de solucionar controvérsias, simplificar o diagnóstico e melhorar o manejo da somatização por parte dos profissionais da saúde. Coelho, C.L.S.; Ávila, L.A. / Rev. Psiq. Clín 34 (6); 278-284, 2007Palavras-chave: Somatização, transtornos somatoformes, medicina psicossomática, classificação. AbstractBackground: Somatization is frequently found in different health services and it presents controversies in its approaches, diagnoses and referrals to treatment. Objectives: Making a systematic review on somatization, characterizing how it has been discussed in scientific literature and its indiscriminate use in several clinical settings. We intend to circumscribe the concept and to demonstrate the need of a univocal definition of this classification. Methods: A literature review was conducted in the Medline and Lilacs databases between the years 2001 and 2004 with the search terms somatization, somatoform disorders and psychosomatic medicine. We proposed a content classification according to the main theme, in association with the concept of somatization, emphasizing questions about classification. Results: We found contradictions in definitions, uses and classifications of somatization. Currently most papers on somatization are connected to psychiatry (191), followed by other medical specialties (139), detecting the spreading

Hysteria and its metamorphoses

“…Patients that, in the past, were formally acknowledged as suffering from hysteria may currently be complying with badly-specified criteria including fibromyalgia, borderline personality disorders, irritable bowel syndrome, chronic fatigue syndrome, multiple chemical sensitivities, etc. The adoption of labels such as fibromyalgia or other putative organic pathologies, gives legitimacy to the complaints of the patient, avoiding stigmatization by society and permitting patients to assume the role of sick people, as their problems are not considered as imaginary by healthcare professionals (Coelho & Ávila, 2007;Ford, 1997).…”

“…Thus, when no organic pathology is identified, 50% of all primary healthcare consultations are considered somatization, thus this condition is very prevalent in the general population (Mai, 2004;Coelho & Ávila, 2007;Wilkinson & Bass, 1994;Kirmayer & Robbins, 1991;Escobar et al, 1987;Thomassen et al, 2003). But somatization disorders, strictly speaking, affect only 0.3% of the population according to epidemiological studies (Bass et al, 2001;Escobar et al, 1987;Hillee et al, 2003;Jackson & Kroenke, 2008).…”

“…Frequently diagnosed from Hippocrates' times till the beginning of the XX century, hysteria enigmatically disappeared, as a whole, from the clinical setting and even from the research papers of Psychiatry and other specialties during the XX century, culminating in its elimination from the official disease classification manuals during the 1990s (Micale, 2000;Stone et al, 2008;Merskey, 2004;Ávila, 2002e 2006Mai, 1980;Shorter, 2005;Coelho & Ávila, 2007).…”

A Biopsychosocial Approach to Creative Dissociation: Remarks on a Case of Mediumistic Painting

“…It has been common for researchers to verify positive associations between somatization and dissociation (Kruesi et al, 2004;Ross et al, 1990;Saxe et al, 1994;Walker et al, 1992), as well as between somatization and conversion (Binzer, Andersen, & Kullgren, 1997;Stonnington, Barry, & Fisher, 2006). It is known that somatization is strongly linked to anxiety and depressive symptoms, and that stress is a common factor underlying dissociation, conversion, and somatization (Coelho & Ávila, 2007). The psychosocial causes or triggers of somatization are varied, ranging from traumatic childhood experiences -also common in dissociative and conversion disorders (Binzer, Andersen, & Kullgren, 1997;Roelofs et al, 2002;Stonnington, Barry, & Fisher, 2006) -to stressors related to specific socioeconomic conditions such as poverty or exposure to violence (Tófoli, Andrade, & Fortes, 2011).…”

O Que Se Perde Quando a Psicossomática É Substituída Pela Somatização?

“…So, it is relevant to discuss the presentations of both psychosomatics and somatization in scientific publications and the structuring order chosen by researchers. Coelho and Ávila (2007) published a study with the aim of discussing how somatization was being debated in widespread contexts and medical situations. For this, the authors reviewed publications from 2001 to 2004 in the MEDLINE and LILACS databases searching using the keywords 'somatization', 'somatoform disorders' and 'psychosomatics'.…”