Somatic symptom reporting in women and men

Abstract

Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief. W omen and men experience somatic symptoms, bodily distress, and physical health differently. In this paper, we review the empirical evidence regarding gender differences in symptoms, consider various explanations for these differences, and discuss their implications for clinical practice. Since all physical symptoms contain both somatic and psychological components, the distinction betweeǹ`o rganic'' and``functional'' symptoms is theoretically unsound, arbitrary, and clinically impossible to establish. Accordingly, we will discuss somatic symptom reporting in general, including studies of symptoms which do and do not have a clearly demonstrable pathophysiologic correlate. The term sex is generally used to refer to biological characteristics differentiating males and females, while gender is used to refer to the socially allocated roles and expectations associated with sex, i.e., masculinity and femininity. In this review, however, we will use the terms interchangeably, as it is difficult to distinguish the biological and the social role aspects of somatic symptom reporting. METHODSThe MEDLINE and PsycInfo databases were searched for articles from 1966 through March 1999 that included any of the following MeSH terms: symptoms, somatoform disorders, pain, chronic illness, health behavior, and illness behavior combined with sex, sex differences, gender, gender role, and gender differences. The search was extended by using the bibliographies of selected, recent articles and systematic reviews. Articles were screened for relevance based on title, key words, and abstracts. Only English-language papers were included. The initial search identified approximately 450 articles. Cursory inspection of these led to the elimination of approximately 275 as insufficiently relevant or insufficiently scientific to warrant inclusion. T...

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

“…Thus, sex differences may only emerge when separately assessing individual symptoms. On the other hand, as has been mentioned elsewhere (Barsky et al, 2001), 'since positive findings are more likely to find their way into the literature than negative ones, gender differences are more likely to be emphasised and published than the absence of such differences' (p.270).…”

“…Numerous epidemiological studies have reported SFDs to be more prevalent among female and younger patients (Barsky et al, 2001, Fink et al, 2004Jacobi et al, 2004;Nimnuan et al, 2001), among those who were not married, and those of lower social class (Fink et al, 2004;Jacobi et al, 2004). Reasons put forward to explain sex differences include: a greater willingness of women to admit health problems and to seek medical help, a higher incidence of depressive and anxiety disorders among women which in turn are associated with somatic symptoms, a higher incidence of predisposing factors such as physical and sexual abuse in women, biological differences in responses to pain, a greater bodily awareness of women as compared to men, and gender bias in research and clinical practice (Barsky et al, 2001).…”

“…Reasons put forward to explain sex differences include: a greater willingness of women to admit health problems and to seek medical help, a higher incidence of depressive and anxiety disorders among women which in turn are associated with somatic symptoms, a higher incidence of predisposing factors such as physical and sexual abuse in women, biological differences in responses to pain, a greater bodily awareness of women as compared to men, and gender bias in research and clinical practice (Barsky et al, 2001). …”

Gender related differences in pain in spinal cord injured individuals

“…It is possible that men and women di er in their acknowledgement of pain as well as in evaluating and interpreting bodily discomfort. 20,32 This is supported by Canli and colleagues 33 showing that women have better emotional memory than men.…”

“…But the greater prevalence of pain in women in our population of 456 individuals is supported by epidemiological studies of gender di erences in general. 17,20 The underlying reasons are largely unknown. Several studies emphasize that no di erence in sensitivity is apparent sexwise in pain thresholds tested pre-pubertally, while a signi®cant increase is noted in women post-pubertally.…”