Somatization in survivors of catastrophic trauma: a methodological review.

Abstract

The literature on mental health effects of catastrophic trauma such as community disasters focuses on posttraumatic stress disorder. Somatization disorder is not listed among the classic responses to disaster, nor have other somatoform disorders been described in this literature. Nondiagnostic "somatization," "somatization symptoms," and "somatic symptoms" form the basis of most information about somatization in the literature. However, these concepts have not been validated, and therefore this work suffers from multiple methodological problems of ascertainment and interpretation. Future research is encouraged to consider many methodological issues in obtaining adequate data to address questions about the association of somatization with traumatic events, including a) appropriate comparison groups, b) satisfactory definition and measurement of somatization, c) exclusion of medical explanations for the symptoms, d) recognition of somatizers' spurious attribution of symptoms to medical causes, e) collection of data from additional sources beyond single-subject interviews, f) validation of diagnosis-unrelated symptom reporting or reconsideration of symptoms within diagnostic frameworks, g) separation of somatization after an event into new (incident) and preexisting categories, h) development of research models that include sufficient variables to examine the broader scope of potential relationships, and i) novel consideration of alternative causal directionalities.

Disaster-related injury and predictors of health complaints after exposure to a natural disaster: an online survey

“…In a study in Puerto Rico, exposure to a natural disaster was related to a high prevalence of medically unexplained physical symptoms, particularly gastrointestinal and pseudoneurological symptoms. This and other studies are suggestive of clinically important new somatisation after disasters 25 34. The results from this study also show significantly elevated scores on the somatic subscale of the SCL-90, predominantly caused by high somatic complaints in the acute phase.…”

The Course of PTSD, Major Depression, Substance Abuse, and Somatization After a Natural Disaster

“…The picture of postdisaster psychological sequelae emerging from this research is inconsistent and often confusing. Even rigorous methods, when used, have included a widely divergent array of questionnaires, surveys, interviews, and psychiatric classification systems (North, 2003) that have limited comparability across studies and likely contributed to the wide variation and contradiction in findings of flood research (Abrahams et al, 1976;Bennet, 1970;Bravo et al, 1990;Canino et al, 1990;Escobar et al, 1992;Green et al, 1989;Logue et al, 1981;Melick, 1978;Miller et al, 1981;Ollendick and Hoffmann, 1982;Powell and Penick, 1983;Price, 1978;Robins et al, 1986;Smith et al, 1986;Solomon et al, 1987;Steinglass and Gerrity, 1990). Historically, few disaster studies have diligently applied the formal diagnostic criteria of the American Psychiatric Association.…”

Multidimensionality of symptom complexes in irritable bowel syndrome and other functional gastrointestinal disorders

“…The available findings, although limited, are consistent with the concept of somatization outside the context of the currently diagnosed disorders, and with the concept of somatization as a continuum from mild, intermittent, and/or arising from one or a few organ systems, to severe, chronic, and/or arising from many organ systems [23,24]. Considering somatization as a dimensional construct rather than as part of SD may improve our understanding (although it may deflect us from the harder job of making a diagnosis of SD), yet it is not clear what therapeutic benefit may be derived from this construct.…”