Somatization: from physiology to abnormal illness behavior.

Somatization is a generic and ambiguous concept widely utilized for pathological conditions where somatic symptoms are interpreted as the consequence of psychological problems or stress. It could be defined as “the transitory or persistent tendency to experiment or communicate psychological suffering as somatic symptoms and to search help for them” (Lipowski, 1988). In these patients symptoms are mainly visceral, but a lot of them also undergo psychological suffering (in particular, anxiety, depression and hypochondria) and the co-morbility with psychiatric diseases is very high. In most cases clinical or laboratory tests fail to find biological alterations that explain somatic symptoms, and the diagnosis is made by exclusion, becoming only an alibi for cultural ignorance or therapeutic inefficacy. In clinical practice, somatization is a complex problem that presents in a continuum from normal physiology to psychiatric suffering. The perception of the body activity in somatic or psychological ways depends on Illness Behaviour, i.e. “the ways in which individuals react to aspects of their own functioning which they evaluate in terms of health and illness” (Pilowsky, 1978). This disposition is highly conditioned by development, family education, cultural factors and by attachment experiences. In DMM perspective the tendency to deny or falsify negative forbidden affects (anger, fear, vulnerability, sexual excitation) is a characteristic of A configurations, especially type A+. In these cases, specific Abnormal Illness Behaviors are frequent and accompanied by somatization symptoms or functional syndromes. In some cases, the increase of emotional arousal is subjectively perceived only by its somatic aspects, the only ones that can be recognized and communicated. In this way, the subject can search help (from his attachment figure or from the doctor) for his somatic needs and not for psychological problems. In other cases, denial of the bodily signals of danger (pain, altered somatic perceptions, body function alterations) don’t permit an adequate search for psychological or medical help, resulting in the development of serious organic alterations and medical illnesses