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Am J Psychiatry 1991; 148:1494-1500
Copyright © 1991 by American Psychiatric Association
Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study
GE Simon and M VonKorff
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101.
OBJECTIVE: Somatization has often been viewed as a defense against
awareness of emotional distress or as a masked version of depression. This
report examines whether community residents with high levels of functional
somatic symptoms also report overt psychological distress and whether
somatization is associated with any specific psychiatric disorder. METHOD:
Analyses used data from the community sample of the National Institute of
Mental Health Epidemiologic Catchment Area (ECA) study, a population-based
survey of psychiatric morbidity among more than 18,000 residents of five
U.S. communities. RESULTS: Increasing number of somatization symptoms was
strongly associated with overt expression of psychological distress and
psychiatric symptoms. Among ECA respondents with five or more current
functional somatic symptoms, 63% reported current psychological symptoms
and 50% met criteria for a current psychiatric diagnosis (compared to 7%
and 6%, respectively, among those with no current somatization symptoms).
Somatization symptoms showed strongest associations with anxiety and
depressive symptoms, intermediate association with symptoms of psychotic
disorders, and weakest associations with symptoms of substance abuse and
antisocial personality. CONCLUSIONS: ECA study respondents with high levels
of somatization symptoms typically reported overt psychological distress,
especially anxiety and depression. Patterns of response do not support a
dissociation between physical and emotional symptoms. Functional somatic
symptoms appear to be common expressions of distress instead of defenses
against awareness.
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