Skip to main content
Log in

Somatization in the population: from mild bodily misperceptions to disabling symptoms

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

This study investigates the prevalence of current somatization in the population by taking different levels of symptom severity into account. Somatization is described along a continuum from mild and negligible bodily misperceptions to severe and disabling somatoform symptoms.

Methods

A representative sample of 2.552 persons in Germany was examined with a screening instrument for medically unexplained physical complaints that had occurred during the past 7 days. All 53 symptoms from the ICD-10/DSM-IV sections of somatoform disorders were included.

Results

81.6% reported at least one symptom causing at least mild impairment and 22.1% at least one symptom causing severe impairment. The entire sample had an average of 6.6 symptoms associated with at least mild distress. Somatization of any degree was associated with female gender, age above 45, lower educational level, lower household income and rural area. The most common symptoms with prevalence rates > 20% were various types of pain (back, head, joints, extremities), food intolerance, sexual indifference, painful menstruations and erectile/ejaculatory dysfunction.

Conclusion

This population survey demonstrates that medically unclear complaints are an everyday phenomenon. About three out of four cases are below clinical relevance with only low level of impairment. Epidemiological correlates are similar between clinical and non-clinical forms of somatization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Barsky AJ, Borus JF (1995) Somatization and medicalization in the era of managed care. JAMA 274:1931–1934

    Article  PubMed  CAS  Google Scholar 

  2. World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders, diagnostic criteria for research. WHO, Geneva

    Google Scholar 

  3. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  4. Hotopf M (2002) Childhood experience of illness as a risk factor for medically unexplained symptoms. Scand J Psychol 43:139–146

    Article  PubMed  Google Scholar 

  5. Barsky AJ (1992) Amplification, somatization, and the somatoform disorders. Psychosomatics 33:28–34

    PubMed  CAS  Google Scholar 

  6. Rief W, Hiller W, Margraf J (1998) Cognitive aspects of hypochondriasis and the somatization syndrome. J Abnorm Psychol 107:587–595

    Article  PubMed  CAS  Google Scholar 

  7. Gaab J, Engert V, Heitz V, Schad T, Schürmeyer TH, Ehlert U (2004) Associations between neuroendocrine responses to the insulin tolerance test and patient characteristics in chronic fatigue syndrome. J Psychosom Res 56:419–424

    Article  PubMed  Google Scholar 

  8. Nimnuan C, Hotopf M, Wessely S (2001) Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res 51:361–367

    Article  PubMed  CAS  Google Scholar 

  9. Hessel A, Geyer M, Schumacher J, Brähler E (2002) Somatoforme Beschwerden in der Bevölkerung Deutschlands [Somatoform complaints in the German population]. Z Psychosom Med Psychother 48:38–58

    PubMed  Google Scholar 

  10. Wittchen H-U, Jacobi F (2005) Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15:357–376

    Article  PubMed  CAS  Google Scholar 

  11. Robins LN, Regier DA (eds) (1991) Psychiatric disorders in America: the Epidemiologic Catchment Area Study. The Free Press: New York

    Google Scholar 

  12. Canino GJ, Bird HR, Shrout PE, Rubio-Stipec M, Bravo M, Martinez R, Sesman M, Guevara LM (1987) The prevalence of specific psychiatric disorders in Puerto Rico. Arch Gen Psychiatry 44:727–735

    PubMed  CAS  Google Scholar 

  13. Wittchen H-U, Essau CA, von Zerssen D, Krieg J-C, Zaudig M (1992) Lifetime and six-month prevalence of mental disorders in the Munich follow-up study. Eur Arch Psychiatry Clin Neurosci 241:247–258

    Article  PubMed  CAS  Google Scholar 

  14. Meyer C, Rumpf H-J, Hapke U, John U (2001) Prevalence of DSM-IV psychiatric disorders including nicotine dependence in the general population: results from the Northern German TACOS study. Neurol Psychiat Brain Res 9:75–80

    Google Scholar 

  15. Grabe HJ, Meyer C, Hapke U, Rumpf HJ, Freyberger HJ, Dilling H, John U (2003) Specific somatoform disorder in the general population. Psychosomatics 44:304–311

    Article  PubMed  Google Scholar 

  16. Faravelli C, Salvatori S, Galassi F, Aiazzi L, Drei C, Cabras P (1997) Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 32:24–29

    Article  PubMed  CAS  Google Scholar 

  17. Jacobi F, Wittchen HU, Holting C, Hofler M, Pfister H, Müller N, Lieb R (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34:597–611

    Article  PubMed  CAS  Google Scholar 

  18. Escobar JI, Waitzkin H, Silver RC, Gara M, Holman A (1998) Abridged somatization: a study in primary care. Psychosom Med 60:466–472

    PubMed  CAS  Google Scholar 

  19. Hiller W, Fichter MM, Rief W (2003) A controlled treatment study of somatoform disorders including analysis of health care utilization and cost-effectiveness. J Psychosom Res 54:369–380

    Article  PubMed  Google Scholar 

  20. Rief W, Hiller W, Heuser J (1997) SOMS—Das Screening für Somatoforme Störungen: manual zum Fragebogen (SOMS—The Screening for Somatoform Symptoms Manual). Huber, Bern

    Google Scholar 

  21. Rief W, Hiller W (2003) A new approach to the assessment of the treatment effects of somatoform disorders. Psychosomatics 44:492–498

    Article  PubMed  Google Scholar 

  22. Hiller W, Janca A (2003) Assessment of somatoform disorders: a review of strategies and instruments. Acta Neuropsychiatrica 15: 167–179

    Article  Google Scholar 

  23. Rief W, Hessel A, Braehler E (2001) Somatization symptoms and hypochondriacal features in the general population. Psychosom Med 63:595–602

    PubMed  CAS  Google Scholar 

  24. Fahrenberg J (1995) Somatic complaints in the German population. J Psychosom Res 39:809–817

    Article  PubMed  CAS  Google Scholar 

  25. Schumacher J, Brähler E (1999) Prävalenz von Schmerzen in der deutschen Bevölkerung: Ergebnisse repräsentativer Erhebungen mit dem Gießener Beschwerdebogen. [The prevalence of pain in the German population: results of population-based studies with the Giessen Subjective Complaints List (Giessener Beschwerdebogen GBB)]. Schmerz 13:375–384

    Article  PubMed  CAS  Google Scholar 

  26. Swartz M, Blazer D, George L, Landerman R (1986) Somatization disorder in a community population. Am J Psychiatry 143:1403–1408

    PubMed  CAS  Google Scholar 

  27. Jacobi F, Wittchen HU, Holting C, Sommer S, Lieb R, Hofler M, Pfister H (2002) Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey. Int J Methods Psychiatr Res 11:1–18

    Article  PubMed  Google Scholar 

  28. Wool CA, Barsky AJ (1994) Do women somatize more than men? Gender differences in somatization. Psychosomatics 35:445–452

    PubMed  CAS  Google Scholar 

  29. Gijspers van Wijk CMT, Kolk AM (1997) Sex differences in physical symptoms: the contribution of symptom perception theory. J Psychosom Res 45:231–46

    Google Scholar 

  30. Peveler R, Kilkenny L, Kinmonth A-L (1997) Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res 42:245–252

    Article  PubMed  CAS  Google Scholar 

  31. Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stoltzman RK, Farmer A, Brockington IF (1985) A comparison of clinical and Diagnostic Interview Schedule diagnoses. Arch Gen Psychiatry 42:657–666

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wolfgang Hiller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hiller, W., Rief, W. & Brähler, E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiat Epidemiol 41, 704–712 (2006). https://doi.org/10.1007/s00127-006-0082-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-006-0082-y

Key words

Navigation