Somatization disorders in obstetrics and gynecology

Summary Somatization refers to the phenomenone of physical symptoms not being conditioned by physical structural defects but primarily by mental processes. The basic understanding integrating psychodynamic, cognitive behavioral and systemic views conceptualized the underlying process as a signal processing circle in which the perceptual, interpretative and the effectiv-behavioral part interact in a dysfunctional manner. The clinical entities of this basic mechanism are variable in the localization and intensity of the symptoms which is reflected in the existing classification of ICD 10 and DSM IV. These classifications do not differentiate between gender. In obstetrics and gynecology somatization disorders are quantitatively important and qualitatively distinct. The pathogenetic factors are linked to gender specific biopsychosocial conditions, psychoendocrine interactions and genital organ subjective experiences. Therefore we propose a gender-sensitive classification into three groups of somatization disorders: Somatizing reactions during specific life phases or transitional periods, pychoendocrine disorders and somatoform disorders of the female genital organs. In each group the dysfunction may manifest itself mainly on the perceptual part or the effective-behavioral part of the signal processing circle. The pathogenetic pathways, comorbidities, specific diagnostic and therapeutic interventions for these different groups are summarized. Accepted October 6, 2002; Published online December 9, 2002 Correspondence: Prof. Johannes Bitzer, Department of Social Medicine and Psychosomatics, University Hospital of Gynecology and Obstetrics Basel, Schomzenstrasse 46, CH-4031 Basel, Switzerland; e-mail: jbitzer@uhbs.ch