Somatization: A Perspective from Self Psychology

Somatization is a complex phenomenon that occurs in many forms and diverse settings. It is not necessarily pathological and may be found in a variety of psychiatric disorders. Much of the psychiatric literature has focused on patients with conversion disorders and hypochondriasis. Psychoanalytic theories regarding such conditions were largely based upon concepts of drive, conflict, and defense. The perspective from self psychology, with its emphasis on subjective experience and the sense of self, may further enhance the psychoanalytic understanding of somatization. Individuals with disturbances in the stability and organization of the self may present with somatic symptoms and disturbances in emotional awareness. Somatization in such cases may be the experiential manifestation of a disturbance in the cohesion of the self and/or may result from defensive operations to ward off affect. The latter may be prominent when affective arousal triggers the psychological threat of fragmentation. Somatization may diminish in such individuals when a self-object relationship is formed that bolsters and consolidates the sense of self. The integration of affect into ongoing subjective experience may also be an important aspect of psychoanalytic treatment in such patients.

Somatization has been defined as the presence of somatic symptoms in the absence of organic disease (Kellner, 1986) or as the expression of emotional discomfort and psychosocial distress in the physical language of bodily symptoms (Barsky and Klerman, 1983). These definitions include states of bodily preoccupation and the tendency to experience one's self in physical terms. Although there are somatic manifestations of all emotional states, the term somatization seems most meaningful psychiatrically