Somatization increases disability independent of comorbidity.
BACKGROUND
Somatoform disorders are an important factor in functional disability and role impairment, though their independent contribution to disability has been unclear because of prevalent medical and psychiatric comorbidity.


OBJECTIVE
To assess the extent of the overlap of somatization with other psychiatric disorders and medical problems, to compare the functional disability and role impairment of somatizing and non-somatizing patients, and to determine the independent contribution of somatization to functional disability and role impairment.


METHODS
Patients were surveyed with self-report questionnaires assessing somatization, psychiatric disorder, and role impairment. Medical morbidity was indexed with a computerized medical record audit.


METHODS
Consecutive adults making scheduled visits to their primary care physicians at two hospital-affiliated primary care practices on randomly chosen days.


METHODS
Intermediate activities of daily living, social activities, and occupational disability.


RESULTS
Patients with somatization, as well as those with serious medical and psychiatric illnesses, had significantly more impairment of activities of daily life and social activities. When these predictors were considered simultaneously in a multivariable regression, the association with somatization remained highly significant and was comparable to or greater than many major medical conditions.


CONCLUSIONS
Patients with somatization had substantially greater functional disability and role impairment than non-somatizing patients. The degree of disability was equal to or greater than that associated with many major, chronic medical disorders. Adjusting the results for psychiatric and medical co-morbidity had little effect on these findings.
Harris
Ashley M
AM
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115-6106, USA. aharris6@partners.org
Orav
E John
EJ
Bates
David W
DW
Barsky
Arthur J
AJ
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards; D013001:Somatoform Disorders / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards