Somatization and Decreased Congruency in Patients with Pain


Somatization is when a patient believes that they have a genuine physical condition that the physicians have failed to diagnose. Persons with this disorder will often seek care from many different physicians, trying to find one who will find “the problem.” One of the difficulties with somatization is that it is possible for a physician to miss a diagnosis and that current medical knowledge and diagnostic tools do not yet understand the genuine underlying condition. 


Several theories attempt to explain the disconnect between mind and body in somatization. A psychological theory, likely the most cited theory, is that somatization is a conversion of psychological stress. Thus, the patient needs to be guided through the process of identifying and addressing stressors in their psychological environment. A physiological theory proposes that some people are more sensitive to internal physical sensations. As somatization tends to be familial, this theory may reflect a genetically transmitted cause. A psychophysiological theory suggests that negative thinking, fear, catastrophizing lead to physiological symptoms. The patient may believe that there is a genuine injury that the physician missed and that they could further injure the area if they move, so they decrease their activity, which makes the symptoms worse and confirms, to them, that there really is a terrible problem that is being over looked, etc. Cognitive behavioral therapy is used to help the patient identify their automatic thoughts and primary/secondary appraisals to help them find the source of their catastrophic thinking.


The most objective evidence of somatization, at this point, is the congruency of the physiological evidence, the patients’ reported symptoms, and psychological discomfort. General psychological discomfort, however, is commonly present in patients with back pain and, further, patients with chronic pain tend to have increased coexistent psychological distress compared to those with acute pain. The Symptom Checklist-90-R (SCL-90-R) is used in medical settings to assess this general psychological distress. It has been suggested that the Somatization scale of the SCL-90-R can be used to distinguish psychological from physical discomfort better than the SCL-90-R’s composite Global Severity Index measure (GSI).


This project will examine the congruency of the physiological evidence (as indicated by the physicans’ diagnosis), the patients’ reported symptoms (as measured by the Oswestry and Pain Questionnaire), and psychological discomfort (as measured by the SCL-90-R) to investigate whether somatization is evidenced in decreased congruency. The project hypothesizes that increases in congruency will be related to decreases in somatization.