Somatization in refugees: a review



To present a review of the literature concerning medically unexplained physical symptoms in refugees.


We outline a variety of definitions and explanations of somatization, as well as the role of culture in the concept of disease. In addition, we present a review of the epidemiological literature about somatization in refugees.


Refugees from non-Western countries exhibit more unexplained somatic symptoms than the general Western population. Although different studies have employed different methodologies and are therefore difficult to compare, it can be concluded that refugees form a particular population in which somatization is prominent.


Potential, not mutually exclusive, explanations of the high number of somatic symptoms in the refugee population include general psychopathology, specifically traumatisation, results of torture, and stigmatisation of psychiatric care. There are implications for assessment, clinical treatment and further research concerning somatization in refugees.

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  1. 1.

    A branch of Foundation Centrum '45, the National Expert Centre for the Treatment of Victims of Persecution, War and Violence, Rijnzichtweg 35, 2342 AX Oegstgeest.


  1. 1.

    Ring A, Dowrick CF, Huphris GM, Davies J, Salmon P (2005) The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med 61:1505–1515

    PubMed  Article  Google Scholar 

  2. 2.

    Morriss R, Gask L, Dowrick C, Dunn G, Peters S, Ring A, Davies J, Salmon P (2010) Randomized trial of reattribution on psychological talk between doctors and patients with medically unexplained symptoms. Psychol Med 40:325–333

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Bäärnhielm S, Ekblad S (2000) Turkish migrant women encountering health care in Stockholm: a qualitative study of somatization and illness meaning. Cult Med Psychiatry 24:431–452

    PubMed  Article  Google Scholar 

  4. 4.

    Borra R (2008) Interculturele aspecten van somatisatie [Intercultural aspects of somatization]. In: Van der Feltz-Cornelis C, Van der Horst H (eds) Handboek somatisatie [Handbook of somatization]. Utrecht, De Tijdstroom, pp 49–64

    Google Scholar 

  5. 5.

    Ritsner M, Ponizovsky A, Kurs R, Modai I (2000) Somatization in an immigrant population in Israel: a community survey of prevalence, risk factors, and help-seeking behavior. Am J Psychiatry 157:385–392

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Van Moffaert MMMP (1998) Somatization patterns in Mediterranean patients. In: Okpaku SO (ed) Clinical methods in transcultural psychiatry. American Psychiatry Press, Washington, DC, pp 301–320

    Google Scholar 

  7. 7.

    Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365:1309–1314

    PubMed  Article  Google Scholar 

  8. 8.

    American Psychiatric Association (2000) Diagnostic and statistical manual of psychiatric disorders-text revision. American Psychiatric Association, Washington, DC

    Google Scholar 

  9. 9.

    Lipowski ZJ (1988) Somatization: the concept and its clinical application. Am J Psychiatry 145:1358–1368

    PubMed  CAS  Google Scholar 

  10. 10.

    Raguram R, Weiss MG, Channabasavanna SM, Devins GM (1996) Stigma, depression, and somatization in South India. Am J Psychiatry 153:1043–1049

  11. 11.

    Rao D, Young M, Raguram R (2007) Culture, somatization, and psychological distress: symptom presentation in South Indians patients from a public psychiatric hospital. Psychopathol 40:349–355

    Article  CAS  Google Scholar 

  12. 12.

    Kirmayer LJ, Robbins JM (1991) Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis 179:647–655

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Liedl A, O’Donnell M, Creamer M, Silove D, McFarlane A, Knaevelsrud C, Bryant RA (2010) Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms. Psychol Med 40:1215–1223

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Laban CJ, Komproe IH, Gernaat HBPE, de Jong JTVM (2008) The impact of a long asylum procedure on quality of life, disability and physical health in Iraqi asylum seekers in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 43:507–515

    PubMed  Article  Google Scholar 

  15. 15.

    Kirmayer LJ, Young A (1998) Culture and somatization. Psychosom Med 60:420–430

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Kroenke K (2003) Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Meth Psychiatr Res 12:34–43

    Article  Google Scholar 

  17. 17.

    Huygen FJA, Van den Hoogen HJM, Van de Logt A, Smits AJA (1984) Nerveus-functionele klachten in de huisartsenpraktijk. I.Een epidemiologisch onderzoek. [Psychophysiologic disorders in general practice. I. An epidemiologic study.] Nederl Tijdschrift Geneeskunde 128:1321–1327

  18. 18.

    Davar BV (1999) Mental health of Indian women: a feminist agenda. Sage, New Delhi

    Google Scholar 

  19. 19.

    Bal SS, Cochrane R (1990) Why do more Asians at primary care present psychological problems physically? Health Psychol Papers 2:59–67

    Google Scholar 

  20. 20.

    Ryder AG, Yang J, Zhu X, Yao S, Yi J, Heine SJ, Bagby RM (2008) The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? J Abnorm Psychol 117:300–313

    PubMed  Article  Google Scholar 

  21. 21.

    Gureje O, Simon GE, Ustun TB, Goldberg DP (1997) Somatization in cross-cultural perspective. Am J Psychiatry 154:989–995

    PubMed  CAS  Google Scholar 

  22. 22.

    Escobar JI, Rubio-Stipec M, Canino G, Karno M (1989) Somatic symptom index (SSI): a new and abridged somatization construct: prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis 177:140–146

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Kebede D, Alem A (1999) Major mental disorders in Addis Ababa, Ethiopia. III. Neurotic and somatoform disorders. Acta Psychiatr Scand 100:24–29

    Article  Google Scholar 

  24. 24.

    Roelofs K, Spinhoven P (2007) Trauma and medically unexplained symptoms. Towards an integration of cognitive and neuro-biological accounts. Clin Psychol 27:789–820

    Google Scholar 

  25. 25.

    Gupta MA (2013) Review of somatic symptoms in post-traumatic stress disorder. Int Rev Psychiatry 25:86–99

    PubMed  Article  Google Scholar 

  26. 26.

    Pacella ML, Hruska B, Delahanty DL (2013) The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anx Disord 27:33–46

    Article  Google Scholar 

  27. 27.

    Lie B (2002) A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr Scand 106:415–425

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Westermeyer J (1989) Somatization among refugees: an epidemiologic study. Psychosomatics 30:34–43

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Beiser M, Cargo M, Woodbury MA (1994) A comparison of psychiatric disorder in different cultures: depressive typologies in Southeast Asian refugees and resident Canadians. Int J Meth Psychiatric Res 4:157–172

  30. 30.

    Gerritsen AAM, Bramsen I, Devillé W, Van Willigen L, Hovens JE, Van der Ploeg HM (2005) Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 41:18–26

    Article  Google Scholar 

  31. 31.

    Geltman PL, Grant-Knight W, Ellis H, Landgraf JM (2008) The “Lost Boys” of Sudan: use of health services and functional outcomes of unaccompanied refugee minors resettled in the U.S. J Imm Min Health 10:389–396

    Article  Google Scholar 

  32. 32.

    Fenta H, Hyman I, Rourke SB, Moon M, Noh S (2010) Somatic symptoms in a community sample of Ethiopian immigrants in Toronto, Canada. Int J Cult Ment Health 3:1–15

    Article  Google Scholar 

  33. 33.

    Schubert CC, Punamäki R-J (2011) Mental health among torture survivors: cultural background, refugee status and gender. Nord J Psychiatry 65:175–182

    PubMed  Article  Google Scholar 

  34. 34.

    Schweitzer R, Brough M, Vromans L, Asic-Kobe M (2010) Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Aust N Z J Psychiatry 45:299–307

    Article  Google Scholar 

  35. 35.

    Bentley J, Thoburn JW, Stewart DG, Boynton LD (2011) The indirect effect of somatic complaints on report of posttraumatic psychological symptomatology among Somali refugees. J Traum Stress 24:479–482

    Article  Google Scholar 

  36. 36.

    Hollifield M, Warner TD, Krakow B, Jenkins J, Westermeyer J (2009) The range of symptoms in refugees of war. J Nerv Ment Dis 197:117–125

    PubMed  Article  Google Scholar 

  37. 37.

    Lin EH, Carter WB, Kleinman AM (1985) An exploration of somatization among Asian refugees and immigrants in primary care. Am J Publ Health 75:1080–1084

    Article  CAS  Google Scholar 

  38. 38.

    Holtz TH (1998) Refugee trauma versus torture trauma: a retrospective controlled cohort study of Tibetan refugees. J Nerv Ment Dis 186:24–34

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Crescenzi A, Ketzer E, Van Ommeren M, Phuntsok K, Komproe I, de Jong JT (2002) Effect of political imprisonment and trauma history on recent Tibetan refugees in India. J Traum Stress 15:369–375

    Article  Google Scholar 

  40. 40.

    Van Ommeren M, Sharma B, Sharma GK, Komproe I, Cardena E, de Jong JT (2002) The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression. J Trauma Stress 15:415–421

    PubMed  Article  Google Scholar 

  41. 41.

    Thijs WA, van Willigen LHM (1989) De medische opvang van asielzoekers [The medical care for asylum seekers]. Medisch Contact 44:1683–1686

    Google Scholar 

  42. 42.

    Hondius AJK, van Willigen LHM, Kleijn WC, van der Ploeg HM (2000) Health problems among Latin-American and middle-eastern refugees in The Netherlands: relations with violence exposure and ongoing sociopsychological strain. J Trauma Stress 13:619–634

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Oldsen LK (2006) Posttraumatic stress and somatization in Iraqi Shiiite refugees: Clinicians’ Judgments. Diss Abstr Int Sect B. 67:2841

    Google Scholar 

  44. 44.

    Junod Perron N, Hudelson P (2006) Somatisation: illness perspectives of asylum seeker and refugee patients from the former country of Yugoslavia. BMC Family Pract 7:10

    Article  Google Scholar 

  45. 45.

    Raghavan S, Rasmussen A, Rosenfeld B, Keller AS (2012) Correlates of symptom reduction in treatment-seeking survivors of torture. Psychol Trauma 4:1–10

    Article  Google Scholar 

  46. 46.

    de Williams AC, Peña C, Rice A (2010) Persistent pain in survivors of torture: a cohort study. J Pain Symptom Manag 40:715–722

  47. 47.

    van Wyk S, Schweitzer R, Brough M, Vromans L, Murray K (2012) A longitudinal study of mental health in refugees from Burma: the impact of therapeutic interventions. Aust N Z J Psychiatry 46:995–1003

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Hinton DE, Kredlow MA, Pich V, Bui E, Hofmann S (2013) The relationship of PTSD to key somatic complaints and cultural syndromes among Cambodian refugees attending a psychiatric clinic: the Cambodian Somatic Symptom and Syndrome Inventory (CSSI). Transcult Psychiatr 50:347–37049

  49. 49.

    Bettancourt TS, Newnham EA, Layne CM, Kim S, Steinberg AM, Ellis H, Birman D (2012) Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States. J Trauma Stress 25:682–690

  50. 50.

    Güzelcan Y, Köycü B (2002) Somatisatie in niet-Westerse culturen [Somatization in non-Western cultures]. In: Van Eekeren E, Limburg-Okken A, May R (eds) Culturen binnen psychiatrie-muren [Cultures within psychiatry]. Boom, Amsterdam, pp 317–324

    Google Scholar 

  51. 51.

    Richters A (2002) Het lijdende lichaam in een gestoorde wereld.[The suffering body in a disturbed world]. In: Van Eekeren E, Limburg-Okken A, May R (eds) Culturen binnen psychiatrie-muren [Cultures within psychiatry]. Boom, Amsterdam, pp 292–303

    Google Scholar 

  52. 52.

    Alexander F (1950) Psychosomatic medicine. Norton, New York

    Google Scholar 

  53. 53.

    Weiner H (1977) Psychobiology and human disease. Elsevier, New York

    Google Scholar 

  54. 54.

    Hinton D, Hinton S (2002) Panic disorder, somatization and the new cross-cultural psychiatry. Cult Med Psychiatr 26:155–178

    Article  Google Scholar 

  55. 55.

    Hinton DE, Howes D, Kirmayer LJ (2008) Towards a medical anthropology of sensations. Transcult Psychiatr 45:142–163

    Article  Google Scholar 

  56. 56.

    Hinton DE, Hinton SD, Loeum RJR, Pich V, Pollack MH (2008) The ‘Multiplex Model’ of somatic symptoms: application to tinnitus among traumatized Cambodian refugees. Transcult Psychiat 45:287–318

    Article  Google Scholar 

  57. 57.

    De Gucht V, Heiser W (2003) Alexithymia and somatisation: quantitative review of the literature. J Psychosom Res 54:425–434

    PubMed  Article  Google Scholar 

  58. 58.

    De Ridder D, Geenen R, Van Kuijer R, Middendorp H (2008) Psychological adjustment to chronic disease. Lancet 372:246–255

    PubMed  Article  Google Scholar 

  59. 59.

    Hermannson AC, Timka T, Thyberg M (2002) The mental health of war-wounded refugees: an 8 year follow-up. J of Nerv Ment Dis 190:374–380

  60. 60.

    Liedl A, Müller J, Morina N, Karl A, Denke C, Knaevelsrud C (2011) Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design. Pain Med 12:234–245

    PubMed  Article  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Hans G. Rohlof.

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Rohlof, H.G., Knipscheer, J.W. & Kleber, R.J. Somatization in refugees: a review. Soc Psychiatry Psychiatr Epidemiol 49, 1793–1804 (2014).

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  • Refugees
  • Migrants
  • Somatization
  • Medically unexplained physical symptoms
  • Traumatization