Sensitization, somatization, and subjective health complaints

  • H. Ursin
Review Article


More than half of the days lost due to sickness absence are due to diagnostic groups that solely or mainly depend on subjective statements from the patient. The most frequent subjective health complaints are musculoskeletal pain. These conditions do not seem to qualify as psychiatric or mental disorders, but are not strictly somatic states either. Terms like somatization may be inadequate terms for states that may be best understood as psychobiological feedback loops. Subjective health complaints is suggested as a neutral, descriptive term. Only a minority requires treatment and sickness compensation for prolonged periods for these very common states. In these patients the neurons in feed-forward and positive feed-back loops may have developed sensitization. These patients tend to show an abnormal sensitivity to sensory input from muscles, the gastrointestinal tract, and to smell and taste. It seems to be futile to search for single-factor solutions. This approach opens up for the possible effectiveness of many different types of treatment, breaking the feedback loops.

Key words

sensitization somatization subjective health muscle pain multiple chemical sensitivity psychosomati 


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  2. Antelman, S. M. (1988). Time-dependent sensitization as the comerstone for a new approach to pharmacotherapy: Drags as foreign/stressful stimuli. Drug Development Research, 14, 1–30.CrossRefGoogle Scholar
  3. Bell, I. R., Miller, C. S., & Schwartz, G. E. (1992). An olfactory-limbic model of multiple chemical sensitivity syndrome: Possible relationships to kindling and affective spectrum disorders. Biological Psychiatry, 32, 218–242.PubMedCrossRefGoogle Scholar
  4. Bell, I. R., Markley, E. J., King, D. S., Asher, S., Marby, D., Kayne, H., Greenwald, M., Ogar, D. A., & Margen, S. (1993) Poly symptomatic syndromes and autonomic reactivity to nonfood stressors in individuals with self-reported adverse food reactions. Journal of the American College of Nutrition, 12, 227–238.PubMedGoogle Scholar
  5. Bell, I. R. (1994). White paper: Neuropsychiatric aspects of sensitivity to low-level chemicals: A neural sensitization model. Toxicology and Industrial Health, 10, 277–312.PubMedGoogle Scholar
  6. Bell, I. R., Peterson, J. M., & Schwartz, G. E. (1995). Medical histories and psychological profiles of middle-aged women with and without self-reported illness from environmental chemicals. Journal of Clinical Psychiatry, 56, 151–160.PubMedGoogle Scholar
  7. Bliss, T. V. P., & Lamo, T. (1973). Long-lasting potentiation of synaptic transmission in the dentate area of the anesthetized rabbit following stimulation of the perforant path. Journal of Physiology, 232, 331–56.PubMedGoogle Scholar
  8. Chatel, J. C., & Peele, R. (1970). The concept of neurasthenia. International Journal of Psychiatry, 9, 36–49.PubMedGoogle Scholar
  9. Chodoff, P. (1974), The diagnosis of hysteria: A review. American Journal of Psychiatry, 131, 1073–1078.PubMedGoogle Scholar
  10. Dongier, M. (1983). Briquet and Briquet’s syndrome viewed from France. Canadian Journal of Psychiatry, 28, 422–427.Google Scholar
  11. Dubner, R., & Ruda, M. A. (1992). Activity dependent neuronal plasticity following tissue injury and inflammation. Trends in Neurosciences, 15, 96–103.PubMedCrossRefGoogle Scholar
  12. el Islam, M. F. (1994). Cultural aspects of morbid fears in Qatari women. Social Psychiatry Psychiatric Epidemiology, 29, 137–40.Google Scholar
  13. Elks, M. L. (1994). On the genesis of somatization disorder: The role of the medical profession. Medical Hypotheses, 43, 151–4.PubMedCrossRefGoogle Scholar
  14. Eriksen, H. R., Svendsrød, R., Ursin, G., & Ursin, H. (in press). Prevalence of subjective health complaints in the Nordic European countries in 1993. European Journal of Public Health.Google Scholar
  15. Gardner, R. M., Morell, J. A., Jr., & Ostrowski, T. A. (1990). Somatization tendencies and ability to detect internal body cues. Perceptual and Motor Skills, 71, 364–366.PubMedGoogle Scholar
  16. Goddard, G. V. (1987). Development of epileptic seizures through brain stimulation of low intensity. Nature, 214, 1020.CrossRefGoogle Scholar
  17. Golding, J. M., Smith, G. R., & Kashner, T. M. (1991), Does somatization disorder occur in men? Clinical characteristics of women and men with multiple unexplained somatic symptoms. Archives of General Psychiatry, 48, 231–235.PubMedGoogle Scholar
  18. Guze, S. B. (1975). The validity and significance of the clinical diagnosis of hysteria (Briquet’s syndrome). American Journal of Psychiatry, 132, 138–141.PubMedGoogle Scholar
  19. Haug, T. T., Svebak, S., Hausken, T., Wilhelmsen, I., Berstad, A., & Ursin, H. (1994). Low vagal activity as mediating mechanism for the relationship between personality factors and gastric symptoms in functional dyspepsia. Psychosomatic Medicine, 56, 181–186.PubMedGoogle Scholar
  20. International Classification of Diseases. (1994). Clinical modification (9th rev., ICD-9-CM). Washington, DC: U.S. Department of Health and Human Services.Google Scholar
  21. Jellestad, F. K., Follesø G. S., & Ursin, H. (1991). The neurobiological foundation of exploration. In H. Keller, K. Schneider, & B. Henderson (Eds.), Curiosity and exploration (pp. 43–63). Berlin: Springer.Google Scholar
  22. Leden, I., Eriksson, A., Lilja, B., Sturfelt, G., & Sundkvist, G. (1983). Autonomic nerve function in rheumatoid arthritis of varying severity. Scandinavian Journal of Rheumatology, 12, 166–170.PubMedCrossRefGoogle Scholar
  23. Lembo, T., Munakata, J., Mertz, H., Niazi, N., Kodner, A., Nikas, V., & Mayer, E. A. (1994). Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. Gastroenterology, 107, 1686–1696.PubMedGoogle Scholar
  24. Levine, J. D., Taiwo, Y. O., Collins, S. D., & Tarn, J. K. (1986). Noradrenaline hyperalgesia is mediated through interaction with sympathetic postganglionic neurone terminals rather than activation of primary afferent nociceptors, Nature (London), 323, 158–160.CrossRefGoogle Scholar
  25. Mearin, F., de-Ribot, X., Balboa, A., Salas, A., Varas, M. J., Cucala, M., Bartholome, R., Armengol, J. R., & Malagelada, J. R. (1995). Does helicobacter pylori infection increase gastric sensitivity in functional dyspepsia? Gut, 37, 47–51.PubMedCrossRefGoogle Scholar
  26. Nakamura-Craig, M., & Smith, T. W. (1989). Substance P and peripheral inflammatory hyperalgesia. Pain, 38, 91–98.CrossRefGoogle Scholar
  27. Nivison, M. E., & Endresen, I. M. (1993). An analysis of relationships among environmental noise, annoyance and sensitivity to noise, and the consequences for health and sleep. Journal of Behavioral Medicine, 16, 257–276.PubMedCrossRefGoogle Scholar
  28. Pribor, E. F., Yutzy, S. H., Dean, J. T., & Wetzel, R. D. (1993). Briquet’s syndrome, dissociation, and abuse. American Journal of Psychiatry, 150, 1507–1511.PubMedGoogle Scholar
  29. Raja, S., Meyer, J. N., & Meyer, R. A. (1988). Peripheral mechanisms of somatic pain. Anaesthesiology, 68, 571–590.CrossRefGoogle Scholar
  30. Schulkin, J., McEwen, B. S., & Gold, P. W. (1994). Allostasis, amygdala, and anticipatory angst. Neuroscience and Biobehavioral Reviews, 18, 385–396.PubMedCrossRefGoogle Scholar
  31. Statistics Norway, (1993). Working environment 1993 (NOS C 228). Oslo: Author.Google Scholar
  32. Sulloway, F. J. (1983), Freud, biologist of the mind: Beyond the psychoanalytic legend. New York: Basic Books.Google Scholar
  33. Tellnes, G., Svendsen, K. O. B., Bruusgaard, D., & Bjerkedal, T. (1989). incidence of sickness certification. Scandinavian Journal of Primary Health Care, 7, 111–118.PubMedCrossRefGoogle Scholar
  34. Thompson, R. F., & Spencer, W. A. (1966). Habituation: A model phenomenon forthe study of neuronal substrates of behavior. Psychological Review, 73, 16–43.PubMedCrossRefGoogle Scholar
  35. Ursin, H., Endresen, I. M., & Ursin, G. (1988). Psychological factors and self-reports of muscle pain. European Journal of Applied Physiology, 57, 282–290.CrossRefGoogle Scholar
  36. Ursin, H., Endresen, I. M., Håland, E., & Mjellem, N. (1993a). Sensitization: Aneurobiologicat theory for muscle pain. In H. Værøy & H. Merskey (Eds.), Progress in fibromyalgia and myofascial pain (pp. 411–25). Amsterdam: Elsevier.Google Scholar
  37. Ursin, H., Endresen, I. M., Svebak, S., Tellnes, G., & Mykletun, R. (1993b). Muscle pain and coping with working life in Norway: A review. Work and Stress, 7, 247–258.CrossRefGoogle Scholar
  38. Værøy, H., Helle, R., Førre, Ø., Kiss, E., & Terenius, L. (1988). Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: New features for diagnosis. Pain, 32, 21–26.PubMedCrossRefGoogle Scholar
  39. Wessely, S. (1990). “Old wine in new bottles”: Neurasthenia and “M. E.” Psychological Medicine, 20, 35–53.PubMedCrossRefGoogle Scholar
  40. Wolf, C. J., & Thompson, W. N. (1991). The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain, 44, 293–299.CrossRefGoogle Scholar
  41. Woolf, C. J. (1989). Recent advances in the pathophysiology of acute pain. British Journal Anaesthesia, 63, 139–146.CrossRefGoogle Scholar
  42. Yehuda, R., Boisoneau, D., Lowy, M. T., & Giller, E. L. (1996). Dose-response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder. Archives of General Psychiatry, 52, 583–593.Google Scholar

Copyright information

© International Society of Behavioral Medicine 1997

Authors and Affiliations

  • H. Ursin
    • 1
  1. 1.Department of Biological and Medical PsychologyUniversity of BergenBergenNorway

Personalised recommendations