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Somatization Increases Disability Independent of Comorbidity

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Abstract

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.

Objectives

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.

Design

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

Participants

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

Measurements

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.

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Acknowledgements

We wish to acknowledge the invaluable assistance of Deborah Williams, MHA, and Julie Fiskio, BA, and of Lindsay B. Renner, BA, Jessica Payne-Murphy, BA, Kathryn A. Griffiths, MA, and Susan L. Rose.

This study was supported by a research grant from the Aetna Quality Care Research Fund.

Conflict of interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115–6106, USA

    Ashley M. Harris MD

  2. Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115–6106, USA

    E. John Orav PhD

  3. Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115–6106, USA

    David W. Bates MD, MSc.

  4. Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115–6106, USA

    Arthur J. Barsky MD

  5. Department of Health Care Policy, Harvard School of Public Health, 75 Francis Street, Boston, MA, 02115–6106, USA

    David W. Bates MD, MSc.

Authors
  1. Ashley M. Harris MD
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  2. E. John Orav PhD
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  3. David W. Bates MD, MSc.
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  4. Arthur J. Barsky MD
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Corresponding author

Correspondence to Ashley M. Harris MD.

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Harris, A.M., Orav, E.J., Bates, D.W. et al. Somatization Increases Disability Independent of Comorbidity. J GEN INTERN MED 24, 155–161 (2009). https://doi.org/10.1007/s11606-008-0845-0

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  • DOI: https://doi.org/10.1007/s11606-008-0845-0

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