Aetiology

Relatively specific predisposing factors are physical or sexual abuse and parental complaints of poor physical health and medically unexplained symptoms during childhood, but neither parental nor childhood well-defined physical illnesses. (2,27)

The reported family transmission in somatization disorder may be due to sociocultural learning. However, there is some support for genetic transmission in somatization disorder, although twin studies have been inconclusive.(28)

Different unspecific predisposing factors common for different mental disorders are also of importance. (29) Psychological theories

In the classical psychodynamic drive theory, medically unexplained physical symptoms are believed to develop as a reaction to the repression of unacceptable wishes or instinctual impulses and internal psychic conflicts.(30)

According to the theory of self-psychology, the anxiety connected with a threatening defragmentation or disintegration of the self is the most profound form of anxiety that a person can experience/30' In a defence against the feeling of emptiness the individual becomes directed on the outside world and on physical stimuli. This process has been called 'stimulus entrapment', i.e. in somatization disorder the individual becomes addicted to stimuli to his or her body. (31,)

Individuals with alexithymia have a poorly developed language of emotions, and it has been suggested that instead they might respond with bodily symptoms. It is, however, unlikely that alexithymia has a specific aetiological role in somatization disorder.

The cognitive theory endorses the importance of the patients' misinterpretation of benign symptoms and normal physical sensations that they erroneously attribute to a physical disease.(32)

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