The onset of multiple physical symptoms after the age of 40, in a previously physically and mentally healthy individual, is almost always due to a general medical condition. However, multiple vague physical complaints may be prominent in mood disorders, dementia, and withdrawal states.
Only a limited number of general medical conditions present vague, non-specific, and multiple somatic symptoms (e.g. hyperparathyroidism, hyperthyroidism, acute intermittent porphyria, myasthenia gravis, AIDS, multiple sclerosis, systemic lupus erythematosus, Lyme disease, and connective tissues disease). In most of these medical conditions there will be positive paraclinical findings.
In genuine somatic disorders the key symptoms will usually be characteristic from one patient to another and across illness episodes. In contrast, the constellation of symptoms in somatization disorder will usually be incompatible with any known authentic somatic disease, and the symptom picture will be of a more fluctuating nature.
The fear of overlooking a definite physical disease, as an explanation of the physical symptoms, is probably the major reason why many doctors attempt to rule out even the most rare physical causes before a somatization disorder is even considered. However, there is little evidence that important medical diagnoses are missed in patients with somatoform disorders/1,.,23 It must always be borne in mind that patients with a somatoform disorder may also have a concurrent physical disease.
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