Psychological Medicine

Original Articles

Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics

Laurence J. Kirmayera1 c1 and James M. Robbinsa1

a1 Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis – Jewish General Hospital and Division of Social and Transcultural Psychiatry, McGill University, Montreal, Québec, Canada; and Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Arkansas, USA


We examined the cognitive and sociodemographic characteristics of patients making somatic presentations of depression and anxiety in primary care. Only 15% of patients with depressive symptomatology on self-report, and only 21 % of patients with current major depression or anxiety disorders on diagnostic interview, presented psychosocial symptoms to their GP. The remainder of patients with psychiatric distress presented exclusively somatic symptoms and were divided into three groups - initial, facultative and true somatizers - based on their willingness to offer or endorse a psychosocial cause for their symptoms. Somatizers did not differ markedly from psychologizers in sociodemographic characteristics except for a greater proportion of men among the true somatizers. Compared to psychologizers, somatizers reported lower levels of psychological distress, less introspectiveness and less worry about having an emotional problem. Somatizers were also less likely to attribute common somatic symptoms to psychological causes and more likely to endorse normalizing causes. In the 12 months following their initial visit, somatizers made less use of speciality mental health care and were less likely to present emotional problems to their GP. Somatizers were markedly less likely to talk about personal problems to their GP and reported themselves less likely to seek help for anxiety or sadness. Somatization represents a persistent pattern of illness behaviour in which mental health care is not sought despite easily elicited evidence of emotional distress. Somatization is not, however, associated with higher levels of medical health care utilization than that found among patients with frank depression or anxiety.


c1 Address for correspondence: Dr Laurence J. Kirmayer Institute of Community and Family Psychiatry 4333 Chemin de la Cote Ste. Catherine Montréal Québec H3T 1E4 Canada.

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