Somatization, Somatic Symptoms, and Somatic Disorders. And Variayr.
Somatization is a fairly simple concept. It refers to any type of physical manifestation of symptoms originating from a mental health condition. Notably, somatization is not neurological, and the conflation of these two things comes from somatization originally being considered part of conversion disorder (which was later split into somatoform and functional neurological disorders). The difference between these two presentations is very important. FND is diagnosed by a neurologist, SSD is diagnosed by a psychiatrist, as it is a mental disorder.
Secondary somatization, or what Iâll just call somatic symptoms, are physical symptoms caused by non-somatic disorders. Examples of somatic symptoms include GI involvement in severe anxiety disorders or soreness and numbness in depression. Most often, somatic symptoms related to non-somatic disorders tend to have similar presentations across different patients. Feeling stomach or chest pain are incredibly common manifestations in people with anxiety, and even occur in people without anxiety disorders when they experience anxiety. This symptom is very well-established in its link to anxiety as a condition, so there isnât much discourse for it to be considered anything more than a somatic symptom of anxiety. In a disorder where somatization has been less studied, like dysphoria, it can be harder to identify a more âuniversalâ set of somatic symptoms that someone might develop, but physical symptoms related to dysphoria, such as psychogenic pain of the sex characteristics, would be in this category of somatization.
Somatic disorders, however, are primary somatization. This is somatization as the first a foremost symptom (although Iâm going to touch on some cases where it isnât exactly). Somatic disorders are a type of structural dissociative disorder, which means that, unlike other conditions with somatic symptoms, somatic disorders are inherently trauma-related. Dr. Onno van der Hart, known for his work on CDDs, also outlined that simple somatoform disorders (the preceding diagnosis of SSD) are a type of primary structural dissociation, one ANP and one EP, although more complex cases could exist. He posited that the existence of somatic symptoms could be a greater indicator of PTSD and complex dissociative disorders than many of our current tests at the time, and he highly favored the somatoform dissociation questionnaire (created by Dr. Nijenhuis, who also writes quite a bit on this topic). Manifestations of somatic symptoms in people with SDDs or a dissociative disorder that subsumes SDD (which is to say, much like how someone with DID is not also diagnosed with DPDR, an SDD diagnosis is generally considered unnecessary), these symptoms are highly individual. Patients with these disorders experience an extremely wide array of physical symptoms that are, most often, manifestations of physical trauma their body has endured (such as an SA survivor feeling pain in their genitalia), or are metaphorically representative of it (a DID alter that doesnât see because it intends to protect itself by not witnessing the trauma). These types of disorders are, although ranging in complexity, nearly always going to be more complex than the cookie cutter standard somatic symptoms of well-established conditions. Treating somatic disorders generally requires trauma integrative therapies or EMDR, whereas somatic symptoms in other conditions can be more easily treated with generalized programs like eight week CBT.
All of this to get to the thing that inspired this post, the âvariayrâ thing going around. Even if you truly had a somatic disorder which resulted in hormonal changes (which, yes, actually has been studied, although only one study on a patient with DID, so not exactly universally compelling evidence), it would not result in a âneurological sex difference,â because that is not what the term neurological means, and it isnât how the somatization of simpler disorders like dysphoria works. And if it did? Why on earth would a spontaneous hormonal change not just be fucking intersex
