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Yıl:2013; Cilt: 3; Sayı: 1>> Özet
Psikiyatride Güncel; 2013;3(1):1-16
Somatizasyon ve somatoform bozukluklar: Uygulamaya yansıyan anlam karmașası
İ Kırpınar
Bezmiâlem Vakıf Üniversitesi, İstanbul.
Somatizasyon, tıbbi olarak açıklanamayan belirtilerin varlığını tanımlayan ve bu belirtilerin psikolojik unsurları olduğunu ima eden genel bir terimdir. Klinik ortamlarda iki anlamda kullanılır: ruhsal sorunların fiziksel belirtilerle ifadesi ve organik bir hastalığa bağlı olma-yan çok sayıda bedensel belirtiler için tekrarlayan tıbbi çare arama. Psikodinamik kuramda somatizasyon, bastırılmış emosyonların bilinçdışı olarak bedensel belirtilere yönlendirilmesi şeklinde bir ego savunması olarak kavramsallaştırılmıştır. Ancak güncel kanıtlar, bu kavramın birbiriyle etkileşen psikolojik, sosyal ve biyolojik çok etmenli bir etyolojiyle ilişkili olduğunu desteklemektedir. Bilinen herhangi bir organik hastalığa bağlanamayan bedensel belirtilere; tıbbi olarak açıklanamayan somatik (fiziksel) belirtiler, fonksiyonel somatik (fiziksel) sendromlar (FFS), idiyopatik semptomlar veya somatoform belirtiler gibi çeşitli isimler verilmiştir. Bedenselleştiren hastalar homojen bir grubu temsil etmezler. Süregen somatizasyon, somatoform bozukluklar başta olmak üzere çok sayıda psikiyatrik bozuklukla birlikte görülürler. Somatoform bozukluklar DSM-III’ün tanıttığı kurgusal bir kategoridir. Genel bir tıbbi durumla açıklanamayan bedensel belirtileri nedeniyle daha önceleri ihmal edilen hastalara dikkati çekmeyi başarmasına karşılık; sınıflandırma ve değerlendirme ile ilgili sürüp giden kuramsal ve pratik sorular nedeniyle somatoform bozuklukların nozolojik durumu tartışmalıdır. Tedavi girişimleri; belirtilerin ve varsa eşlik eden bozuklukların tedavisi ve hastanın işlevsel durumunu düzeltmekle gereksiz tıbbi değerlendirmeleri en aza indirmek üzere tedavi edici bir işbirliğini kurmayı amaçlayan genel bir yaklaşımı içerir. Hekim, hastanın “bedensel” dilini anlamaya çalışmalıdır. Çok sayıda randomize kontrollü çalışma, uzmanlar veya uzmanlaşmış kliniklerce yapılan bilişsel-davranışçı terapilerin fonksiyonel somatik belirtilerde ve somatoform bozukluklarda etkili olduğunu kanıtlamaktadır.
Somatization and somatoform disorders: ambiguity reflected to practise
Somatization is a general term that describes the presence of medically unexplained symptoms and implies a psychological component to the symptoms. It is used in clinical settings for two meanings: the expression of psychological problems through physical symptoms, and repeated medical help-seeking for multiple somatic symptoms without organic disease. In psychodynamic theory, somatization is conceptualized as an ego defense, the unconscious rechannelling of repressed emotions into somatic symptoms. But current evidences suggest that this concept is related to multifactorial etiology with interacting psychological, social, and biological factors. Somatic symptoms not attributable to any known organic disease have been given various names such as medically unexplained somatic (physical) symptoms, functional somatic (or physical) syndromes, idiopathic symptoms, and somatoform symptoms. Somatizing patients do not represent a homogeneous group. Persistent somatization is associated with a large number of psychiatric disorders, especially somatoform disorders. DSM-III introduced the somatoform disorders as a speculative diagnostic category. Although it has succeeded in focusing attention onto previously neglected patients with somatic symptoms that are unexplained by a general medical condition, the nosologic status of somatoform disorders is controversial by persistent theoretical and practical questions of classification and assessment. Therapeutic interventions consist of treating symptoms and comorbid disorders when present and instituting a general approach to the patient aimed at maintaining the therapeutic alliance, improving the patient’s functional status, and minimizing unnecessary medical tests. The doctor must attempt to understand the patient’s “somatic” language. Several randomized controlled trials have proven cognitive behavioural therapy performed by specialists or in specialized settings are effective in the management of functional somatic syndromes and somatoform disorders.

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