Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Somatization Disorder


Related Terms

  • Briquet's Disorder
  • Briquet's Syndrome
  • Hysteria

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Gastroenterologist
  • Gynecologist
  • Internal Medicine Physician
  • Neurologist
  • Pain Medicine Physician/Pain Specialist
  • Psychiatrist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on severity of the illness, presence or lack of bona fide medical conditions, the individual's willingness to seek help from mental health professionals, the presence of an associated psychiatric condition, substance abuse, or other personality disorder and type of treatment.

Medical Codes

ICD-9-CM:
300.81 - Somatization Disorder; Briquets Disorder; Severe Somatoform Disorder
306.1 - Physiological Malfunction Arising from Mental Factors, Respiratory; Psychogenic: Air Hunger, Cough, Hiccough, Hyperventilation, Yawning
306.2 - Physiological Malfunction Arising from Mental Factors, Cardiovascular; Cardiac Neurosis; Cardiovascular Neurosis; Neurocirculatory Asthenia; Psychogenic Cardiovascular Disorder

Overview

Somatization disorder falls under the classification of somatoform disorders. These disorders are characterized by physical complaints lacking a known physical (organic) basis. Somatization disorder is characterized by many somatic symptoms that cannot be explained adequately on the basis of physical and laboratory examinations. It begins early in life, affecting mostly women, and is characterized by recurrent multiple complaints involving most organ systems. The physical complaints, often dramatically described, are unexplained and typically include pain, anxiety and mood-related symptoms; gastrointestinal disturbance; and genitourinary symptoms. For a symptom to be significant, the individual may report that it caused him or her to take a medicine, alter his or her life pattern, or see a physician.

Followed long-term, individuals are shown to have an excessive number of surgeries. They develop both anxiety and depression and have a history of suicidal threats, occupational difficulties, and marital discord. This disorder is considered chronic and is associated with impairment in the individual's social and occupational functioning. Though the cause is unknown, it is thought that development of symptoms may be a way to make social contact, to avoid obligations, to express emotions, or to symbolize a feeling or belief.

Incidence and Prevalence: Somatization disorder is not uncommon. The reported prevalence of the disorder has varied, but 0.1% of the general population is estimated to be affected; when more loose diagnostic criteria are used, the prevalence climbs to 11.6% (Yates).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Somatization disorder often begins in the teenage years, and social, ethnic, and cultural factors may be involved in the development of symptoms. Ten percent to twenty percent of first-degree female relatives (mother, sisters, or daughters) are afflicted with this condition (DSM-IV-TR 488). Females are 10 times more likely than males to be afflicted with somatization disorder (Yates). The prevalence has been thought to range from 0.2% to 2% in females and to be under 0.2% in males (DSM-IV-TR 487). Somatization disorder has been reported to be more prevalent in rural areas and among the less educated.

Source: Medical Disability Advisor



Diagnosis

History: The history will reveal that symptoms have been present for several years, beginning before age 30. These individuals have demonstrated long-term, excessive medical help-seeking behavior, probably beginning in adolescence or in the late teens. Their history may reveal repeated surgical operations, drug dependence, marital separation or divorce, and suicide attempts. Their medical history can be long and complicated and involve many somatic complaints. Family history is important, as somatization disorder is found in about 10% to 20% of first-degree female relatives (DSM-IV-TR 488) of those who have the disorder. First-degree male relatives of individuals with somatization disorder show an increased prevalence of both antisocial personality disorder and alcoholism. About 50% of individuals with somatization disorder have a coexisting mental disorder.

The specific criteria for diagnosis of this disorder are given in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). They include a past medical history of many physical complaints starting before age 30 that happen over the course of several years and cause treatment to be sought or severe problems in social, occupational, or other significant areas of function. During the course of the disorder, the individual must have complained of at least four pain symptoms (a history of pain related to at least four different areas of the body or functions, such as pain in the head, abdomen, back, joints, extremities, chest, or rectum or pain during menstruation, sexual intercourse, or urination); at least two gastrointestinal symptoms other than pain (nausea, bloating, emesis other than during pregnancy, diarrhea, or intolerance of many types of food); at least one sexual symptom other than pain (sexual indifference, impotence or premature ejaculation [erectile or ejaculatory dysfunction]), irregular periods (menses), excessive menstrual bleeding (menometrorrhagia), or vomiting throughout pregnancy (hyperemesis gravidum); and at least one unexplained neurological (pseudoneurological) symptom other than pain (at least one symptom or deficit suggesting a neurological condition, with conversion symptoms such as lack of coordination or balance, paralysis or localized weakness, difficulty swallowing (dysphagia) or lump in throat, inability to speak (aphonia), inability to urinate (urinary retention), seeing visions or hearing voices that aren't there (hallucinations), loss of touch or pain sensation, double vision (diplopia), blindness, deafness, seizures; suddenly forgetting one's identity or whereabouts or feeling unreal (dissociative symptoms), or loss of consciousness other than fainting. None of these symptoms will be completely explained by physical or laboratory examinations.

Additionally, according to the DSM-IV-TR, after through investigation, all the symptoms cannot be attributed to a diagnosed general medical condition or the direct effects of a substance (such as the side effects of medication, drugs, or alcohol), or in cases where there is an associated general medical condition, the physical symptoms or social or occupational dysfunction is greater than what would be expected from the history, physical examination, or laboratory results. Finally, it is determined that the symptoms are not intentionally faked (as in factitious disorder or malingering).

Physical exam: Physical examination is an important part of the diagnosis of somatization disorder. The individual's symptoms, which involve multiple organ systems, require the clinicians to rule out nonpsychiatric (organic) conditions. Close attention should be focused on particular areas of complaints. For example, if one of the complaints is perceived menstrual irregularities (dysmenorrhea), then a pelvic exam would be indicated.

Tests: Tests should include psychological testing and psychiatric evaluation. The Whiteley 7-Scale and Illness Convection Subscale is a psychological test helpful in detecting somatoform disorders. The Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) is another psychological test that helps to confirm the diagnosis of somatoform disorder. Exhaustive medical workups are often done to rule out organic causes of the individual's symptoms. Patients may also need thyroid function tests, pheochromocytoma screen, urine drug screen, and blood alcohol level to rule out other medical problems. Imaging studies are needed to rule out medical problems.

Source: Medical Disability Advisor



Treatment

Individuals benefit from regular psychotherapy (individual and/or group therapy by a mental health worker or psychiatrist). The goal is to have individuals learn to cope with their symptoms. This may be done by having them identify ways to express their emotions other than by somatic complaints. Supportive primary care physicians may help these individuals by reassuring them that their complaints are being understood. However, individuals with somatization disorder tend to be resistant to psychological explanations of their problems, and thus may be resistant to psychological interventions.

The effectiveness of drug treatment alone in somatization disorder is unknown. However, coexisting mental disorders should be treated with drugs, if indicated. Monitoring medication(s) is essential with these individuals, as they are often erratic and unreliable with treatment.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Stress-related Conditions
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

This disorder is chronic and oftentimes debilitating. These individuals continue to seek medical attention for their symptoms, usually at least every year, and tend to have frequent hospitalizations. If they become involved in psychotherapy, their medical help-seeking behaviors and number of hospitalizations can decrease by as much as 50%. However, they tend to resist the idea that their symptoms are rooted in psychological conflicts rather than physical disorders.

Source: Medical Disability Advisor



Complications

Some of the most frequent and important complications of this disorder are repeated surgical operations, drug dependence, marital separation or divorce, and suicide attempts.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Time-limited restrictions and work accommodations are necessary only infrequently, for the most serious cases. In these instances, time-limited restrictions and work accommodations should be individually determined, based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote a timely and safe transition back to full work productivity.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual's behavior meet the criteria for somatization disorder?
  • Has diagnosis been confirmed?
  • Has an appropriate investigation been made for each physical complaint to rule out an underlying medical condition or to justify the symptoms?

Regarding treatment:

  • What medication is individual currently taking and for what condition(s)?
  • Is there any overlap of medications?
  • Is there any indication of medication overuse or abuse?
  • Is the physician aware of all medications that the individual is currently receiving from all participating healthcare providers?
  • Does individual have a therapeutic rapport with the physician? What can be done to facilitate this relationship?
  • Is individual participating in psychotherapy?
  • Does current therapy help the individual cope with symptoms and learn to express emotions in ways other than somatic complaints?

Regarding prognosis:

  • Because somatization is chronic and often debilitating, is the physician supportive and reassuring?
  • Does individual trust primary physician, or is individual constantly seeking assistance from other health care providers?
  • Is individual involved in a solo or group therapy program?
  • Has therapy helped individual decrease medical help-seeking behaviors?

Source: Medical Disability Advisor



References

Cited

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Yates, William R. "Somatoform Disorders." eMedicine. Eds. Mohammed Memon, et al. 1 Oct. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/med/topic3527.htm>.

Source: Medical Disability Advisor






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