sAn Integrative Model of Somatization

Physiological, psychological, interpersonal and sociocultural processes all contribute to vicious cycles of
symptom amplification that can result in disabling medically unexplained somatic symptoms. Only a few
of these potential cycles are depicted:

(A) illness worry and catastrophizing thoughts result in increased emotional arousal and anxiety which in
turn give rise to somatic symptoms associated with autonomic arousal and hyperventilation;

(B) avoidance of activity and sick role behavior lead to physical deconditioning, sleep disturbance and
other forms of physiological dysregulation;

(C & D) cultural interpretations of symptoms and sick role behavior reinforce pathologizing attributions
for new sensations as well as distress and disablement; (E) sick role behavior may lead to interpersonal
conflict which, in turn, increases emotional arousal, leading to more somatic symptoms. Each of these
processes may be targeted by specific clinical interventions aimed at interrupting the vicious cycles.