What is Somatization?

Night in Saint-Cloud, Painting by Edvard Munch, 1890

Somatization is a psychological process where emotional distress, unconscious conflict, relational tension, or other difficulties are experienced and expressed through physical symptoms. These symptoms are real and often distressing, yet they cannot be fully explained by medical findings alone. From a psychodynamic perspective, somatization reflects the mind’s attempt to manage overwhelming affect when emotional awareness or expression feels unsafe or unavailable. The body becomes the primary language through which distress is communicated, especially when verbal or relational avenues have been limited earlier in life.

Within George Vaillant’s hierarchy of defences, somatization is generally understood as an immature or neurotic defence, depending on its rigidity and impact on functioning. Vaillant conceptualized somatization as a way of discharging psychological tension through bodily channels rather than through conscious reflection or affective processing. Somatization operates outside awareness and acts as a protective function by keeping threatening emotions, such as anger, grief, shame, or fear, out of conscious experience, unlike conscious fabrication or exaggeration. In this sense, the defence is adaptive in the short term, even if it becomes entrenched over time.

The Moorish Chief, Painting by Eduard Charlemont, 1878

Developmentally, somatization can be associated with early environments in which emotional expression was discouraged, banned, misunderstood, or responded to inconsistently. When a child’s emotional states are not adequately named or tolerated by caregivers, the body may become a safer and more reliable medium for signalling distress. Over time, this pattern can turn into a coping mechanism in adulthood, particularly under stress, relational conflict, perceived loss of control, or other difficulties. Cultural factors may also shape somatization, especially in contexts where psychological suffering carries stigma but physical illness is more socially acceptable.

Clinically, individuals who rely on somatization may present with recurrent pain, gastrointestinal symptoms, fatigue, or cardiopulmonary complaints, which usually come with frequent medical consultations and persistent anxiety about health. Psychodynamically, these symptoms can be understood as symbolic expressions of unmentalized affect or conflict, rather than signs of intentional avoidance or resistance. Vaillant emphasized that defences should be understood with empathy, as they represent the best available psychological solution at a given stage of development.

In psychodynamic psychotherapy, work with somatization focuses on gradually bringing emotional awareness, affect tolerance, maturity, and symbolic thinking, rather than directly challenging the symptoms themselves. The therapeutic relationship provides a setting where bodily experiences can be linked to emotional states and relational patterns over time. As patients develop greater capacity to recognize, name, understand, and reflect on these, the reliance on somatic expression can usually go away gradually.