Which is possible with somatization? Select all that apply.

Somatization is a psychological phenomenon where emotional distress is manifested as physical symptoms. In somatic symptom disorder, the client’s suffering is authentic, even if a clear organic or physiological cause cannot be identified through diagnostic testing. The focus is on the client's maladaptive response to the symptoms rather than the presence of an underlying medical diagnosis. Rationale: A. Clients cannot consciously control these symptoms. Unlike factitious disorder or malingering, where symptoms are intentionally produced for secondary gain, somatization is involuntary. The client genuinely perceives the pain or dysfunction and is not faking the illness. B. Real, existing medical symptoms can worsen due to psychological factors. For example, a client with known chronic back pain may experience a significant increase in pain intensity during periods of high stress or anxiety, even if the structural integrity of the spine has not changed. C. Real physical symptoms can begin as a direct result of psychological distress. The autonomic nervous system can trigger physical responses, such as tension headaches, palpitations, or gastrointestinal upset, in response to internalized emotional conflict. D. Unrelated symptoms can occur simultaneously, often involving multiple organ systems. A client may report a combination of neurological symptoms (like dizziness), gastrointestinal issues (like nausea), and musculoskeletal pain (like joint aches) that do not follow a single pathophysiological pattern. E. Real symptoms can continue long after an acute physical injury has healed. The brain may continue to process pain signals or maintain a state of physical dysfunction because the underlying psychological trigger remains unresolved, leading to chronic illness behavior.