Somatic Symptom Disorder
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A somatic symptom disorder, formerly known as a somatoform disorder,(2013) Somatic Symptom Disorder Fact Sheet
"
dsm5.org. Retrieved April 8, 2014.
is any
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
that manifests as physical symptoms that suggest
illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...
or injury, but cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder (e.g.,
panic disorder Panic disorder is a mental disorder, mental and Abnormal behavior, behavioral disease#Disorder, disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear th ...
). Somatic symptom disorders, as a group, are included in a number of diagnostic schemes of mental illness, including the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
''. (Before
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
this disorder was split into ''
somatization disorder Somatization disorder is a mental disorder, mental and Abnormal behavior, behavioral disease#Disorder, disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic nervous system, somatic symptoms. It ...
'' and ''undifferentiated somatoform disorder''.) In people who have been diagnosed with a somatic symptom disorder,
medical test A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic te ...
results are either normal or do not explain the person's symptoms (
medically unexplained physical symptoms Medically unexplained physical symptoms (MUPS or MUS) are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the ca ...
), and history and physical examination do not indicate the presence of a known medical condition that could cause them, though the DSM-5 cautions that this alone is not sufficient for diagnosis. The patient must also be excessively worried about their symptoms, and this worry must be judged to be out of proportion to the severity of the physical complaints themselves. A diagnosis of somatic symptom disorder requires that the subject have recurring somatic complaints for at least six months. Symptoms are sometimes similar to those of other illnesses and may last for years. Usually, the symptoms begin appearing during adolescence, and patients are diagnosed before the age of 30 years. Symptoms may occur across cultures and gender. Other common symptoms include anxiety and depression. However, since anxiety and depression are also very common in persons with confirmed medical illnesses, it remains unproven whether such symptoms are a consequence of the physical impairment or a cause. Somatic symptom disorders are not the result of conscious
malingering Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work. Malingering is not a medical diagnosis, but may be recorded as a "focus of c ...
(fabricating or exaggerating symptoms for secondary motives) or
factitious disorder A factitious disorder is a condition in which a person, ''without'' a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient' ...
s (deliberately producing, feigning, or exaggerating symptoms). Somatic symptom disorder is difficult to diagnose and treat. Some advocates of the diagnosis believe this is because proper diagnosis and treatment requires psychiatrists to work with neurologists on patients with this disorder.


History

Somitisation disorder was first described by
Paul Briquet Paul Briquet or Pierre Briquet (12 January 1796 – 25 January 1881) was a French physician and psychologist who advanced the reasoned treatment of disturbed people said to be hysteria, hysterics. Briquet became a medical doctor in 1824, a profess ...
in 1859 and was subsequently known as Briquet's syndrome. He described patients who had been sickly most of their lives and complained of multiple symptoms from different organ systems. Symptoms persist despite multiple consultations, hospitalisations and investigations.


Definition

Somatic symptom disorders are a group of disorders, all of which fit the definition of physical symptoms similar to those observed in physical disease or injury for which there is no identifiable physical cause. As such, they are a
diagnosis of exclusion A diagnosis of exclusion or by exclusion (''per exclusionem'') is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or ...
. Somatic symptoms may be generalized in four major medical categories: neurological, cardiac, pain, and gastrointestinal somatic symptoms.


''Diagnostic and Statistical Manual of Mental Disorders''

Somatic symptom disorders used to be recognized as Somatoform disorders in the ''Diagnostic and Statistical Manual of Mental Disorders'' of the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
. The following were conditions under the term Somatoform Disorders: *
Conversion disorder Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness ...
: A somatic symptom disorder involving the actual loss of bodily function such as blindness, paralysis, and numbness due to excessive anxiety *
Somatization disorder Somatization disorder is a mental disorder, mental and Abnormal behavior, behavioral disease#Disorder, disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic nervous system, somatic symptoms. It ...
*
Hypochondriasis Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
*
Body dysmorphic disorder Body dysmorphic disorder (BDD), occasionally still called dysmorphophobia, is a mental disorder characterized by the obsessive idea that some aspect of one's own body part or appearance is severely flawed and therefore warrants exceptional meas ...
: wherein the individual is concerned with body image, and the disorder is manifested as excessive concern about and preoccupation with a perceived defect of their physical appearance. *
Pain disorder Pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few d ...
* Undifferentiated somatic symptom disorder – only one unexplained symptom is required for at least six months. In the newest version of DSM-5 (2013) somatic symptom disorders are recognized under the term ''somatic symptom and related disorders'': * Somatic symptom disorder: To replace many of what was formerly known as somatization disorders and hypochondriasis (hypochondria). * Factitious disorder: Can be either imposed on oneself, or to someone else (formally known as factitious disorder by proxy). *
Illness anxiety disorder Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
: A somatic symptom disorder involving persistent and excessive worry about developing a serious illness. This disorder has recently gone under review and has been altered into three different classifications. * Somatoform disorder not otherwise specified (NOS) Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called
mass hysteria Mass psychogenic illness (MPI), also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria, or mass hysteria, involves the spread of illness symptoms through a population where there is no infectious agent responsible for c ...
). Somatization disorder as a mental disorder was recognized in the
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
classification system, but in the latest version DSM-5, it was combined with
undifferentiated somatoform disorder Somatization disorder is a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest ve ...
to become ''somatic symptom disorder'', a diagnosis which no longer requires a specific number of somatic symptoms.


International Statistical Classification of Diseases and Related Health Problems

The
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
, the latest version of the
International Statistical Classification of Diseases and Related Health Problems The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
, classifies conversion disorder as a
dissociative disorder Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily. The ind ...
. ICD-10 still includes somatization syndrome.


Treatment

Psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
, more specifically,
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT), is the most widely used form of treatment for somatic symptom disorder. In 2016, a randomized 12-week study suggested steady and significant improvement in health anxiety measures with cognitive behavioral therapy compared to the control group. CBT can help in some of the following ways: * Learn to reduce stress * Learn to cope with physical symptoms * Learn to deal with depression and other psychological issues * Improve quality of life * Reduce preoccupation with symptom Moreover, brief psychodynamic interpersonal psychotherapy (PIT) for patients with multisomatoform disorder has shown its long-term efficacy for improving the physical quality of life in patients with multiple, difficult-to-treat, medically unexplained symptoms. Antidepressant medication has also been used to treat some of the symptoms of depression, anxiety, and pain that are common among people who have somatic symptom disorder. Medications will not cure somatic symptom disorder, but can help the treatment process when combined with CBT.


Controversy

Somatic symptom disorder has been a controversial diagnosis, since it was historically based primarily on negative criteria; that is, the absence of a medical explanation for the presenting physical complaints. Consequently, any person with a poorly understood illness can potentially fulfill the criteria for this psychiatric diagnosis, even if they exhibit no psychiatric symptoms in the conventional sense.Morrison, J. (2014). DSM-5® made easy: The clinician's guide to diagnosis. New York: Guildford Press.


Misdiagnosis

In the opinion of
Allen Frances Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as cha ...
, chair of the DSM-IV task force, the DSM-5's somatic symptom disorder brings with it a risk of mislabeling a sizable proportion of the population as mentally ill.


See also


References


Further reading

* {{Authority control Somatic psychology