Somatic symptom disorder
|Somatic symptom disorder|
|Classification and external resources|
A somatic symptom disorder, formerly known as a somatoform disorder, is a mental disorder characterized by symptoms that suggest physical illness or injury – symptoms that 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). In people who have a somatic symptom disorder, medical test results are either normal or do not explain the person's symptoms, and history and physical examination do not indicate the presence of a medical condition that could cause them. Patients with this disorder often become worried about their health because doctors are unable to find a cause for their symptoms. This may cause severe distress. Preoccupation with the symptoms may portray a patient's exaggerated belief in the severity of their ill-health. Symptoms are sometimes similar to those of other illnesses and may last for several 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. In order for an individual to be diagnosed with somatic symptom disorder, they must have recurring somatic complaints for several continuous years.
Somatic symptom disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) – sufferers perceive their plight as real. Additionally, a somatic symptom disorder should not be confused with the more specific diagnosis of a somatization disorder. Various laboratory tests, physical examinations, and surgeries on these individuals show no evidence supporting the idea that these exaggerating symptoms are present. Mental disorders are treated separately from physiological or neurological disorders. Somatic symptom disorder is difficult to diagnose and treat since doing so requires psychiatrists to work with neurologists on patients with this disorder. Those that do not pass the diagnostic criteria for a somatic symptom disorder but still present physical symptoms are usually referred to as having "somatic preoccupation".
Somatic symptom disorders are actually a group of disorders, all of which fit the definition of physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause; as such, they are a diagnosis of exclusion. They are recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association as the following:
- Conversion disorder: A somatic symptom disorder involving the actual loss of bodily function such as blindness, paralysis, and numbness due to excessive anxiety
- Somatization disorder: A disorder characterized by multiple physical complaints which do not have a medical explanation.
- Hypochondriasis: 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.
- Body dysmorphic disorder
- Pain disorder
- Undifferentiated somatic symptom disorder – only one unexplained symptom is required for at least 6 months.
Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).
- Somatoform disorder Not Otherwise Specified (NOS)
Additional proposed somatic symptom disorders are:
- Abridged somatization disorder – at least 4 unexplained somatic complaints in men and 6 in women
- Multisomatoform disorder – at least 3 unexplained somatic complaints from the PRIME-MD scale for at least 2 years of active symptoms
These disorders have been proposed because the recognized somatic symptom disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found:
- Somatization disorder – 1%
- Abridged somatization disorder – 6%
- Multisomatoform disorder – 24%
- Undifferentiated somatoform disorder – 69%
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, defines somatization disorder as:
- A history of many physical complaints beginning before age 30 years, occurring over several years, resulting in seeking treatment, or signiﬁcant impairment.
- Each one of the following criteria must have been met, with individual symptoms occurring at any time:
- Four pain symptoms (related to different sites or functions)
- Two gastrointestinal symptoms (other than pain)
- One sexual symptom (other than pain)
- One "pseudoneurological" symptom (not limited to pain)
- Either (1) or (2):
- after appropriate investigation, each of the symptoms cannot be fully explained by a known general medical condition (GMC) or direct effects of a substance.
- when there is a related GMC, the physical complaints or resulting impairment are in excess of what would be expected from the history, physical examination, or laboratory findings.
- The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering).
In the opinion of Allen Frances, chair of the DSM-IV task force, the DSM-5's new somatic symptom disorder brings with it a risk of mislabeling a sizable proportion of the population as mentally ill. “Millions of people could be mislabeled, with the burden falling disproportionately on women, because they are more likely to be casually dismissed as ‘catastrophizers’ when presenting with physical symptoms.”
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- Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
- Frances A (2013). "The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill". BMJ 346: f1580. doi:10.1136/bmj.f1580. PMID 23511949.