Talk:Somatic symptom disorder

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An update

This article needs an update since the DSM-5 proposes new naming for this category "Somatic Symptom Disorders" and Hypochondriasis is proposed to be devided in two subcategories: "Complex somatic symptom disorder" and "Illness Anxiety Disorder". — Preceding unsigned comment added by 46.217.70.179 (talk) 07:19, 9 November 2011 (UTC)

The proposed disorders seem dated. --Candide124 (talk) 21:21, 17 September 2017 (UTC)

Objective Evidence

Is there any objective evidence demonstrating that this condition actually exists, as oppose to a patient have both physical and mental pain or indeed, only physical pain of unknown origin? —Preceding unsigned comment added by 89.145.198.172 (talk) 18:11, 23 October 2009 (UTC)

Considering the limitations of "modern medicine", the inattentiveness of most physicians in family practice, and the vast amount of unknown information/tests/diagnostic procedures that have yet to be discovered - how can any physician say with any degree of certainty that a patient consistently complaining of the same symptom for an extended period of time is just making it up or manifesting the problem subconsciously when it could just as likely be the failing of the physician to properly diagnose an organic illness/problem. My doctor tried to pull the old somatization bull on me as well only to later find out I was having vertebral-basilar TIA's. It seems that such labels as hypochondriasis and somatization are hapharzardly being tossed about to cover the failings of the treating physicians in order to justify their inability to help their ailing patient. Not only that, but any note alluding to hypochondriasis in a patients chart, even when later proven to be erroneous, will forever alter the way any future doctors treat you and sets a framework for just how seriously they may take you, no matter how wrong that information may be. Extreme caution, coupled with ACTUAL psychological testing should be utilized before even considering making mention of such suspicions in patient records let alone confronting the patient on your suspicions.

Terminology confusion

Could someone explain to us laypeople what the difference is between a psychosomatic illness, somatization disorder, and somatoform disorder? It would be helpful if these articles could differentiate themselves from each other, if they are actually different things. -- Beland 23:50, 8 December 2006 (UTC)

"Somatoform disorder (also known as Briquet's syndrome) is a mental disorder characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause[1]"

So is it a disorder or a group of disorders? makeswell 02:24, 16 April 2010 (UTC) —Preceding unsigned comment added by Makeswell (talk • contribs)

I think that "somatoform disorder" is the broad category of illnesses (including somatization disorder, conversion disorder, hypochondriasis, chronic pain and others where physical symptoms are experienced but have no clear biological cause). Therefore, "somatization disorder" is a particular type of somatoform disorder. 23rd July 2010 —Preceding unsigned comment added by 147.197.20.137 (talk) 11:31, 23 July 2010 (UTC)

Including chronic pain in that list seems like an odd choice, as chronic pain generally DOES have a biological cause, and often a known one, though sometimes it takes time to discover it (in part due to popular misconceptions that it’s frequently “all in the patient’s head.”

If mentioned in the article, it really ought to include something about that misconception and how it delays diagnosis of the causes of chronic pain. Catfrost (talk) 23:09, 24 November 2023 (UTC)

Differential Diagnosis

A word on differential diagnosis may be nice here. The disorders are similar and overlapping, so explaining how they are each unique would be nice. --1000Faces (talk) 17:27, 5 February 2011 (UTC)

Untitled

Update to references. The link to http://www.familydoctor.org/162.xml is no longer active. The somatoform disorder page is now at http://familydoctor.org/familydoctor/en/diseases-conditions/somatoform-disorders.html -GN from AAFP — Preceding unsigned comment added by 208.35.133.11 (talk • contribs) 20:16, 26 July 2013‎

Hi User:208.35.133.11! Thank you for your message, and I've fixed this. You know that you could have fixed it yourself? Next time, please be bold and give it a try! With friendly regards, Lova Falk talk 07:23, 4 October 2013 (UTC)

 Fixed

Rename page

Ok if I move this page to Somatic symptom disorder per DSM5 (http://www.dsm5.org/documents/somatic%20symptom%20disorder%20fact%20sheet.pdf)? Robert Badgett 21:37, 19 October 2013 (UTC)

Fine by me! Lova Falk talk 08:01, 31 October 2013 (UTC)

I agree this should be done. 24.97.201.230 (talk) 01:59, 8 April 2014 (UTC)

Can someone that knows how to move this page to be called "Somatic symptom disorder" do so please? 24.97.201.230 (talk) 02:02, 8 April 2014 (UTC)

The DSM 5 has rendered somatoform disorder obsolete.

• http://www.dsm5.org/Documents/Somatic%20Symptom%20Disorder%20Fact%20Sheet.pdf
• http://www.mayoclinic.org/medical-professionals/clinical-updates/psychiatry-psychology/diagnostic-statistical-manual-mental-disorders-redefines-hypochondriasis
• http://dsm.psychiatryonline.org/content.aspx?bookid=556&sectionid=41101775

24.97.201.230 (talk) 02:02, 8 April 2014 (UTC)

It would also be excellent if someone that is familiar with the DSM-5 and psychiatry could edit. 24.97.201.230 (talk) 02:03, 8 April 2014 (UTC)

 Done The page has been moved to the title indicated by the included sources. Thank you for affecting this change by your request.—John Cline (talk) 03:25, 8 April 2014 (UTC)

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Great danger here of error in how to classify if it seems equally likely that there is not a sufficient physical cause or it it seems equally likely there is a physical cause but the diagnosis of the physical cause is still being sought, just not yet found. 3-29-2014 eg. Justina Pelletier case. 146.115.171.24 (talk) 03:05, 30 March 2014 (UTC)

---

A critcal change in the DSM IV is that “an SSD diagnosis does not require that the somatic symptoms are medically unexplained. In other words, symptoms may or may not be associated with another medical condition.” http://www.dsm5.org/Documents/Somatic%20Symptom%20Disorder%20Fact%20Sheet.pdf — Preceding unsigned comment added by 71.234.174.39 (talk) 22:24, 4 November 2014 (UTC)

Physiological Manifestations

I think it may be important to recognize that even though the individual's symptoms don't point to anything physiologically wrong, they can develop other health risks associated with their perceptions. I would like to add this to the introductory section. --CKemble (talk) 21:51, 18 April 2015 (UTC)

misnamed reference

This reference:

<ref name="pmid9107152">{{cite journal |author=LaFrance WC |title=Somatoform disorders |journal=Seminars in Neurology |volume=29 |issue=3 |pages=234–46 |date=July 2009 |pmid=19551600 |doi=10.1055/s-0029-1223875}}</ref>

shares its name, pmid9107152, with this reference:

<ref name="pmid9107152">{{cite journal |author=Kroenke K |title=Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care |journal=Arch. Gen. Psychiatry |volume=54 |issue=4 |pages=352–8 |year=1997 |pmid=9107152 |doi=10.1001/archpsyc.1997.01830160080011 |author2= Spitzer RL |author3= deGruy FV |displayauthors=etal}}</ref>

One or both are used four times in the article with this reference tag: <ref name="pmid9107152"/>. Clearly the first reference definition should be renamed to be something different from the second, perhaps <ref name="pmid19551600">.

Somatic system disorder is not my topic so I will leave it to others to determine which if any of the <ref name="pmid9107152"/> references need to be changed to match the new name.

—Trappist the monk (talk) 19:55, 1 August 2015 (UTC)

Incorrect and potentially damaging description of the disorder

"A somatic symptom disorder, formerly known as a somatoform disorder,[1][2][3] is any mental disorder which manifests as physical symptoms that suggest illness or injury, but which 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)."

"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."

There are subtle but important differences between the outdated "somatoform disorder" and the current definition of "somatic symptom disorder." Perhaps the most important is that the somatic symptom(s) CAN (but don't have to) be fully explained by a general medical condition. To quote the American Psychiatric Association, "Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms...while medically unexplained symptoms were a key feature for many of the disorders in DSM-IV, an SSD diagnosis does not require that the somatic symptoms are medically unexplained. In other words, symptoms may or may not be associated with another medical condition. DSM-5 narrative text description that accompanies the criteria for SSD cautions that it is not appropriate to diagnose individuals with a mental disorder solely because a medical cause cannot be demonstrated. Furthermore, whether or not the somatic symptoms are medically explained, the individual would still have to meet the rest of the criteria in order to receive a diagnosis of SSD." - Information copied from the American Psychiatric Association's DSM 5 fact sheet for somatic symptom disorder published in 2013 (found at https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-fact-sheets) 204.139.85.250 (talk) 13:50, 24 April 2018 (UTC)

Yes! WTH?! This article is totally inaccurate- the somatic symptoms don’t have to be MUPS! This is a psychiatric disorder. This info affects peoples lives. It can’t be completely made up!

I will attempt to edit this buy can’t do much. Can I get some help to fix this article, pls? JustinReilly (talk) 20:27, 4 July 2023 (UTC)

hey i'm currently working on updating this article and in my draft i have a section that specifically talks about somatic symptom disorder coexisting in medical ailments as well as the controversy surrounding labelling MUPS as SSD and the DSM-5 no longer requiring symptoms to be unexplained to be categorized as SSD. From what I've found the debate of MUPS being required for SSD is highly controversial and therefore it's been hard to write this article. I would love to have someone to collaborate on this project as it is such a large concept. I'm not sure how contacting others on wikipedia works but maybe we could make a shared google doc to share info and ideas? CursedWithTheAbilityToDoTheMath (talk) 03:33, 1 August 2023 (UTC)

Hey, not sure if you are still looking for help with this project. While I can’t necessarily collaborate on a full rewrite, I’d be happy to help if you need folks to preview the draft. I am not a doctor nor a psychologist, so I lack the expertise to properly review the article in its entirety but can provide disability perspective in avoiding biased wording if that is needed. As that seems to have been an ongoing issue with this article. Past edits and tone in the article have reflected various cultural biases (both within the medical community and society as a whole) regarding things like invisible illness and conditions primarily affecting women. Catfrost (talk) 02:27, 2 March 2024 (UTC)

Ah, also, I’d suggest any future draft expand substantially on the controversy/misdiagnosis section. Right now it feels like an afterthought when it is a truly massive topic that deserves substantial attention in any article that discusses the mislabeling of physical conditions as psychiatric ones.

It’s also probably important to include info regarding the use of psychiatric labels as a “diagnosis of dismissal” (i.e. a polite way to call a perceived “problem patient” a hypochondriac rather than actually give them a well-supported diagnosis and further treatment for that diagnosis). I don’t have them offhand (would need to do a search) but there are quite a few relevant articles on this issue written by members of the disability community and some HCWs.

And as a small note, if the bit about the use of SSRIs to reduce pain perception remains in your new draft, that needs to be expanded upon/clarified to better reflect the wide range of medical experiences. As-is it looks like an opinion disguised as fact via over-reliance on limited source material.

I know anecdotal experience is not a source, but I know for a fact that statement is over-simplified, as a chronic pain patient who takes SSRIs (which have had zero impact on my chronic pain) and I know that while there are arguably not enough studies done on chronic pain to properly reflect the broad range of patient experiences at the moment, there ARE sources out there that could be used to expand this section to be more accurate and neutral.

This is another area where you can probably supplement with sourcing articles written by members of the disability community and various well-trained/informed doctors to at least show the claims/conclusions of certain studies are hotly debated. Catfrost (talk) 02:39, 2 March 2024 (UTC)

I appreciate your input. I did rewrite the article (the current version is my rewrite). While I agree that SSRIs and SNRIs don’t improve most chronic pain conditions that isn’t something that can be expanded on here since the article needs to remain on topic. I can see what I can do to expand the controversy section. I can’t use articles that aren’t from a reputable medical source for encyclopedic reasons. I do understand the frustration around the misuse of Somatic symptom disorder however i still have to follow the wikipedia editing guidelines and policies. thanks again for the input it’s really appreciated. CursedWithTheAbilityToDoTheMath (talk) 10:09, 9 March 2024 (UTC)

Medically unexplained comment

This article is incorrect. The diagnosis does not require the symptoms to be medically "unexplained" in the DSM-V criteria for "somatic symptom disorder." This was the case in DSM-IV with the predecessor diagnoses only. e.g. see this review: Management of somatic symptom disorder - PubMed (nih.gov). I will wait for any comments before correcting the article. InnerCitadel (talk) 08:02, 22 March 2022 (UTC)

Definition of "psychosomatic" across pages

(Comment simultaneously posted on the three relevant talk pages.)

There appears to be a disconnect between the definition of "psychosomatic" in use for the Psychogenic disease, Psychosomatic medicine, and Somatic symptom disorder pages.

Psychogenic disease describes it as "illnesses with a known medical cause where psychological factors may nonetheless play a role (e.g., asthma can be exacerbated by anxiety)."

Somatic symptom disorder, which is the redirect for "psychosomatic," doesn't directly reference the word at all in the body of the article, but if we assume from the redirect that the two words are implied to be synonymous, it is "any mental disorder that manifests as physical symptoms that suggest illness 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)." Already, these two conflict.

Psychosomatic medicine corroborates the definition used in Psychogenic illness, saying "in contemporary psychosomatic medicine, the term is normally restricted to those illnesses that do have a clear physical basis, but where it is believed that psychological and mental factors also play a role." But it further states that "psychiatry traditionally distinguishes between psychosomatic disorders, disorders in which mental factors play a significant role in the development, expression, or resolution of a physical illness, and somatoform disorders, disorders in which mental factors are the sole cause of a physical illness."

It also appears to use the terms "psychosomatic" and "psychogenic" interchangeably (or without a clarified distinction) without linking to Psychogenic disease.

As Somatic symptom disorder is the redirect for somatoform disorder, this now means Psychosomatic medicine claims two of its redirects are distinct concepts.

This appears to be a tangle in need of cleaning up and I do not know how to approach it. Aliengeometries (talk) 05:50, 13 September 2022 (UTC)

I totally agree, and i dont beleive that the definition "any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general medical condition" is accurate, correct me if im wrong but the syptoms aren't always physical, (for example psychogenic amnesia, witch presents more mental symptoms than physical). But even the page for psychogenic disease has a similar definition, witch dosent line up with a variety of the definitions for disorder with psychogenic in the name, ill try to get an idea of how to clean this up, but it seems like a fairly large projects, especially when it comes to correcting the deffinitions of everything, as well as fixing up witch (matic)/(genic) each article is reffering to. ¿V0id? {have a great day!} (talk) 14:28, 25 October 2022 (UTC)

Questioning why these conditions were added to the See Also section

A recent anonymous edit added links to 3 complex (but most definitely not psychological) chronic illnesses to the “See Also” section. As every other link there appears to be about some form of psychological or fictitious disorder, I have to question the motives behind this recent edit.

The conditions in question (ME/CFS, POTS, and EDS) are all conditions lacking decent public awareness, making diagnosis difficult, and being that they are dynamic and generally outwardly invisible illnesses, patients with these conditions are frequently accused of hypochondria and other psychological issues by the uninformed. CFS is infamous for getting this treatment, and while most people are still unfamiliar with EDS snd POTS, this has been happening to them as well as awareness (but not necessarily *informed* awareness/understanding) increases.

If the motive in including those on this page was to highlight the above issue, I’m not sure it was well-executed, considering the conditions aren’t mentioned in the article itself. Listing them with a bunch of fictitious and psychological disorders gives the impression that they also fit that description (which is already a frustratingly common misconception, as stated above).

It’s also possible they were added ignorantly or even maliciously by someone with these misconceptions. If so, that’s concerning. I’d encourage people to not add info to wikipedia about medical conditions if they lack a decent understanding, as this can have harmful effects they may not even be aware of.

I’ve removed the links (one didn’t even link to the correct page anyway) and I’d argue they need to stay removed unless someone can make a good case for why those three ought to be singled out and included in that section when no other physical conditions were. (Uninformed personal bias is not a valid source) Catfrost (talk) 23:41, 24 November 2023 (UTC)

Hello @Catfrost. Thanks for deleting these, I agree they did not belong in this article. Please be aware of the norms on Wikipedia around talking about other editors: it's really not done to ascribe motivations to other people's actions. Instead, we should simply WP:Focus on content. —Femke 🐦 (talk) 13:22, 23 March 2024 (UTC)

Thank you for your reply and for the very polite correction! Obviously that’s a sound policy. My apologies, will make an effort to avoid doing that in the future. What is the protocol with mistakes like this on the talk page? Should I leave my above comment as-is or is it preferred to edit it? Catfrost (talk) 16:25, 23 March 2024 (UTC)

You can strike it using <s> and </s> tags. Normally when somebody has replied to it, you can't simply remove it. —Femke 🐦 (talk) 18:03, 23 March 2024 (UTC)

I agree with what @Femke has to say but to answer your question I believe these disorders were added to the see also section because there has been studies showing somatic symptoms overlap or are prevalent in CFS/ME,[1][2] POTS [3], and hEDS[4]. I'm not saying they belong in this article but that's most likely why they were originally added. CursedWithTheAbilityToDoTheMath (talk) 22:16, 23 March 2024 (UTC)

The ME/CFS papers I think would be a reach here. The first one is a primary source that's quite specific that it was studying Chronic Fatigue, not CFS. This is specifically pointed out in the discussion. The 2nd is a review, I guess, though the abstract reads like an opinion piece. I couldn't find a way to access it, but assuming it would qualify as a reliable secondary source in line with WP policy, it'd probably be an odd fit as well. It's a German text and if the linkage were valid to include ME/CFS papers in this article, wouldn't it stand to reason that an English publication would be the best option? Beyond that, both date back some 15+ years, during which time we've seen significant revisions of ME/CFS case definitions in much of the English-speaking world. I'd go even further & suggest that that paper looks to have arguably been an outlier even by 2007 standards, perhaps explaining why it's not likely there's an English language equivalent that would've previously made sense in the ME/CFS article. That said, all I could see was the abstract, so it's not wise to judge on that alone, but it certainly came off as atypical in the context of ME/CFS literature generally. NeurastheniaMilkshake (talk) 00:03, 25 March 2024 (UTC)

Yeah I'm not trying to argue anything in particular because I honestly don't feel educated enough on this topic to form a strong opinion either way. I'm not advocating for these disorders to be considered somatic symptom disorders and I think it was appropriate to remove them. If we included every disease that's ever been linked to somatic symptom disorder then we wouldn't have enough room on the page as it's a very complex topic. Regardless I just wanted to provide some input as to why someone might have felt the need to add these articles. CursedWithTheAbilityToDoTheMath (talk) 22:41, 25 March 2024 (UTC)

(Tiny comment: somatic means bodily. The word disorder here implies that's it's related to mental health. That is "cancer is a somatic disease"). —Femke 🐦 (talk) 06:47, 26 March 2024 (UTC)

Thank you for pointing this out, I'll edit my comment for clarity. CursedWithTheAbilityToDoTheMath (talk) 23:08, 26 March 2024 (UTC)

Yeah the EDS association seems like a reach as well based on that source. Admittedly I can only access the abstract, but the abstract doesn’t mention EDS at all, only hypermobility. EDS IS a connective tissue disorder and the most common type (and several other types) have hypermobility as a key symptom, but it still requires some personal inference/assumptions to connect EDS itself to somatic symptom disorders.

And yeah like you said, including every condition that has ever been speculated to fall into this category would be excessive. And singling out a few of them feels like giving undue weight in a way risks presenting a non-neutral viewpoint. Catfrost (talk) 08:27, 14 October 2024 (UTC)

Classification and difference between Somatic symptom disorder vs. Somatization disorder

I was wondering if I could have some help clarifying the difference between Somatic symptom disorder and Somatization disorder. It seems like Somatic symptom disorder is supposed to be a category of disorders however most literature establishes it as its own disorder. Somatic symptom disorder and Somatization disorder mostly contain the same information and I'm wondering if Somatization disorder should be redirected to Somatic symptom disorder. CursedWithTheAbilityToDoTheMath (talk) 19:34, 9 March 2024 (UTC)

Merge proposal

I propose merging Somatization disorder into Somatic symptom disorder. Both articles describe the same condition but uner different terminology. Somatic symptom disorder seems to be the more commonly used term and has more page views so that's why I'm proposing merging Somatization disorder into Somatic symptom disorder. CursedWithTheAbilityToDoTheMath (talk) 05:44, 24 June 2024 (UTC)

Beyond the fact that it is quite a bit of work, I suggest you just go ahead with it as an uncontroversial merge. CFCF (talk) 10:28, 29 June 2024 (UTC)

Sounds good. CursedWithTheAbilityToDoTheMath (talk) 19:19, 29 June 2024 (UTC)