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Somatic symptom disorder

This article's lead section may be too short to adequately summarize the key points. Please consider expanding the lead to provide an accessible overview of all important aspects of the article.(March 2021)

A somatic symptom disorder, formerly known as a somatoform disorder, 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). 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. (Before DSM-5 this disorder was split into somatization disorder and undifferentiated somatoform disorder.)

Somatic symptom disorder
SpecialtyPsychiatry, Psychology

In people who have been diagnosed with a somatic symptom disorder, medical test results are either normal or do not explain the person's symptoms (medically unexplained physical symptoms), 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 (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (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.

Contents

Somitisation disorder was first described by Paul Briquet 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.

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. 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 following were conditions under the term Somatoform Disorders:

  • 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
  • Hypochondriasis
  • Body dysmorphic disorder: wherein the afflicted 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
  • 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: Will take over 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: 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.[citation needed]
  • Somatoform disorder not otherwise specified (NOS)

Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).

Somatization disorder as a mental disorder was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder 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, the latest version of the International Statistical Classification of Diseases and Related Health Problems, classifies conversion disorder as a dissociative disorder. ICD-10 still includes somatization syndrome.

Psychotherapy, more specifically, cognitive behavioral therapy (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 and anxiety 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.

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 suffering from a poorly understood illness can potentially fulfill the criteria for this psychiatric diagnosis, even if they exhibit no psychiatric symptoms in the conventional sense.

Misdiagnosis

In the opinion of Allen Frances, 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. “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.”

  1. (2013)"Somatic Symptom Disorder Fact Sheet Archived 2013-11-02 at the Wayback Machine" dsm5.org. Retrieved April 8, 2014.
  2. "DSM-5 redefines hypochondriasis Archived 2015-02-23 at the Wayback Machine" mayoclinic.org. Retrieved April 8, 2014.
  3. "Somatic Symptom and Related Disorders" psychiatryonline.org. Retrieved April 8, 2014.
  4. American Psychiatric Association. Task Force on DSM-IV (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. p. 485. ISBN 978-0-89042-025-6.
  5. Oyama O, Paltoo C, Greengold J (November 2007). "Somatoform disorders". American Family Physician. 76 (9): 1333–8. PMID 18019877.
  6. Kroenke K; Spitzer RL; deGruy FV; et al. (1997). "Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care". Arch. Gen. Psychiatry. 54 (4): 352–8. doi:10.1001/archpsyc.1997.01830160080011. PMID 9107152.
  7. LaFrance WC (July 2009). "Somatoform disorders". Seminars in Neurology. 29 (3): 234–46. doi:10.1055/s-0029-1223875. PMID 19551600.
  8. Cassem, Edwin H. (March 1995). "Depressive Disorders in the Medically Ill". Psychosomatics. 36 (2): S2–S10. doi:10.1016/S0033-3182(95)71698-X. PMID 7724710.
  9. Skumin, V. A. (1991). Pogranichnye psikhicheskie rasstroĭstva pri khronicheskikh bolezniakh pishchevaritel'noĭ sistemy u deteĭ i podrostkov [Borderline mental disorders in chronic diseases of the digestive system in children and adolescents]. Zhurnal Nevropatologii I Psikhiatrii Imeni S.s. Korsakova (Moscow, Russia : 1952) (in Russian). Moscow: Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova. 91 (8): 81–814. OCLC 117464823. Archived from the original on 10 July 2015. Retrieved18 January 2015.
  10. "Briquet's Syndrome (somatization disorder, DSM-IV- TR #300.81)"(PDF).
  11. Williams, Sara E.; Zahka, Nicole E. (2017). Treating Somatic Symptoms in Children and Adolescents (Guilford Child and Adolescent Practitioner Series). 370 Seventh Avenue, Suite 1200, New York, NY 10001: The Guilford Press. pp. 18–21. ISBN 9781462529520. LCCN 2016049135.CS1 maint: location (link)
  12. American Psychiatric Association. Task Force on DSM-IV (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. p. 485. ISBN 978-0-89042-025-6.
  13. Hales, Robert E; Yudofsky, Stuart C (2004).Essentials of Clinical Psychiatry. American Psychiatric Pub. p. 444. ISBN 9781585620333. Somatoform disorder Not otherwise specified.
  14. "Highlights of Changes from DSM-IV-TR to DSM-5"(PDF). American Psychiatric Association. May 17, 2013. Archived(PDF) from the original on September 17, 2013. RetrievedSeptember 6, 2013.
  15. "ICD-10 Version:2015". Archived from the original on 2015-11-02. Retrieved2015-05-23.
  16. Hedman, Erik; Axelsson, Erland; Andersson, Erik; Lekander, Mats; Ljótsson, Brjánn (2016-11-01). "Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial". The British Journal of Psychiatry. 209 (5): 407–413. doi:10.1192/bjp.bp.116.181396. ISSN 1472-1465. PMID 27491531.
  17. N, van Dessel; M, den Boeft; Jc, van der Wouden; M, Kleinstäuber; Ss, Leone; B, Terluin; Me, Numans; He, van der Horst; H, van Marwijk (2014-11-01). "Non-pharmacological Interventions for Somatoform Disorders and Medically Unexplained Physical Symptoms (MUPS) in Adults". The Cochrane Database of Systematic Reviews (11): CD011142. doi:10.1002/14651858.CD011142.pub2. PMID 25362239.
  18. "Somatic symptom disorder Treatments and drugs - Mayo Clinic". Mayo Clinic. Archived from the original on 2017-04-19. Retrieved2017-04-19.
  19. Sattel H, Lahmann C, Gundel H, Guthrie E, Kruse J, Noll-Hussong M, Ohmann C, Ronel J, Sack M, Sauer N, Schneider G, Henningsen P. Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial. The British Journal of Psychiatry. 2012;200(1):60-7.
  20. Morrison, J. (2014). DSM-5® made easy: The clinician's guide to diagnosis. New York: Guildford Press.
  21. 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. S2CID 206897269.
  • Suzanne O'Sullivan (2017). Is It All in Your Head?: True Stories of Imaginary Illness. Other Press. ISBN 978-1590517956.
Classification
External resources

Somatic symptom disorder
Somatic symptom disorder Language Watch Edit This article s lead section may be too short to adequately summarize the key points Please consider expanding the lead to provide an accessible overview of all important aspects of the article March 2021 A somatic symptom disorder formerly known as a somatoform disorder 1 2 3 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 4 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 Before DSM 5 this disorder was split into somatization disorder and undifferentiated somatoform disorder Somatic symptom disorderSpecialtyPsychiatry Psychology In people who have been diagnosed with a somatic symptom disorder medical test results are either normal or do not explain the person s symptoms medically unexplained physical symptoms 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 1 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 5 A diagnosis of somatic symptom disorder requires that the subject have recurring somatic complaints for at least six months 6 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 7 Symptoms may occur across cultures and gender 6 Other common symptoms include anxiety and depression 6 However since anxiety and depression are also very common in persons with confirmed medical illnesses 8 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 fabricating or exaggerating symptoms for secondary motives or factitious disorders deliberately producing feigning or exaggerating symptoms 9 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 6 Contents 1 History 2 Definition 2 1 Diagnostic and Statistical Manual of Mental Disorders 2 2 International Statistical Classification of Diseases and Related Health Problems 3 Treatment 4 Controversy 4 1 Misdiagnosis 5 See also 6 References 7 Further readingHistory EditSomitisation disorder was first described by Paul Briquet 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 10 Definition EditSomatic 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 Somatic symptoms may be generalized in four major medical categories neurological cardiac pain and gastrointestinal somatic symptoms 11 Diagnostic and Statistical Manual of Mental Disorders Edit 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 following 12 were conditions under the term Somatoform Disorders 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 Hypochondriasis Body dysmorphic disorder wherein the afflicted 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 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 Will take over 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 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 citation needed Somatoform disorder not otherwise specified NOS 13 Included among these disorders are false pregnancy psychogenic urinary retention and mass psychogenic illness so called mass hysteria Somatization disorder as a mental disorder was recognized in the DSM IV TR classification system but in the latest version DSM 5 it was combined with undifferentiated somatoform disorder to become somatic symptom disorder a diagnosis which no longer requires a specific number of somatic symptoms 14 International Statistical Classification of Diseases and Related Health Problems Edit The ICD 10 the latest version of the International Statistical Classification of Diseases and Related Health Problems classifies conversion disorder as a dissociative disorder ICD 10 still includes somatization syndrome 15 Treatment EditPsychotherapy more specifically cognitive behavioral therapy 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 16 17 CBT can help in some of the following ways 18 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 19 Antidepressant medication has also been used to treat some of the symptoms of depression and anxiety that are common among people who have somatic symptom disorder 18 Medications will not cure somatic symptom disorder but can help the treatment process when combined with CBT Controversy EditSomatic 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 suffering from a poorly understood illness can potentially fulfill the criteria for this psychiatric diagnosis even if they exhibit no psychiatric symptoms in the conventional sense 20 21 Misdiagnosis Edit In the opinion of Allen Frances 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 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 21 See also EditHypochondriasis Hysteria Medically unexplained physical symptoms Munchausen syndrome Nocebo Psychosomatic medicine PsychoneuroimmunologyReferences Edit a b 2013 Somatic Symptom Disorder Fact Sheet Archived 2013 11 02 at the Wayback Machine dsm5 org Retrieved April 8 2014 DSM 5 redefines hypochondriasis Archived 2015 02 23 at the Wayback Machine mayoclinic org Retrieved April 8 2014 Somatic Symptom and Related Disorders psychiatryonline org Retrieved April 8 2014 American Psychiatric Association Task Force on DSM IV 2000 Diagnostic and statistical manual of mental disorders DSM IV TR American Psychiatric Pub p 485 ISBN 978 0 89042 025 6 Oyama O Paltoo C Greengold J November 2007 Somatoform disorders American Family Physician 76 9 1333 8 PMID 18019877 a b c d Kroenke K Spitzer RL deGruy FV et al 1997 Multisomatoform disorder An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care Arch Gen Psychiatry 54 4 352 8 doi 10 1001 archpsyc 1997 01830160080011 PMID 9107152 LaFrance WC July 2009 Somatoform disorders Seminars in Neurology 29 3 234 46 doi 10 1055 s 0029 1223875 PMID 19551600 Cassem Edwin H March 1995 Depressive Disorders in the Medically Ill Psychosomatics 36 2 S2 S10 doi 10 1016 S0033 3182 95 71698 X PMID 7724710 Skumin V A 1991 Pogranichnye psikhicheskie rasstroĭstva pri khronicheskikh bolezniakh pishchevaritel noĭ sistemy u deteĭ i podrostkov Borderline mental disorders in chronic diseases of the digestive system in children and adolescents Zhurnal Nevropatologii I Psikhiatrii Imeni S s Korsakova Moscow Russia 1952 in Russian Moscow Zhurnal nevropatologii i psikhiatrii imeni S S Korsakova 91 8 81 814 OCLC 117464823 Archived from the original on 10 July 2015 Retrieved 18 January 2015 Briquet s Syndrome somatization disorder DSM IV TR 300 81 PDF Williams Sara E Zahka Nicole E 2017 Treating Somatic Symptoms in Children and Adolescents Guilford Child and Adolescent Practitioner Series 370 Seventh Avenue Suite 1200 New York NY 10001 The Guilford Press pp 18 21 ISBN 9781462529520 LCCN 2016049135 CS1 maint location link American Psychiatric Association Task Force on DSM IV 2000 Diagnostic and statistical manual of mental disorders DSM IV TR American Psychiatric Pub p 485 ISBN 978 0 89042 025 6 Hales Robert E Yudofsky Stuart C 2004 Essentials of Clinical Psychiatry American Psychiatric Pub p 444 ISBN 9781585620333 Somatoform disorder Not otherwise specified Highlights of Changes from DSM IV TR to DSM 5 PDF American Psychiatric Association May 17 2013 Archived PDF from the original on September 17 2013 Retrieved September 6 2013 ICD 10 Version 2015 Archived from the original on 2015 11 02 Retrieved 2015 05 23 Hedman Erik Axelsson Erland Andersson Erik Lekander Mats Ljotsson Brjann 2016 11 01 Exposure based cognitive behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder randomised controlled trial The British Journal of Psychiatry 209 5 407 413 doi 10 1192 bjp bp 116 181396 ISSN 1472 1465 PMID 27491531 N van Dessel M den Boeft Jc van der Wouden M Kleinstauber Ss Leone B Terluin Me Numans He van der Horst H van Marwijk 2014 11 01 Non pharmacological Interventions for Somatoform Disorders and Medically Unexplained Physical Symptoms MUPS in Adults The Cochrane Database of Systematic Reviews 11 CD011142 doi 10 1002 14651858 CD011142 pub2 PMID 25362239 a b Somatic symptom disorder Treatments and drugs Mayo Clinic Mayo Clinic Archived from the original on 2017 04 19 Retrieved 2017 04 19 Sattel H Lahmann C Gundel H Guthrie E Kruse J Noll Hussong M Ohmann C Ronel J Sack M Sauer N Schneider G Henningsen P Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder randomised controlled trial The British Journal of Psychiatry 2012 200 1 60 7 Morrison J 2014 DSM 5 made easy The clinician s guide to diagnosis New York Guildford Press a b 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 S2CID 206897269 Further reading EditSuzanne O Sullivan 2017 Is It All in Your Head True Stories of Imaginary Illness Other Press ISBN 978 1590517956 ClassificationDICD 10 F45ICD 9 CM 300 8MeSH D013001DiseasesDB 1645External resourceseMedicine med 3527 Retrieved from https en wikipedia org w index php title Somatic symptom disorder amp oldid 1049928566, wikipedia, wiki, book,

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