Somatic symptom disorder

Background

• Somatic symptoms associated with distress and impairment that cannot be medically explained
  • Most common symptom is pain — may be specific, generalized, or nonspecific (eg, fatigue)
  • May represent normal bodily sensations (eg, borborygmus)
  • May occur concurrently or secondarily to a medical condition
• Typically encountered in primary care and other medical settings
  • Less commonly encountered in psychiatric and other mental health settings

Clinical Features

DSM-5 Diagnostic Criteria for Somatic Symptom Disorder

1. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
2. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
3. Although any one somatic symptom may not be continuously present, the state of be­ing symptomatic is persistent (typically more than 6 months).

Differential Diagnosis

• Medical condition
  • Irritable bowel syndrome
  • Fibromyalgia
  • Diabetes, heart disease, etc
• Psychiatric condition
  • Panic disorder
  • Generalized anxiety disorder
  • Depressive disorders
  • Illness anxiety disorder
  • Conversion disorder
  • Delusional disorder
  • Body dysmorphic disorder
  • Obsessive-compulsive disorder
  • Factitious disorder
  • Malingering

Evaluation

Difficult to diagnose, as often a diagnosis of exclusion. Refer to the patient's medical record for indication of repeated visits or recurrent testing.

Management

Close outpatient psychotherapy focused on establishing and maintaining a relationship with the patient.

Disposition

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See Also

• Factitious disorder
• Illness anxiety disorder
• Conversion disorder