Somatic symptom disorder

Background

Disorder in which a patient experiences physical symptoms that suggest physical illness or injury, but 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. Formerly known as somatoform disorder.

Clinical Features

• A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
• B. 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.
• C. Although any one somatic symptom may not be continuously present, the state of be­ing symptomatic is persistent (typically more than 6 months).

Differential Diagnosis

• Panic disorder
• Generalized anxiety disorder
• Depressive disorders
• Factitious disorder
• Malingering
• Illness anxiety disorder
• Conversion disorder
• Delusional disorder
• Body dysmorphic disorder
• Obsessive-compulsive disorder

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

Home

See Also

• Factitious disorder
• Illness anxiety disorder
• Conversion disorder