somatic symptom & related disorders

8/13/2019 Somatic Symptom & Related Disorders

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psychiatric conditions where pts experiencedistressing physical symptoms that are notfully explained by other medical, neurologic,

or psychiatric disorders. abnormal thoughts, feelings, and behaviors in

response to these symptoms.

may result from psychological stress that isunconsciously (without awareness) expressedsomatically.


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Somatic Symptom Disorder

Illness Anxiety Disorder

Conversion Disorder Psychological factors affecting other

Medical conditions

Other specified somatic symptom andrelated disorder.


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charac. by somatic symptoms that are

either very distressing or result in

significant disruption of functioning, aswell as excessive & disproportionatethoughts, feelings & behaviors regardingthose symptoms. To be diagnosed with

SSD, the pt must be persistentlysymptomatic (typically at least for 6months).


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A. One or more somatic symptoms that aredistressing or result in significant disruption ofdaily life.

B. Excessive thoughts, feelings, or behaviors related

to the somatic symptoms or associated healthconcerns manifested by following:1. Persistent thoughts abt seriousness of symptoms2. Persistently high level of anxiety3.

Excessive time & energy devoted to symptomsand health concerns.


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C. Although any one somatic symptommay not be continuously present, thestate of being symptomatic is persistent

(typically more than 6 months).

Specify if

- Predominant pain (previously PainDisorder)


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multiple, current, somatic symptoms that aredistressing or result in disruption of daily life

Symptoms may or may not be associated with medicalillness.

high levels of worry abt illness. Assumption of bodily symptoms as unduly

threatening, harmful, or troublesome & often think theworst abt their health.

high level of medical care utilization, which rarely

alleviates the individual's concerns. Attention focused on somatic symptoms. Worry about illness & fear that any physical activity

may damage the body.


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SSD is common in older population & Focus onCriteria B is crucial for Dx.

Underdiagnosed in old since symptoms (pain,

fatigue) are normal part of ageing & illnessworry is considered understandable in old.

In children, the most common symptoms arerecurrent abdominal pain, headache,fatigue,and nausea.

SSD is frequent in individuals with few yrs ofeducation and low socioeconomic status.


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Panic Disorder - somatic symptoms & anxiety abthealth tend to occur in acute episodes.

Generalized anxiety disorder Individuals worry

abt multiple events, situations, or activities, onlyone of which may involve their health. Main focusis not usually somatic symptoms or fear of illnessas it is in SSD.

Illness anxiety disorder - If the individual hasextensive worries about health but no or minimalsomatic symptoms, it may be more appropriate toconsider illness anxiety disorder.


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Conversion disorder - presenting symptom is lossof function (e.g of a limb). In SSD focus is on thedistress that particular symptoms cause. CriterionB of SSD can differentiate the 2 disorders.

Delusional Disorder (somatic type)- the somaticsymptom beliefs & behavior are stronger thanthose found in SSD.

Body Dysmorphic Disorder - the individual isexcessively concerned abt & preoccupied by, aperceived defect in his physical features. In SSDthere is fear of underlying illness, but not of defectin appearance.


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A. Preoccupation with having or acquiring a seriousillness.

B. Somatic symptoms are not present or, if present,

are only mild in intensity.C. There is a high level of anxiety abt health & the

individual is easily alarmed abt personal healthstatus.

D. The individual performs excessive health-relatedbehaviors (e.g., repeatedly checks his body forsigns of illness) or exhibits maladaptive avoidance(e.g., avoids doctor appointments & hospitals).


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E. Illness preoccupation has been present for atleast 6 months, but the specific illness that isfeared may change over that period of time.

Specify whether:Care-seeking type: Medical care, including

physician visits or undergoing tests &procedures, is frequently used.

Care-avoidant type: Medical care is rarely used.


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Preoccupation with diseases, despite constantreassurance by physicians

Belief is not delusional

Daily functioning is affected. Individuals oftenexamine themselves repeatedly. Excessiveresearch abt their suspected disease. Frequentlyseek reassurance from family, friends &

physicians. Thorough evaluation fails to identify a serious

medical condition

Duration of at least 6 months.


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Both sexes equally affected.

Common age of onset is 20-30 yrs.

May be precipitated by a major life stressor a serious but ultimately benign threatto the individual's health.

A Hx of childhood abuse or illness maybe a predisposing factor.


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SSD - is diagnosed when significant somaticsymptoms are present. In contrast, individualswith illness anxiety disorder have minimal

somatic symptoms & are primarily concernedwith the idea they are ill.

Anxiety disorders - In generalized anxietydisorder, individuals worry abt multiple

events, situations, or activities, only one ofwhich may involve health. In panic disorder,the anxiety is episodic and acute.


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Major depressive disorder - Some individualswith a major depressive episode ruminateabout their health & worry excessively abtillness. Dx of illness anxiety disorder is notmade if these concerns occur only during majordepressive episodes.

Psychotic disorders - Individuals with illnessanxiety disorder are not delusional. Their ideasdo not attain the rigidity & intensity seen in thesomatic delusions. (e.g an organ is rotting ordead)


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A disorder in which an individual experiencesone or more neurological symptoms thatcannot be explained by a medical or

neurological condition. Usually a Hx of sexual/physical abuse,

unstable childhood, Hx of trauma-relateddisorders.


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A. One or more symptoms of altered voluntarymotor or sensory function.

B. Clinical findings provide evidence of

incompatibility between the symptom andrecognized neurological or medical conditions.

C. The symptom or deficit is not better explainedby another medical or mental disorder.

D. The symptom or deficit causes clinicallysignificant distress or impairment in social,occupational, or other important areas offunctioning or warrants medical evaluation.


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Specify symptom type

- With weakness or paralysis

- With abnormal movement (tremor, gait

disorder)- With swallowing symptoms

- With speech symptoms (slurred)

- With attacks or seizures- With sensory loss


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One or two neurologic symptoms affectingvolountary function. May have paralysis, gaitdisturbance, weakness, tics, jerks.

Give way weakness - When testing motorstrength, sudden collapse after several secondsof full resistance can indicate psychogenicaetiologies.

False sensory findings blindness, tunnelvision, paresthesias, deafness.


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Distractable symptoms - Symptoms abateduring the exam when attention is drawnelsewhere. E.g a tremor that stops when pt isasked to perform a cognitive task.

Psychogenic non-epileptic seizures : backarching & side to side head movements.

Gait disorders - inability to use legs, unstable

gait. Bizarre movements.

Cognitive complaints unintentional use ofwrong words, forget whole conversations.


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Neurological disease

Factitious disorder - Patients feign, deliberatelyproduce, or exaggerate their physical symptoms.

Deceptive behaviou is usually eveident. Panic disorder - the neurological symptoms are

typically transient and acutely episodic withcharacteristic cardiorespiratory symptoms.

SSD - The excessive thoughts, feelings, andbehaviors characterizing somatic symptomdisorder are often absent in conversion disorder.


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establish rapport with patients by showinggenuine interest & concern.

Throrough physical exam looking for evidence

of pseudoneurological signs. Lab and other investigations normal.

Psychotherapy is the mainstay of treatment for

most patients.


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