Somatic symptom disorder

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See also: Medically unexplained physical symptoms

Somatic symptom disorder, called somatoform disorder until publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),is "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. To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for 6 months)."[1]

Classification

The following disorders are recognized by the DSM-IV-TR:

  • Hypochondriasis is a well known somatoform disorder, in which the patient worries excessively about his or her health. Hypochondriacs misinterpret their symptoms as signs of a serious illness and usually present to a physician already having determined a diagnosis. These fears are irrational because they persist despite medical evidence to the contrary, but not delusional since the feared illness is usually an ordinary syndrome, such as coronary heart disease or cancer
  • Somatization disorder is a pattern of numerous and repeated physical complaints that begin by age 30, persist for several years, and causes the person to seek medical treatment but cannot be medically explained. A diagnosis requires a specific combination of pain, gastrointestinal, sexual and neurological symptoms.
  • Undifferentiated somatoform disorder is a diagnosis for unexplained physical complaints that last for at least six months, but do not meet the diagnostic threshold for somatization disorder.
  • Pain disorder is characterized by pain that is seen as the disorder itself, not as a symptom. Even when a medical condition exists, the pain seems to be more severe than can be explained by a physical cause, psychological factors are assumed to play a role.
  • Conversion disorder is an actual disability that mimics a neurological or medical condition, yet cannot be explained by an organic cause. The most common conversion symptoms are blindness, deafness, paralysis, and anesthesia.

Proposed changes to the classification include: Additional proposed somatoform disorders are:

  • Abridged somatization disorder[2] - at least 4 unexplained somatic complaints in men and 6 in women
  • Multisomatoform disorder (MSD)[3] is defined as "defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (> or = 2 years) history of somatization."[4]
  • Physical symptom disorder (PSD) is proposed to be on Axis III (rather than Axis I) and "replace somatization disorder, undifferentiated somatoform disorder, and pain disorder. PSD would consist of one or more physical symptoms currently present, not fully explainable by another medical or psychiatric disorder (with the exception of functional somatic syndromes), causing functional impairment. Duration must be at least 6 months, and severity could be graded as mild, moderate, or severe using a 15-symptom checklist (PHQ-15)."[5]

These disorders have been proposed because the recognized somatoform disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found:[6]

  • Somatization disorder - 1%
  • Abridged somatization disorder - 6%
  • Multisomatoform disorder - 24%
  • Undifferentiated somatoform disorder - 79%

Treatment

Cognitive behavioral treatment is best according to a systematic reviews of randomized controlled trials.[7][8]

Reassurance may help according to a randomized controlled trial.[9]

Frequent visits, perhaps monthly, with their primary care physician may reduce may reduce health expenditures according to a randomized controlled trial.[10]

Primary care physicians can treat somatization.[11]

Medications

Antidepressive agents may help.[12]

References

  1. American Psychiatric Association (2013) Somatic Symptom Disorder. American Psychiatric Publishing
  2. Escobar JI, Rubio-Stipec M, Canino G, Karno M (1989). "Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples". J. Nerv. Ment. Dis. 177 (3): 140–6. PMID 2918297[e]
  3. Jackson JL, Kroenke K (2008). "Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study.". Psychosom Med 70 (4): 430-4. DOI:10.1097/PSY.0b013e31816aa0ee. PMID 18434494. Research Blogging.
  4. Kroenke K, Spitzer RL, deGruy FV, Hahn SR, Linzer M, Williams JB 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. PMID 9107152[e]
  5. Kroenke K (2006). "Physical symptom disorder: a simpler diagnostic category for somatization-spectrum conditions.". J Psychosom Res 60 (4): 335-9. DOI:10.1016/j.jpsychores.2006.01.022. PMID 16581354. Research Blogging.
  6. Lynch DJ, McGrady A, Nagel R, Zsembik C (1999). "Somatization in Family Practice: Comparing 5 Methods of Classification". Primary care companion to the Journal of clinical psychiatry 1 (3): 85–89. PMID 15014690. PMC 181067[e]
  7. Sumathipala A (2007). "What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies". Psychosom Med 69 (9): 889–900. DOI:10.1097/PSY.0b013e31815b5cf6. PMID 18040100. Research Blogging.
  8. Kroenke K (2007). "Efficacy of treatment for somatoform disorders: a review of randomized controlled trials". Psychosom Med 69 (9): 881–8. DOI:10.1097/PSY.0b013e31815b00c4. PMID 18040099. Research Blogging.
  9. van Bokhoven MA, Koch H, van der Weijden T, et al (2009). "Influence of watchful waiting on satisfaction and anxiety among patients seeking care for unexplained complaints". Ann Fam Med 7 (2): 112–20. DOI:10.1370/afm.958. PMID 19273865. Research Blogging.
  10. Smith GR, Monson RA, Ray DC (1986). "Psychiatric consultation in somatization disorder. A randomized controlled study.". N Engl J Med 314 (22): 1407-13. PMID 3084975.
  11. Smith RC, Gardiner JC, Luo Z, Schooley S, Lamerato L, Rost K (2009). "Primary care physicians treat somatization.". J Gen Intern Med 24 (7): 829-32. DOI:10.1007/s11606-009-0992-y. PMID 19408058. PMC PMC2695533. Research Blogging.
  12. Muller JE, Wentzel I, Koen L, Niehaus DJ, Seedat S, Stein DJ (2008). "Escitalopram in the treatment of multisomatoform disorder: a double-blind, placebo-controlled trial.". Int Clin Psychopharmacol 23 (1): 43-8. DOI:10.1097/YIC.0b013e32825ea301. PMID 18090507. Research Blogging.

See also