Somatic symptom disorder
- 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)."
The following disorders are recognized by the DSM-IV-TR:
- Body dysmorphic disorder is a preoccupation with an imaginary or wildly exaggerated defect in physical appearance.
- 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.
- Somatoform disorder not otherwise specified is a diagnosis for individuals who present with somatoform symptoms but do not meet the criteria for any of the somatoform disorders.
Proposed changes to the classification include: Additional proposed somatoform disorders are:
- Abridged somatization disorder - at least 4 unexplained somatic complaints in men and 6 in women
- Multisomatoform disorder (MSD) is defined as "defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (> or = 2 years) history of somatization."
- 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)."
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:
- Somatization disorder - 1%
- Abridged somatization disorder - 6%
- Multisomatoform disorder - 24%
- Undifferentiated somatoform disorder - 79%
- American Psychiatric Association (2013) Somatic Symptom Disorder. American Psychiatric Publishing
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