Somatic Symptom Disorder

Somatic Symptom Disorder is characterised by persistent and clinically significant somatic complaints that have a disproportionate impact on health-related thoughts, feelings, and behaviours related to said complaints. Both symptoms and the response to symptoms exist on a continuum. Of particular importance is that the symptoms do not need to be medically unexplained. Somatic symptom disorder can be diagnosed in someone with an accompanying recognised medical condition. In this way it avoids questioning the "validity" of the symptoms.

Diagnosis

The entity was first introduced in DSM-V in 2013 within the field of bodily distress. There are two important changes: (1) no requirement for the symptoms to be "organic" in origin, (2) certain psychological and behavioural features have to be present.

Table 1. Criteria for Somatic Symptom Disorder[1]
Criterion Feature
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
(i) Disproportionate and persistent thoughts about the seriousness of one's symptoms.

(ii) Persistently high level of anxiety about health or symptoms

(iii) 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).
Specifiers
Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.
Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
Specify current severity: Mild: Only one of the symptoms specified in Criterion B is fulfilled

Moderate: Two or more of the symptoms specified in Criterion B are fulfilled

Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom)

Table 2. Subsets of Somatic Symptom Disorder[2]
Subset Features
Conversion disorder One or more symptoms of altered voluntary motor or sensory function inconsistent with a known condition
Factitious disorder Falsification of physical or psychological symptoms, or induced injury or disease; can be with regard to self or imposed on others, although not for personal gain (as with malingering)
Illness anxiety disorder Preoccupation with getting or having a serious medical disorder; the two types include care-seeking and care-avoidant; previously included in hypochondriasis
Psychological factors affecting other medical conditions A medical condition must exist and psychological factors must negatively affect the condition
Other specified somatic symptom and related disorders Symptoms consistent with somatic symptom disorder are present, but do not meet full criteria for any of the above disorders
Unspecified somatic symptom and related disorders Symptoms consistent with somatic symptom disorder are present, but do not meet criteria for any of the above disorders; should be used only when there is insufficient information to make a more specific diagnosis

Musculoskeletal Medicine Context

It is usually not appropriate for a Musculoskeletal Medicine specialist to apply this diagnosis. This is a term from the psychiatry literature and should only be used by psychiatrists. More general descriptive language is preferred for describing any psychosocial distress without applying unvalidated psychiatric diagnoses. However it is useful for the Musculoskeletal Medicine specialist to be aware of the term and its usage.

Resources

• Peter Henningsen on management of somatic symptom disorder.[3]
• American Family Physician article.[2]

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
2. Kurlansik, Stuart L.; Maffei, Mario S. (2016-01-01). "Somatic Symptom Disorder". American Family Physician. 93 (1): 49–54. ISSN 1532-0650. PMID 26760840.
3. Henningsen, Peter (2018-03). "Management of somatic symptom disorder". Dialogues in Clinical Neuroscience. 20 (1): 23–31. doi:10.31887/DCNS.2018.20.1/phenningsen. ISSN 1958-5969. PMC 6016049. PMID 29946208. Check date values in: |date= (help)