Somatic symptom disorder

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The term “somatic symptom” is meant to refer to any persistent bodily function that causes suffering including, but not limited to pain, fatigue, sexual or reproductive problems. It specifically excludes individuals who have a medical illness that explains their somatic complaints (e.g., cancer) and suggests instead an underlying psychological cause of the symptoms.

Proposed as a diagnostic category

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Somatic symptom disorder was first proposed as a diagnostic category in the DSM-5 Neurodevelopmental Disorders workgroup. Members of this workgroup contend that somatic expressions of psychological distress (e.g., pain, fatigue) are under-recognized and frequently misunderstood as medical conditions by physicians and should be assessed more thoroughly for psychiatric comorbidities.

Somatic symptoms last for a minimum of six months

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According to the DSM-5 criteria, an individual with somatic symptom disorder has two or more somatic symptoms that cause significant distress and impairment and last for a minimum of six months. The symptoms lead to clinically significant distress due to:

1) biological reactivity (somatization), such as anxiety or depression about having a symptom

2) excessive thoughts and worries about the somatic symptoms

3) difficulties in the social role or functioning as a result of the somatic symptoms. The individual must either report that he/she is distressed by the somatic symptoms, or if not medically explained it causes clinically significant impairment in social, occupational, educational, or other important areas of functioning.

Diagnosis of an individual who has 2 or more somatic symptoms

Somatic symptom disorder is diagnosed in an individual who has 2 or more somatic symptoms and either:

• The distress and/or impairment is not better explained by a general medical condition, substance use disorder, or as occurring for reasons other than psychological causes (as determined by the judgment of a mental health professional).

• Somatic symptoms are distressing to the individual.

Appropriate medical examination

An appropriate medical examination may be necessary before making this diagnosis. The DSM-5 criteria for somatic symptom disorder state that individuals who have a general medical condition or substance-induced disorder that fully explains their somatic complaints do not qualify for this diagnosis.

For example, irritable bowel syndrome/gastroenterological disorder is listed in the DSM-5 to indicate an appropriate exclusion for making the diagnosis of somatic symptom disorder.

The DSM-5 also includes an exclusion for individuals who experience specified somatic symptoms that are commonly associated with grief (e.g., fatigue, fainting, shortness of breath). The reason to exclude these symptoms is the DSM-5 recently updated criteria for major depressive disorder, which now specifies that an individual should not meet the criteria for major depression if he/she is bereaved (i.e., someone has died).

Distressing somatic symptoms

Individuals may experience distressing somatic symptoms that are not associated with psychological factors, for example, headache, chest pain, fatigue; these individuals would not receive this diagnosis.

• It should be noted that the other mental health conditions listed in DSM-5 (e.g., major depressive disorder, generalized anxiety disorder, panic disorder) can cause somatic symptoms and should be ruled out in an individual before this diagnosis is made.

• Somatic symptom disorder is considered to be a severe mental illness because of the significant distress and impairment it produces. Individuals may lose their job, family and friends, become isolated and have a poor quality of life.

The diagnostic criteria for somatic symptom disorder

The diagnostic criteria for somatic symptom disorder were updated to reduce false-positive diagnoses in response to an increase in requests for medical care from patients presenting with the sole complaint of pain or fatigue following trauma or infection. The diagnosis was also updated to exclude individuals who identify their symptoms as being.

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