Somatic
Symptom and
Related Disorders
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Somatic Symptom and
Related Disorder
• Prominent somatic symptoms
• Prominence of somatic symptoms associated with
significant distress and impairment
• Individuals are more commonly encountered in
primary care units than in mental health settings
Behavioral, Affective, and
Cognitive Component
While making a diagnosis, it is important
to consider these three because they
will help in providing a comprehensive
and accurate reflection of clinical
picture.
Reliability is Limited
Of determining that a somatic symptom
is medically unexplained. So, grounding
a diagnosis on the absence of an
explanation is limited.
Initial somatic symptoms
Some disorders like Depression, Panic
Disorder may initially have some
somatic symptoms. .
Important
Points to
Consider
Somatic Symptoms and Related Disorders
Illness Anxiety Disorder Conversion Disorder
Somatic Symptom Disorder
Psychological
Factors affecting Unspecified
Other Medical Somatic
Conditions Factitious Symptom and
Disorder Other Specified Related Disorder
Somatic
Symptom and
Related Disorder
Diagnostic Criteria
01
Etiology
02
Differential Diagnosis
Topics 03
Covered Treatment
04
Somatic
Symptom
Disorder
Excessive thoughts, Although any
One or more
feelings or behaviors one somatic
somatic related to somatic symptom may
symptoms symptoms or not be
associated health continuously
that are concerns as present, the
distressing manifested by one of state of being
or result in the following symptomatic
significant is persistent
typically more
disruption of than 6
daily life. months.
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
Diagnostic Criteria
Specify:
Persistent
A persistent course is
With Predominant Pain characterized by severe
For individuals whose somatic symptoms, marked
symptoms predominantly impairment, and long
involve pain duration, more than 6 months.
Current Specify if Current Specify if Current
Severity Severity Severity
Mild Moderate Severe
Only one of the symptom Two or more of the symptoms Two or more of the symptoms
specified in criterion B is specified in criterion B are specified in criterion B are
fulfilled. fulfilled. fulfilled, plus three are
multiple somatic complaints
( or one very severe somatic
symptom).
Etiology
Genetic and Biological Factors (Family influence as well)
Increased sensitivity to pain, genetic or environmental, or both
Personality Trait of Negativity
Impacts how you identify and perceive an illness and bodily
symptoms
Decreased awareness of problems accessing emotions
Causing physical symptoms to become the issue rather than
emotional issues
Learned Behavior
Attention or other secondary benefits gained from illness or pain
behaviors in response to symptoms
Treatment
Hard to treat
Hard to treat usually because it is
difficult to convince the client that it
• Psychotherapy is not a real medical condition
• Cognitive
Behavioral
Therapy
Differential
Diagnosis
Somatic Symptom Disorder
Diagnosed when significant somatic symptoms
are present. However, Illness anxiety has
minimal somatic symptoms. Primary concern of
individuals is that they are ill.
Illness Anxiety
Disorder
A. Preoccupation with having or acquiring an illness
B. Somatic symptoms are not present or if present, are only
mild in intensity. If another medical condition is present,
preoccupation is excessive or disproportionate.
C. There is a high level of anxiety about health, individual
almost alarmed about personal health issue.
D. Excessive health related behaviors or exhibits maladaptive
avoidance.
E. Preoccupation at least present for 6 months, the specific
illness that is feared may change over time.
F. Not better explained by any other mental disorder.
Specify whether:
• Care Seeking type
Medical care is frequently used.
• Care Avoidant type
Medical care is rarely used.
Diagnostic
Criteria
Etiology
Cognitive Perceptual distortions
Family history of Illness
Causing physical symptoms to become the issue rather than
emotional issues
Differential Diagnosis
Panic Disorder or Generalized Anxiety
Delusional Disorder
Disorder (sometimes Comorbidity)
Intensity of symptoms is higher than Somatic
Symptom Disorder.
Body Dysmorphic Disorder Obsessive Compulsive Disorder
Concern or preoccupation about a perceived In Somatic Symptom Disorder individuals are
defect in body as compared to former which not associated with repetitive behaviors
has fear of underlying illness. aimed at reducing anxiety.
Treatment
Challenge illness related
misinterpretations
• Stress management and coping
• Cognitive strategies
• Antidepressants offer some help too
Behavioral
Therapy is
generally
effective
Conversion
Disorder
(Functional
Neurological Symptom
Disorder)
Specify symptom
type:
A. One or more symptoms of altered voluntary motor or
sensory function.
•With weakness or
B. Clinical findings provide evidence of incompatibility paralysis
between the symptom and recognized neurological or •With abnormal
medical conditions. movement ( tremor,
C. The symptom or deficit is not better explained by another dystonic movement,
medical or mental disorder. gait disorder)
D. The symptom or deficit causes clinically significant •With swallowing
distress or impairment in social, occupational, or other
symptoms
important areas of functioning or warrants medical
evaluation.
•With speech
symptoms (dysphonia,
Specify if: slurred speech)
• Acute Episode Symptoms present for less than 6 months •With attacks or
• Persistent Symptoms occurring for 6 months or more seizures
•With anesthesia or
Specify if: sensory loss
•With psychological stressor (specify stressor)
•With special sensory
•Without psychological stressor
symptoms (visual,
olfactory, or hearing
Diagnostic Criteria
disturbance)
•With mixed
symptoms
Differential Diagnosis:
1. Neurological Disease
A neurological disease causing the symptoms is rarely found at
follow up. However, reassessment may be required if
symptoms appear to be progressive. May co-exist with
Conversion Disorder.
2. Somatic Symptom Disorder
Most of the somatic symptoms cannot be clearly demonstrated
to be incompatible with pathophysiology whereas in
Conversion Disorder, this incompatibility is required for
diagnosis.
3. Factitious Disorder and Malingering
Conversion Disorder does not require the judgment that the
symptoms are not intentionally produced or feigned
because the assessment of conscious intention is
unreliable. However, definite evidence of feigning would
suggest a diagnosis of Factitious disorder.
Treatment
• Explanation to Family that symptoms are real,
stress needs to be relieved
• Tailor problem; Set goals, take feedback
• Physical Therapy
Psychological
Factors
affecting other
Medical
Conditions
A.A medical symptom or condition (other than a mental disorder) is present.
B.Psychological or behavioral factors adversely affect the medical condition in one of the following ways:
1. The factors have influenced the course of the medical condition as shown by a close temporal
association between the psychological factors and the development of exacerbation of, or delayed
recovery from, the medical condition.
2. The factors interfere with the treatment of the medical condition (poor adherence)
3. The factors constitute additional well- established health risks for the individual.
4. The factors influence the underlying pathophysiology, precipitating or exacerbation symptoms or
necessitating medical attention.
C. The psychological and behavioral factors in Criterion B are not better explained by another medical
disorder.
Specify current severity:
• Mild Increases medical risks (inconsistent adherence with antihypertension treatment).
• Moderate Aggravates underlying medical condition (e.g. anxiety aggravating asthma).
• Severe Results in medical hospitalization or emergency room visit.
• Extreme Results in severe, life-threatening risk (e.g. ignoring heart attack symptoms).
Diagnostic Criteria
Differential Diagnosis
1. Mental Disorder due to another Medical Condition
The presumed causality is in the opposite direction. In the Mental Condition due to
another medical condition, the medical condition is judged to be causing the
mental disorder through a direct physiological mechanism.
2. Somatic Symptom Disorder
It is a combination of distressing somatic symptoms and excessive or maladaptive
thoughts, feelings, and behavior in response to these symptoms or associated
health concerns.
Factitious
Disorder
Imposed on Self
A. Falsification of physical or psychological signs
or symptoms, or induction of injury or disease, Imposed on Another
associated with identified deception. A. Falsification or physical or psychological signs or
B. The individual presents himself or herself to symptoms, or induction of injury or disease, in
others as ill, impaired, or injured. another, associated with identified deception.
C. The deceptive behavior is evident even in the B. The individual presents another individual (victim) to
absence of obvious external rewards. others as ill, impaired, or injured.
D. The behavior is not better explained by another C. The deceptive behavior is evident when in the
medical disorder, such as delusional disorder absence of obvious external rewards.
or another psychotic disorder. D. The behavior is not better explained by another
Specify if: mental disorder, such as delusional disorder or
• Single Episode another psychotic disorder.
• Recurrent episodes (two or more events of
falsification of illness and/or induction of injury) Specify if:
Single Episode
Specify if: Recurrent Episode (Two or more events of falsification)
•With psychological stressor (specify stressor)
•Without psychological stressor
Diagnostic Criteria
Etiology:
•Little data available since they resist
psychiatric intervention.
•Many patients suffered childhood
abuse resulting in frequent
hospitalizations (hospitals viewed as
safe).
•Self Enhancement Models:
To increase or protect self esteem.
Other Specified
Somatic
Symptom and
Related
Disorder
This category applies to presentations in which symptoms
characteristics of Somatic Symptom and Related Disorder that cause
clinically significant distress or imapirment in social, occupational. Or
other important areas of functioning predominate but do not meet the
full criteria for any of the disorders in the somatic symprom and
related disorders dasgnostic criteria.
Examples of presentations that can be specified using the “other
specified” designation include the following:
1. Brief Somatic Symptom Disorder: Duration of symptoms is
less than 6 months.
2. Brief Illness Anxiety Disorder: Duration of symptoms is
less than 6 months.
3. Illness Anxiety Disorder without excessive health-related
behaviors: Criterion D for Illness Anxiety Disorder is not
met.
4. Pseudocyesis: A false belief of being pregnant that is
associated with objective signs and reported symptoms
of pregnancy.
Diagnostic Criteria
Unspecified
Somatic
Symptom and
Related
Disorder
This category applies to presentations in which
symptoms characteristic of a somatic symptom
and related disorder that cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning predominate but do not meet the full
criteria for any of the disorders in the somatic
symptom and related disorders.
Diagnostic Criteria
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Somatic Symptom and Related Disoredrs
