Somatic Symptom Disorder

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Original Editors - Lauren Rouse & Laura Stigler from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Lauren Rouse, Laura Stigler, Elaine Lonnemann, Admin, Wendy Walker, WikiSysop, Kim Jackson and Vidya Acharya  

Definition/Description

Somatic symptom disorder (SSD), as defined by the DSM-V code, occurs in individuals experiencing exaggerated and disrupted physical symptoms in multiple areas of the body, accompanied by exaggerated thoughts impairing activities of daily living. Diagnosis of SSD requires that the individual has experienced these symptoms for at least six months. This disorder has recently been updated from DSM-IV code of "somatization disorder" to the DSM-V code of "SSD". The prior diagnosis required patient complaints from four different symptom groups; however, this is no longer required with the DSM-V code¹. In addition, patients experiencing these symptoms associated with other comorbidities such as heart disease, osteoarthritis, or cancer were previously excluded from the DSM-IV diagnostic code. The DSM-V definition now includes these patients under the diagnostic code of SSD, even if the psychological symptoms were secondary to the primary diagnosis. These patients are considered appropriate for psychological treatment; however, a full psychological evaluation is needed to rule out other possible disorders².

Prevalence

Information about the prevalence of SSD is lacking due to the recent changes in the DSM-V code in 2013. The prevalence of the DSM-IV code of somatization disorder is more widely known and the following data has been obtained: 

• For restrictive diagnoses, rates are low in community samples (0.1%) but this may be due to reporting bias³
• The disorder may be as high as 2% in community dwelling women, whereas some cases are reported to be as high as 11.6% of the population³
  
• The female-to-male ratio is 10:1 and may begin in childhood, adolescence, or early adulthood³.
• Older adults diagnosed with somatization disorder is a rare finding. Older patients should be referred to a medical specialist for an underlying medical illness or consider depression as the primary cause of the individual’s perception of pain³.
  

Van noorden MS, Giltay EJ, Van der wee NJ, Zitman FG. [The Leiden Routine Outcome Monitoring Study: mood, anxiety and somatoform disorders in patients attending a day clinic]. Tijdschr Psychiatr. 2014;56(1):22-31.

The prevalence of medically unexplained symptoms used to diagnose an individual with somatization disorder (DSM IV) are listed below: 

• 15-25% in primary care
  
• 39-52% in specialist clinics
  
• >60% in neurology
  

Stein E. Somatic Symptom Disorders in DSM-5: A step forward or a fall back? [PowerPoint]. Alberta Psychiatric Association; 2013.

Characteristics/Clinical Presentation

Criteria for SSD as defined by the American Psychiatric Assocation (APA):

Table 1.

Criteria for Somatic Symptom Disorder

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:

Disproportionate and persistent thoughts about the seriousness of one's symptoms. Persistently high level of anxiety about health or symptoms. Excessive time and energy devoted to these symptoms or health concerns.

C. Although any one somatic symptom may not be continuously persent, the state of being symptomatic (typically more than 6 months)

 Somatic Symptom Disorder: An important change in DSM

Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM. J Psychosom Res. 2013;75(3):223-8.

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

The interrater reliability of diagnoses for Complex Somatic Symptom Disoder was listed as 0.61 in adult diagnoses.

Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM. J Psychosom Res. 2013;75(3):223-8.

Etiology/Causes

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Systemic Involvement

Patients diagnosed with the DSM-V disoder may present with the following systemic symptoms:

Cardiac

• Shortness of breath
• Palpitations
• Chest pain
  

Gastrointestinal

• Vomiting
• Abdominal pain
• Difficulty swallowing
• Nausea
• Bloating
• Diarrhea
  
  

Musculoskeletal

• Pain in the legs or arms
• Back and joint pain
  

Neurological

• Headaches
• Dizziness
• Amnesia
• Vision changes
• Paralysis or muscle weakness

Urogenital

• Pain during urination
• Low libido
• Dyspareunia
• Impotence
• Dysmenorrhea
  

Available at: http://www.patient.co.uk/doctor/somatic-symptom-disorder. Accessed February 27, 2014.

Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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