Somatic Symptom and Related Disorders

What disorders are included in somatic symptom and related disorders

Somatic symptom disorder / illness anxiety disorder / functional neurological symptom disorder / psychological factors affecting other medical conditions / factitious disorder / other specified somatic symptom and related disorder / unspecified somatic symptom and related disorder

What feature broadly unites somatic symptom and related disorders

Prominent somatic symptoms or illness anxiety associated with significant distress or impairment

Where do people with somatic symptom and related disorders commonly first present

Primary care and other medical settings rather than mental health settings

Must a somatic symptom be medically unexplained to diagnose somatic symptom disorder

No

Can somatic symptom disorder occur when a genuine medical disease is present

Yes

What should never be the sole reason for diagnosing a somatic symptom disorder

Failure to find a medical explanation for physical symptoms

Are physical symptoms in somatic symptom disorder considered fake

No / the person's suffering is authentic whether or not symptoms have a recognized medical explanation

What is somatic symptom disorder

One or more distressing or impairing physical symptoms accompanied by excessive thoughts feelings or behaviors related to the symptoms or health concerns

What is Criterion A for somatic symptom disorder

One or more somatic symptoms that are distressing or significantly disrupt daily life

How many Criterion B features are required for somatic symptom disorder

At least 1 of 3

What are the 3 Criterion B features of somatic symptom disorder

Disproportionate persistent thoughts about symptom seriousness / persistently high health anxiety / excessive time and energy devoted to symptoms or health concerns

How long is the symptomatic state typically present in somatic symptom disorder

More than 6 months

Must the same physical symptom remain present for the entire 6 months

No / individual symptoms may change while the overall state of being symptomatic persists

Can somatic symptom disorder involve only one physical symptom

Yes / one severe symptom may be sufficient

What single symptom is especially common when somatic symptom disorder involves only one symptom

Pain

What does somatic symptom disorder with predominant pain mean

Pain is the primary somatic complaint

What does persistent somatic symptom disorder mean

Severe symptoms / marked impairment / and long duration greater than 6 months

What defines mild somatic symptom disorder

Only 1 Criterion B feature is present

What defines moderate somatic symptom disorder

At least 2 Criterion B features are present

What defines severe somatic symptom disorder

At least 2 Criterion B features plus multiple physical complaints or one very severe physical symptom

What cognitive pattern is common in somatic symptom disorder

Normal or minor bodily sensations may be interpreted as threatening or evidence of serious disease

What behavioral patterns are common in somatic symptom disorder

Repeated body checking / repeated medical visits / reassurance seeking / avoidance of physical activity

How effective is reassurance often in somatic symptom disorder

Relief is often brief and health concerns quickly return

Can someone with diabetes or heart disease also have somatic symptom disorder

Yes / a real medical condition does not exclude the diagnosis

What must be excessive when somatic symptom disorder occurs with a genuine medical condition

Thoughts / anxiety / time / energy / or behaviors related to the symptoms or illness

How does somatic symptom disorder differ from ordinary physical illness

Somatic symptom disorder includes excessive maladaptive thoughts feelings or behaviors beyond the physical symptoms themselves

How does somatic symptom disorder differ from illness anxiety disorder

Somatic symptom disorder has significant distressing physical symptoms / illness anxiety disorder has absent or mild physical symptoms with illness fear as the main problem

How does somatic symptom disorder differ from panic disorder

Panic symptoms and health fears occur in acute episodes / somatic symptom disorder is generally more persistent

How does somatic symptom disorder differ from generalized anxiety disorder

GAD involves worry across many areas / somatic symptom disorder is focused primarily on physical symptoms and health

How does somatic symptom disorder differ from depressive disorders

Depression requires core depressed mood or loss of interest while somatic symptom disorder centers on physical symptoms and related health concerns

How does somatic symptom disorder differ from functional neurological symptom disorder

Somatic symptom disorder focuses on distress and excessive responses to physical symptoms / functional neurological symptom disorder involves altered neurological function shown to be incompatible with recognized neurological disease

How does somatic symptom disorder differ from delusional disorder somatic type

Somatic symptom disorder health beliefs are not held with the fixed delusional conviction seen in delusional disorder

How does somatic symptom disorder differ from body dysmorphic disorder

Somatic symptom disorder focuses on illness or physical symptoms / body dysmorphic disorder focuses on perceived appearance defects

How does somatic symptom disorder differ from OCD

OCD involves intrusive obsessions and repetitive anxiety reducing compulsions / somatic symptom disorder health thoughts are usually less intrusive and lack typical compulsions

How does somatic symptom disorder differ from factitious disorder

Somatic symptom disorder symptoms are genuinely experienced and not intentionally falsified / factitious disorder involves deliberate deception

How does somatic symptom disorder differ from malingering

Somatic symptom disorder does not involve intentional symptom fabrication for external gain

Can anxiety and depressive disorders coexist with somatic symptom disorder

Yes / both are common

Is suicide risk increased in somatic symptom disorder

Yes / suicidal thoughts and attempts are associated with the disorder

What common physical symptoms occur in children with somatic symptom disorder

Abdominal pain / headache / fatigue / nausea

Why is family assessment important with children who have somatic symptoms

Caregiver interpretation and response can affect distress / medical use / intervention seeking / school absence

Why is culture important when evaluating somatic symptoms

Culture influences how bodily distress is described / interpreted / explained / and treated

Can depression present mainly through physical complaints in some cultural contexts

Yes

What is illness anxiety disorder

Preoccupation with having or acquiring a serious illness despite absent or only mild somatic symptoms

What is Criterion A for illness anxiety disorder

Preoccupation with having or acquiring a serious illness

How severe are physical symptoms in illness anxiety disorder

Absent or mild

Can illness anxiety disorder occur when a real medical condition is present

Yes / but illness fear must be clearly excessive or disproportionate

What anxiety feature is required for illness anxiety disorder

High health anxiety with easy alarm about personal health

What behavioral feature is required for illness anxiety disorder

Excessive health related behaviors OR maladaptive avoidance

What are examples of excessive health behaviors in illness anxiety disorder

Repeated body checking / medical visits / tests / reassurance seeking

What are examples of maladaptive avoidance in illness anxiety disorder

Avoiding doctors / hospitals / medical information / or other illness related situations

How long must illness anxiety disorder persist

At least 6 months

Must the same feared disease remain constant for 6 months in illness anxiety disorder

No / the specific feared illness may change

What is care seeking illness anxiety disorder

Medical visits / testing / and procedures are frequently used

What is care avoidant illness anxiety disorder

Medical care is rarely used because of illness related fear or avoidance

What was the older concept most closely related to illness anxiety disorder

Hypochondriasis

What primarily causes distress in illness anxiety disorder

Fear about the meaning or significance of bodily sensations rather than the physical sensation itself

Do negative tests and medical reassurance reliably eliminate illness anxiety disorder fears

No / reassurance often provides little or temporary relief

How does illness anxiety disorder differ from somatic symptom disorder

Illness anxiety disorder has absent or mild physical symptoms / somatic symptom disorder requires distressing or disruptive physical symptoms

How does illness anxiety disorder differ from generalized anxiety disorder

Illness anxiety focuses predominantly on serious disease / GAD involves multiple worry domains

How does illness anxiety disorder differ from panic disorder

Panic health fears are acute and episodic / illness anxiety is persistent and enduring

How does illness anxiety disorder differ from OCD

Illness anxiety commonly focuses on currently having disease / OCD commonly involves intrusive fears of becoming contaminated or acquiring disease and usually includes broader obsessions or compulsions

How does illness anxiety disorder differ from body dysmorphic disorder

Illness anxiety concerns disease / body dysmorphic disorder concerns perceived appearance defects

How does illness anxiety disorder differ from major depressive disorder

Health worries occurring only during a depressive episode are better explained by depression / persistent illness anxiety outside the episode may support a separate diagnosis

How does illness anxiety disorder differ from somatic delusional disorder

People with illness anxiety can acknowledge that the feared disease may not actually be present

Should an actual medical disorder always be ruled out before diagnosing illness anxiety disorder

Medical causes should be appropriately evaluated / but a medical condition and illness anxiety disorder can coexist

What is functional neurological symptom disorder also called

Conversion disorder

What is functional neurological symptom disorder

One or more altered voluntary motor or sensory symptoms with clinical evidence that the symptoms are incompatible with recognized neurological or medical disease

What is Criterion A for functional neurological symptom disorder

One or more symptoms of altered voluntary motor or sensory function

What is Criterion B for functional neurological symptom disorder

Clinical findings show incompatibility between the symptom and recognized neurological or medical conditions

What functional requirement applies to functional neurological symptom disorder

Symptoms cause clinically significant distress or impairment or warrant medical evaluation

Is functional neurological symptom disorder a diagnosis of exclusion

No / it is a rule in diagnosis based on positive clinical findings

Is a normal neurological test by itself enough to diagnose functional neurological symptom disorder

No

Can functional neurological symptom disorder coexist with genuine neurological disease

Yes

Is a psychological stressor required for functional neurological symptom disorder

No

What symptom types can be specified in functional neurological symptom disorder

Weakness or paralysis / abnormal movement / swallowing symptoms / speech symptoms / attacks or seizures / anesthesia or sensory loss / special sensory symptoms / mixed symptoms

What are examples of abnormal movement in functional neurological symptom disorder

Tremor / dystonia / jerks / gait disturbance

What sensory symptoms can occur in functional neurological symptom disorder

Altered or absent touch / vision / hearing / other sensory function

What are functional seizures

Episodes resembling epileptic seizures but arising as functional neurological symptoms rather than epileptic activity

What examination principle supports functional neurological symptom disorder

The symptom changes in ways that reveal internal inconsistency with known neurological physiology

What is Hoover sign used to help identify

Functional limb weakness

What can support identification of functional tremor

Tremor may change / stop / or match another rhythm when attention is redirected

What features may suggest a functional seizure

Persistent eye closure / preserved awareness during bilateral movements / unusually prolonged episodes

What does acute episode mean in functional neurological symptom disorder

Symptoms are present for less than 6 months

What does persistent mean in functional neurological symptom disorder

Symptoms are present for 6 months or more

What stressor specifiers exist for functional neurological symptom disorder

With psychological stressor / without psychological stressor

Does absence of trauma or stress rule out functional neurological symptom disorder

No

Is la belle indifference diagnostic of functional neurological symptom disorder

No / lack of concern can occur but is not specific

Is secondary gain diagnostic of functional neurological symptom disorder

No

Are symptoms in functional neurological symptom disorder intentionally produced

No

How does functional neurological symptom disorder differ from factitious disorder

Functional neurological symptoms are genuinely experienced / factitious disorder involves intentional deceptive falsification

How does functional neurological symptom disorder differ from malingering

Functional symptoms are not intentionally produced / malingering involves intentional symptoms for external gain

How does functional neurological symptom disorder differ from recognized neurological disease

Positive examination findings demonstrate incompatibility with recognized neurological pathophysiology

Can functional neurological symptom disorder and neurological disease occur together

Yes

How does functional neurological symptom disorder differ from panic attacks

Panic neurological sensations generally occur with characteristic panic symptoms / functional neurological disorder may involve focal loss of function or functional seizures

What is psychological factors affecting other medical conditions

A condition in which psychological or behavioral factors adversely affect an actual medical condition

What must be present before diagnosing psychological factors affecting other medical conditions

A medical symptom or medical condition other than a mental disorder

How can psychological factors adversely affect a medical condition

Influence its course / interfere with treatment / create additional health risks / affect pathophysiology and worsen symptoms

What is an example of psychological factors influencing disease course

Anxiety triggering or worsening asthma

What is an example of psychological factors interfering with medical treatment

Poor adherence to prescribed treatment

What is an example of psychological factors creating health risk

Ignoring serious medical symptoms or engaging in behavior that increases medical danger