1.4 Somatic Symptom and Related Disorders

Somatic Symptom Disorder and Related Disorders

Individuals experiencing physical symptoms that are not fully explained by a medical condition, are distressing, and significantly disrupt their daily lives

Somatic Symptom Disorder and Related Disorders

These disorders' focus is on the individual's thoughts, feelings, and behaviors related to their physical symptoms

Somatic Symptom Disorder

Disorder characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life, along with excessive thoughts, feelings, or behaviors related to these symptoms or associated health concerns

At least 6 months

How long should symptoms of Somatic Symptom Disorder last?

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.

B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

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/

3. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Diagnostic Criteria of Somatic Symptom Disorder

With predominant pain, persistent, & severity: mild, moderate, or severe

Specifiers of Somatic Symptom Disorder

Illness Anxiety Disorder (Hypochondriasis)

Disorder characterized by the preoccupation with having or acquiring a serious illness, despite the absence of significant somatic symptoms

A. Preoccupation with having or acquiring a serious illness.

B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type

Diagnostic Criteria of Illness Anxiety Disorder

Care-seeking type & Care-avoidant type

Specifiers of Illness Anxiety Disorder

At least 6 months

How long should symptoms of Illness Anxiety Disorder last?

Conversion Disorder (Functional Neurological Symptom Disorder)

Disorder that involves motor or sensory symptoms (e.g., weakness/paralysis, abnormal movement, swallowing difficulties, speech problems, attacks/seizures, blindness, deafness, anesthesia, or sensory loss) that suggest a neurological condition but are not explained by any neurological or medical disorder

A. One or more symptoms of altered voluntary motor or sensory function.

B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

C. The symptom or deficit is not better explained by another medical or mental disorder.

D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation

Diagnostic Criteria of Conversion Disorder

Acute/Persistent, With Psychological Stressor/Without

Specifiers of Conversion Disorder

Psychological Factors Affecting Other Medical Conditions

When psychological or behavioral factors have an adverse effect on a medical condition

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 or exacerbation of, or delayed recovery from, the medical condition.

2. The factors interfere with the treatment of the medical condition (e.g., poor adherence).

3. The factors constitute additional well-established health risks for the individual.

4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.

C. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder). Diagnostic Criteria of Psychological Factors Affecting Other Medical Conditions

Diagnostic Criteria of when Psychological Factors are Affecting Other Medical Conditions

Severity: Mild, Moderate, Severe, & Extreme

Specifiers of Psychological Factors Affecting Other Medical Conditions

Factitious Disorder

Disorder that involves the falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception

Imposed on Another (Munchausen Syndrome by Proxy)

Presents another individual as ill

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Diagnostic Criteria of Imposed on Another (Munchausen Syndrome by Proxy)

Imposed on Self

Presents him/herself to others as ill

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

B. The individual presents another individual (victim) to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Diagnostic Criteria of Factitious Disorder Imposed on Another

Brief somatic symptom disorder

Brief illness anxiety disorder

Illness anxiety disorder without excessive health-related behaviors

Pseudocyesis

Other Specified Somatic Symptom and Related Disorder

Brief somatic symptom disorder

Somatic Symptom Disorder but the duration of symptoms is less than 6 months

Brief illness anxiety disorder

Illness Anxiety Disorder but the duration of symptoms is less than 6 months

Illness anxiety disorder without excessive health-related behaviors

Illness anxiety Disorder but Criterion D is not met

Pseudocyesis

A false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy.