Somatic Symptoms and Related Disorders

This chapter in the DSM-5-TR includes the following diagnoses:
- Somatic Symptom Disorder (previously known as somatization disorder)
- Illness Anxiety Disorder (previously known as hypochondriasis)
- Functional Neurological Symptom Disorder (conversion disorder)
- Psychological Factors Affecting Other Medical Conditions
- Factitious Disorder
- Other Somatic Symptom and Related Disorders
- Unspecified Somatic Symptom and Related Disorders
Common features of these disorders:
- Prominence of somatic symptoms and/or illness anxiety.
- Associated with significant distress and impairment.
- Individuals are often seen in primary care or medical settings but not commonly in psychiatric or mental health settings.

SSD emphasizes diagnosis based on the presence of symptoms and signs rather than the absence of a medical explanation.
A distinctive characteristic of individuals with SSD is their interpretation and presentation of somatic symptoms rather than the symptoms themselves.
The criteria incorporate affective, cognitive, and behavioral components, providing a more comprehensive clinical picture than solely assessing somatic complaints.

A. One or more somatic symptoms that are distressing or result in significant life disruption.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or health concerns, evidenced by at least one of the following:
- 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
- 2. Persistent high levels of anxiety about health or symptoms.
- 3. Excessive time and energy devoted to these symptoms or health concerns.
C. Persistence of symptomatic state, typically more than 6 months.
- Specify if:
  - With predominant pain (formerly pain disorder): primarily involves pain.
  - Persistent: severe symptoms, marked impairment, duration over 6 months.
- Specify current severity:
  - Mild: One symptom in Criterion B is fulfilled.
  - Moderate: Two or more symptoms in Criterion B fulfilled.
  - Severe: Two or more symptoms in Criterion B plus multiple complaints.

Individuals who earlier would have been diagnosed with hypochondriasis in DSM-IV are now often classified under SSD; however, approximately one-third meet criteria for IAD.
Individuals with IAD believe they are medically ill, leading to more frequent visits to medical settings than mental health settings.
Higher rates of medical and mental health service utilization compared to the general population.
Some individuals may avoid medical care due to anxiety about health.
Often see multiple physicians for the same problem, leading to numerous negative tests.
Exacerbation of anxiety can often result from medical attention received.
Patients typically express dissatisfaction with medical care, feeling dismissed or that medical professionals are frustrated.

A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms may be absent or only mild. If present, preoccupation is excessive relative to any existing condition (ex. strong family history).
C. High level of anxiety regarding health and easily alarmed about personal health status.
D. Exhibiting excessive health-related behaviors, such as checking for signs of illness, or maladaptive avoidance, like avoiding doctor's visits.
E. Preoccupation has been present for at least 6 months, with specific illness fears potentially changing during that time.
F. Not better explained by another mental disorder, e.g., SSD, panic disorder, generalized anxiety disorder, body dysmorphic disorder, OCD, or delusional disorder, somatic type.
- Specify whether:
  - Care-seeking type: Frequent medical visits or tests.
  - Care-avoidant type: Rarely seeks medical care.

A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings indicate an inconsistency between symptoms and established neurological or medical conditions.
C. Symptoms are not better explained by another disorder.
D. Causes clinically significant distress or impairment in social, occupational, or other important areas or requires medical evaluation.
- Specify type of symptom:
  - With weakness or paralysis.
  - With abnormal movement (tremor, dystonia, myoclonus, gait disorder).
  - With swallowing symptoms.
  - With speech symptoms (e.g., dysphonia, slurred speech).
  - With attacks or seizures.
  - With anesthesia or sensory loss.
  - With mixed symptoms.

A. Falsification of physical or psychological signs/symptoms, or induction of injury/disease, associated with identified deception.
B. Individual presents themselves as ill, impaired, or injured.
C. Deceptive behavior occurs even without obvious external rewards.
D. Behavior not better explained by another mental disorder (e.g., delusional disorder or other psychotic disorders).

**A. Falsification of signs/symptoms, or induction of injury/disease **in another, associated with identified deception.
B. The individual presents the other person (victim) as ill, impaired, or injured.
C. The deceptive behavior occurs despite the absence of obvious external rewards.
D. The behavior not better explained by another mental disorder (e.g., delusional disorder or other psychotic disorders).