Somatic Symptom Disorders

DSM-V: Somatic Symptom and Related Disorders

• Common Feature: Prominence of somatic symptoms with distress and impairment (DSM-V, p. 309).

Differential Diagnosis

1. Psychological Factors Affecting Other Medical Conditions

   • A. Presence of a medical symptom/condition.

   • B. Psychological factors affect medical conditions by:

     • 1. Influencing course of the condition.

     • 2. Interfering with treatment.

     • 3. Constituting additional health risks.

     • 4. Influencing underlying pathology.

   • C. Factors in B are not explained by another mental disorder.

2. Conversion Disorder (Functional Neurological Symptom Disorder)

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

   • B. Evidence of incompatibility between symptom and recognized neurological/medical conditions.

   • C. Not better explained by another disorder.

   • D. Causes significant distress/impairment.

3. Illness Anxiety Disorder (previously Hypochondriasis)

   • A. Preoccupation with having/acquiring a serious illness.

   • B. Somatic symptoms absent or mild, with excessive preoccupation.

   • C. High level of health anxiety.

   • D. Excessive health-related behaviors or avoidance.

   • E. Present for at least 6 months.

   • F. Not better explained by another mental disorder.

4. Somatic Symptom Disorder (previously Somatization Disorder)

   • A. One or more distressing somatic symptoms.

   • B. Excessive thoughts/behaviors regarding symptoms.

   • C. Persistent symptomatic state for over 6 months.

5. Factitious Disorder (previously Munchausen Syndrome)

   • A. Falsification of symptoms or induction of disease.

   • B. The individual presents themselves as ill.

   • C. Behavior not explained by another disorder.

6. Malingering (V-Code)

   • Intentional production of false symptoms motivated by external incentives.

   • Suspicions arise under specific conditions (e.g., legal contexts).

Integrative Model of Hypochondriasis

• Etiology:

  • Overlapping causes with anxiety disorders.

  • Genetic contributions; learned behaviors.

  • Major life stressors can trigger.

General Treatment Discussion

• Approaches:

  • Depends on co-morbid conditions.

  • Medication: Anti-anxiety or antidepressants.

  • Psychotherapy: Important reassurance and tailored techniques, including family therapy if needed.