After studying this chapter, the student should be able to:
Identify and describe somatic symptom disorder and related conditions.
Identify the etiology and diagnostic criteria for these disorders.
Describe pharmacologic and nonpharmacologic evidence-based treatments for these disorders.
Somatic symptom disorder and related conditions such as conversion disorder present with physical symptoms that cause significant distress or impairment. A summary of somatic symptom disorder and related disorders is provided in Table 41–1. Individuals with these disorders commonly seek care in medical settings, such as primary care or emergency department settings, as opposed to psychiatric settings. Many patients with these disorders experience a chronic course, and they are often high utilizers of the medical system. Although these disorders are not often discussed, the prevalence is significant. Somatic symptom disorder occurs in 5% to 7% of the adult population, and conversion disorder is the second most common diagnosis in neurology clinics. In addition, previous estimates of hypochondriasis were as high as 10% of the population. These patients frequently seek medical care for their symptoms and are often significantly limited by their condition. Symptoms significantly interfere with many patients’ ability to complete activities of daily living such as maintaining employment or living independently.
TABLE 41–1Diagnostic criteria, epidemiology, and comorbidity of somatic symptom disorder and related disorders. ||Download (.pdf) TABLE 41–1 Diagnostic criteria, epidemiology, and comorbidity of somatic symptom disorder and related disorders.
|Disorder ||Diagnostic Criteria ||Epidemiology ||Comorbidity |
|Somatic symptom disorder || |
≥1 somatic symptom that is distressing or disrupts daily life
Excessive thoughts, feelings, or behaviors related to symptoms
Symptoms are persistent (>6 months)
5%-7% of adult population
Likely higher in females than males
Anxiety and depressive disorders
|Brief somatic symptom disorder ||Same criteria as somatic symptom disorder, but lasting <6 months || || |
|Conversion disorder (functional neurologic symptom disorder) || |
≥1 symptom of altered voluntary motor or sensory function
Incompatibility between symptoms and neurologic or medical conditions
|5% of referrals to neurology clinics || |
Anxiety disorders; in particular, panic disorder
Somatic symptom disorder
Neurologic or other medical conditions
|Illness anxiety disorder || |
Preoccupation with having or acquiring serious illness (if medical illness present, preoccupation excessive)
Mild or no somatic symptoms
Anxiety related to health
Excessive health-related behaviors or maladaptive avoidance
Preoccupation present ≥6 months
Unavailable based on new criteria, but hypochondriasis prevalence was between 1.3% and 10%
Similar prevalence in males and females
Anxiety disorders (eg, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder)
Elevated risk for somatic symptom disorder and personality disorder
|Brief illness anxiety disorder ||Same criteria as illness anxiety disorder, but lasting <6 months || || |
|Illness anxiety disorder without excessive health-related behaviors ||Same criteria as illness anxiety disorder, but without excessive health-related behaviors or maladaptive avoidance || || |
|Body dysmorphic disorder || |
Preoccupation with perceived flaws in physical appearance not apparent to others...