2nd February 2024

Somatic symptom disorder

DSM-5 Criteria 

Criteria A 

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

Criteria B

Excessive thoughts, feelings, or behaviours 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

Criteria C

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

With or without predominant pain

What is this?

Somatic symptom disorder is a diagnosis given when an individual focuses excessively on various bodily symptoms (physical) such as pain, muscle or body weakness, shortness of breath, feeling giddy, etc., to the extent that their day-to-day functioning is impacted. It represents their thoughts, feelings and behaviour (cognitive model) in relation to the physical symptoms. They can exist by themselves or along with a physical illness.

Pathophysiology

The exact pathophysiology is unknown. It could be due to heightened awareness of normal physical sensations in the body. The cognitive distortions, in turn, might interconnect these normal bodily sensations and interpret them in a catastrophic way, resulting in further heightened anxiety. 

Risk factors

There is no single cause for the disorder – multiple factors can increase the risk. It can run in families. Childhood adverse experiences, including abuse and difficult childhood, are a few factors. Reduced threshold for pain and touch sensation can add to the cause. Awareness of the illness and acceptance is a protective factor.

References

• A clinical approach to managing somatoform disorders [Internet]. [cited 2022Dec21]. Available from: https://wchh.onlinelibrary.wiley.com/doi/10.1002/pnp.119 
• Kurlansik SL, Maffei MS. Somatic symptom disorder [Internet]. American Family Physician. 2016 [cited 2022 Dec 21]. Available from: https://www.aafp.org/pubs/afp/issues/2016/0101/p49.html 
• Medically unexplained symptoms, somatisation and bodily distress [Internet]. Cambridge Core. Cambridge University Press; [cited 2022 Dec 21]. Available from: https://www.cambridge.org/core/books/medically-unexplained-symptoms-somatisation-and-bodily-distress/5905F1F140375541B31FC57D5BF7B439 
• MR; PJLM. Conversion disorder [Internet]. National Center for Biotechnology Information. U.S. National Library of Medicine; [cited 2022 Dec 21]. Available from: https://pubmed.ncbi.nlm.nih.gov/31855394/ 
• Page L, Wessely S. Functional somatic syndromes (Chapter 7) – handbook of liaison psychiatry [Internet]. Cambridge Core. Cambridge University Press; [cited 2022 Dec 21]. Available from: https://www.cambridge.org/core/books/handbook-of-liaison-psychiatry/functional-somatic-syndromes/91AD7051D2A460C888F67C73FC37A2F2 
• Somatisation: Medically unexplained symptoms | Oxford Textbook of Social Psychiatry | Oxford Academic (oup.com
• Mehta, U.M. and Chaturvedi, S.K. (2022). Somatisation. Oxford Textbook of Social Psychiatry, [online] pp.421–432. doi:10.1093/med/9780198861478.003.0044.