Somatic Symptom and Related Disorders

This chapter discusses the somatic symptom disorders, which are a heterogeneous group unified by physical symptoms or concerns that are associated with prominent distress or impairment. Somatic symptom disorders are estimated to account for 1 in 10 primary care patient visits. The relative prominence of somatic symptoms is essential to the difference between illness anxiety disorder, which is an example of the obsessional/cognitive subtype (not prominent) and somatic symptom disorder,, in which the somatic symptoms are prominent. Patients with body dysmorphic disorder, also an Obsessional/Cognitive subtype, are preoccupied with a perceived defect in physical appearance. Patients with conversion disorder (functional neurological symptom disorder) (dissociative sub-type) present with neurological symptoms that cannot be fully explained physiologically. Patients with factitious disorder consciously simulate illness for psychological purposes rather than practical gain.

Somatic symptom and related disorders

Textbook of Evolutionary Psychiatry and Psychosomatic Medicine ◽

10.1093/med:psych/9780198717942.003.0014 ◽

2015 ◽

pp. 226-232

Author(s):

Martin Brüne

Keyword(s):

Somatic Symptom ◽

Somatic Symptoms ◽

Somatic Complaints ◽

Conscious Awareness ◽

Factitious Disorder ◽

Illness Anxiety Disorder ◽

Somatic Illness ◽

Illness Anxiety ◽

Somatic symptom disorders are characterized by the presentation of somatic complaints (somatization), often, but not necessarily, in the absence of a medical explanation of these sensations. The level of concern is generally disproportionate in relation to the severity of the somatic illness. Behaviourally, somatic symptom disorder entails signals that call for help and attention from others. Evolutionary considerations of why people present with somatic symptoms in the absence of a medical cause suggest that this behaviour could reflect a strategy to manipulate others in order to evoke care. Signals that aim at eliciting care from others are more persuasive if the ‘real’ intention is hidden from conscious awareness. Thus, self-deception may be involved in the presentation of somatic symptoms. Within the spectrum of somatic symptom and related disorders, the degree of self-deception may vary from high, as in illness anxiety disorder, to relatively low, as in factitious disorder.

Triggers and Clinical Presentations of Functional Neurological Disorders: Lessons from World War 1

European Neurology ◽

10.1159/000507698 ◽

2020 ◽

Vol 83 (2) ◽

pp. 174-181

Author(s):

Stefanie Caroline Linden

Keyword(s):

Life Events ◽

Somatic Symptom ◽

Somatic Symptoms ◽

Symptom Clusters ◽

Physical Factors ◽

World War ◽

Combat Experience ◽

Female Patients ◽

Symptom Profiles ◽

Introduction: The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate. Objective: For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors. Methods: A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests. Results: Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts. Conclusions: Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time.

Somatic Symptom Disorder and Related Conditions

10.2310/psych.13029 ◽

2017 ◽

Author(s):

Stephen Thielke

Keyword(s):

Somatic Symptom ◽

Health Anxiety ◽

Conversion Disorder ◽

Future Research ◽

Factitious Disorder ◽

Patient Relationship ◽

Therapeutic Approaches ◽

Dsm 5 ◽

Medically Unexplained

Somatic symptom disorder (SSD) is a novel construct, first presented in the DSM-5. It has two criteria: distressing or impairing bodily symptoms and excessive or disproportionate thoughts, feelings, or behaviors directed toward those symptoms. The criteria must be applied critically to make sense logically and clinically. The framework does not suggest any causal relationship between the elements. SSD uses a different formulation than in previous constructs, with no requirement that symptoms be medically unexplained. Little research has been conducted about SSD, and it is inappropriate to draw conclusions from similar diagnoses. Therefore, almost nothing is known about epidemiology, natural history, and treatment response in SSD. Health anxiety disorder is similar to SSD, but without significant somatic symptoms. Conversion disorder and factitious disorder entail more specific findings than does SSD. Providers should carefully apply diagnostic criteria for SSD, focus on the individual’s distress, and consider how this diagnosis influences the provider-patient relationship. Future research will refine the understanding of the condition and therapeutic approaches to it. This review contains 1 figure, 5 tables, and 39 references. Key words: behaviors, conversion disorder, disproportionate, excessive, factitious disorder, feelings, health anxiety, somatic symptom disorder, somatization, thoughts

Approach to somatomorphic disorders in children. A case presentation

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.473 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S449-S450 ◽

Cited By ~ 1

Author(s):

M.D. Ortega Garcia ◽

M.V. Marti Garnica ◽

S. Garcia Marin ◽

M.A. Lopez Bernal ◽

R. Gomez Martinez ◽

...

Keyword(s):

Mental Disorders ◽

Body Dysmorphic Disorder ◽

Medical Condition ◽

Conversion Disorder ◽

Recurrent Abdominal Pain ◽

Pain Disorder ◽

Somatization Disorder ◽

Childhood And Adolescence ◽

Factitious Disorder ◽

Operating Characteristics

Description of clinical casePatient 10-year-old pediatrics sent from service due to history of frequent admissions for recurrent abdominal pain. In the bypass request indicate that this is a patient of perfectionistic traits; detect dysfunctional family dynamics highlighting the rivalry in the phratry, and with an equal difficulty in the field. From 2010 to 2016, he has made more than 30 visits to hospital emergency combined intervention of psychiatry and psychology and multidisciplinary service available with a pediatric surgery and pediatrics is performed.Exploration and complementary testsFrom 2011 to 2016, it has made 44 blood tests, sonograms 9 full abdomen, abdominal renal scintigraphy without significant findings.DiagnosisF45.5 pain disorder.Differential diagnosisSymptoms due to a medical condition. Other symptoms substance-induced mental disorders: non-specific conversion disorder, pain disorder, hypochondriasis, body dysmorphic disorder, somatization disorder, simulation, factitious disorder, medical symptoms…ConclusionsPsychosomatic disorders are one of the most common clinical forms of mental disorders in childhood and adolescence expression. Knowing the stages of development and operating characteristics. In clinical practice, mainly in primary care, tend to find an organic cause somatic complaints in children, so prevalence data and/or referral to specialized services vary depending on mental consulted sources is critical to understand the pathogenesis of these disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Somatic symptom and related disorders

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0638 ◽

2020 ◽

pp. 6517-6520

Author(s):

Michael Sharpe

Keyword(s):

Somatic Symptom ◽

Multidisciplinary Care ◽

Conversion Disorder ◽

Physical Symptoms ◽

Somatoform Disorder ◽

Somatization Disorder ◽

Simple Explanation ◽

Liaison Psychiatry ◽

Substantial Risk

Somatic symptom disorder is a diagnosis for patients who have marked concern about physical symptoms that appears to be disproportionate to the severity of any associated disease. In conversion disorder the patient’s symptom is loss of a function, such as movement of a limb. This does not mean that the symptoms are not real. Somatic symptom disorder incorporates the older diagnoses of somatoform disorder, somatization disorder, Briquet’s syndrome, and hypochondriasis. Somatic symptom disorder of mild severity is common in medical clinics; it usually responds to simple explanation and reassurance. More severe somatic symptom disorder with multiple symptoms and severe disability is less common, but important to diagnose because these patients are at substantial risk of iatrogenic harm from excessive investigation and speculative medical or surgical treatment. Severe somatic symptom disorder usually requires multidisciplinary care, including liaison psychiatry.

Retreating From Life: The Boy Whose Body Experienced His Pain

Clinical Case Studies ◽

10.1177/1534650118793969 ◽

2018 ◽

Vol 17 (6) ◽

pp. 406-424

Author(s):

Anna Harwood ◽

Amit Shalev ◽

Sharon Ben-Shaul ◽

Rachel Meir ◽

Ela Kiansky ◽

...

Keyword(s):

Somatic Symptom ◽

Treatment Protocol ◽

Treatment Strategies ◽

Somatic Symptoms ◽

Psychiatric Ward ◽

Current Case ◽

Individual Personality ◽

Somatic Disorders ◽

The expression of psychological distress through somatic symptoms is most prevalent among children. Somatic symptom disorders represent a difficult category of disorders to treat and they are often misdiagnosed due to their physical symptomology and dismissed due to their malingering stigma. The current case report follows the treatment of David, a 10-year-old Caucasian male, admitted into the pediatric psychiatric ward of a general hospital, uncommunicative, showing little signs of responsiveness, and dependent on nursing staff for basic needs. Following a complex treatment protocol which integrated key elements of psychodynamic and cognitive-behavior (CBT) treatment recommendations for somatic disorders, David was discharged after 6 months as an inpatient. This in-depth case study provides a synthesis of the varied research on somatic symptom disorders and an acute understanding of how to combine the understanding of complex family dynamics and individual personality structure with empirically reinforced treatment strategies.

Somatic Symptom Disorders and Factitious Disorders

10.1093/med/9780190265557.003.0020 ◽

2017 ◽

Author(s):

Harvinder Singh ◽

Juan Young ◽

Isabella Michna

Keyword(s):

Somatic Symptom ◽

Somatoform Disorders ◽

Conversion Disorder ◽

Factitious Disorders ◽

In this chapter topics on somatoform disorders will be reviewed including conversion disorder and hypochondriasis/somatic symptom disorder

Persistent unexplained physical symptoms: a prospective longitudinal cohort study in UK primary care

British Journal of General Practice ◽

10.3399/bjgp19x701249 ◽

2019 ◽

Vol 69 (681) ◽

pp. e246-e253 ◽

Cited By ~ 3

Author(s):

Kethakie Lamahewa ◽

Marta Buszewicz ◽

Kate Walters ◽

Louise Marston ◽

Irwin Nazareth

Keyword(s):

Primary Care ◽

Cohort Study ◽

Symptom Severity ◽

Somatic Symptom ◽

Somatic Symptoms ◽

Physical Symptoms ◽

Factors Associated ◽

Unexplained Physical Symptoms ◽

Prospective Longitudinal ◽

Prospective Longitudinal Cohort

BackgroundUnexplained physical symptoms (UPS) are extremely common among primary care attenders, but little is known about their longer-term outcome.AimTo investigate the persistence of somatic symptoms at 6 months among a cohort with multiple UPS, and identify prognostic factors associated with worsening symptom scores.Design and settingProspective longitudinal cohort study involving adults attending UK general practice in North and Central London between January and December 2013.MethodConsecutive adults attending nine general practices were screened to identify those with at least three UPS. Eligible participants completed measures of symptom severity (measured using the Patient Health Questionnaire Somatic Symptom Module [PHQ-15]), physical and mental wellbeing, and past health and social history, and were followed up after 6 months. Multivariable linear regression analysis was conducted to identify prognostic factors associated with the primary outcome: somatic symptom severity.ResultsOverall, 245/294 (83%) provided 6-month outcome data. Of these, 135/245 (55%) reported still having UPS, 103/245 (42%) had symptoms still under investigation, and only 26/245 (11%) reported complete symptom resolution. Being female, higher baseline somatic symptom severity, poorer physical functioning, experience of childhood physical abuse, and perception of poor financial wellbeing were significantly associated with higher somatic symptom severity scores at 6 months.ConclusionThis study has shown that at 6 months few participants had complete resolution of unexplained somatic symptoms. GPs should be made aware of the likelihood of UPS persisting, and the factors that make this more likely, to inform decision making and care planning. There is a need to develop prognostic tools that can predict the risk of poor outcomes.

Prevalence of Alexithymia in Patients with Medically Unexplained Physical Symptoms: A Cross-sectional Study in Egypt

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017902117010136 ◽

2021 ◽

Vol 17 (1) ◽

pp. 136-145

Author(s):

Ahmed Rady ◽

Roa Gamal Alamrawy ◽

Ismail Ramadan ◽

Mervat Abd El Raouf

Keyword(s):

Somatic Symptom ◽

Somatic Symptoms ◽

Cross Sectional Study ◽

Physical Symptoms ◽

Arabic Version ◽

Sectional Study ◽

Cross Sectional ◽

Patient Health ◽

Medically Unexplained ◽

Unexplained Physical Symptoms

Background: There is a high incidence of alexithymia in people who report medically unexplained symptoms. There have been limited studies on the prevalence of alexithymia in patients with medically unexplained physical symptoms (MUPS) in various ethnic and cultural backgrounds. Objective: This study aimed to estimate the prevalence of alexithymia in patients with MUPS and examine their socio-demographic data. Methods: In this cross-sectional study, 196 patients with MUPS were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. Patients completed a structured interview; socio-demographic and medical history data were collected. Somatic symptom severity was assessed using the Arabic version of the Patient Health Questionnaire (PHQ-15). Alexithymia was assessed using the Arabic version of the Toronto Alexithymia Scale. Results: General fatigue was the most common complaint observed, followed by headache and dyspepsia. In addition, 73.5% of patients had a high Patient Health Questionnaire score, 17.9% had somatic symptoms of medium severity, while 8% and 0.5% had low and marginal somatic symptoms, respectively. Alexithymia was presented in 49.5%, 22.9% had no alexithymia, and 27.6% had borderline/intermediate alexithymia.A weak positive correlation (r<0.4) was found between somatic symptom severity and alexithymic psychopathology (r=0.277;p<0.05). Only the ‘difficulty identifying feelings’ dimension of alexithymic psychopathology was positively correlated with the severity of somatic symptoms (r=0.271;p<0.05). Conclusion: Alexithymia is associated with the development of MUPS.

All in the mind? The neural correlates of unexplained physical symptoms

Advances in Psychiatric Treatment ◽

10.1192/apt.12.5.349 ◽

2006 ◽

Vol 12 (5) ◽

pp. 349-358 ◽

Cited By ~ 6

Author(s):

Sean A. Spence

Keyword(s):

Body Dysmorphic Disorder ◽

Conversion Disorder ◽

Chronic Fatigue ◽

Physical Symptoms ◽

The Body ◽

System Structure ◽

Caudate Nuclei ◽

Fatigue Syndrome ◽

And Function ◽

The Brain

Physical symptoms with no medical explanation are commonly experienced by healthy people and those attending clinics. Psychiatrists see such patients in liaison settings and clinics for those with psychotic and affective disorders. The pathophysiology remains obscure; physical investigations are usually performed to exclude pathology rather than elucidate dysfunction. However, modern neuroimaging has allowed the study of nervous system structure and function. Although there are few diagnostically specific findings, patterns of association have emerged: where action is impeded (certain forms of conversion disorder and chronic fatigue syndrome) frontal systems of the brain are often implicated; when subjective awareness of the body is disturbed (passivity phenomena and anorexia nervosa) temporo-parietal cortices appear to be dysfunctional. The caudate nuclei (components of the frontal executive circuit) are implicated in a variety of syndromes (including body dysmorphic disorder, somatisation and chronic fatigue). The brain may be viewed as a cognitive neurobiological entity, crucially oriented towards action (for survival). Psychiatric syndromes that have an impact on bodily awareness signal dysfunction within systems representing that body and its performance in time and space.