Somatic

Symptom and
Related
Disorders

Jazzy Rejel Goloso

Reporter
This Chapter includes Disorders;

Somatic Symptom Disorder

Illness Anxiety Disorder
Conversion Disorder (functional neurological
symptom disorder
Psychological Factors affecting Other
Medical Conditions
Factitious Disorder
And Other Unspecified and Specified
Somatic Symptom and related Disorder
All of the disorders in this chapter share a
common Feature :

The prominence of somatic symptoms

associated with significant distress and
impairment.

Individuals with disorders with prominent

somatic symptoms are commonly
encountered in primary care and other
medical settings but are less commonly
encountered in psychiatric and other
mental health settings.
 DSM IV and DSM V

DSM IV term somatoform

disorders

DSM V term somatic

symptom and related
disorders
Factors of that may contribute to somatic
symptom and related disorders ;
Genetic and Biological Vulnerability (e.g.
Increased sensitivity to pain )

Early traumatic Experiences ( e.g. Violence ,

abuse , deprivation)

Learning (e.g. attention obtained from illness

,lack of reinforcement of non somatic
expressions of distress) as well as

Cultural / Social norms that devalue and

stigmatize psychological suffering as
compared with physical suffering.
Somatic Symptom Disorder

Psychological disorder in
which the symptoms take a
somatic ( bodily) form
without apparent physical
cause.

People with somatic symptom

disorder are preoccupied with
their symptoms and spend
excessive amounts of time and
energy on these symptoms
and health concerns.
Doctors diagnose the disorder when
people continue to be preoccupied
and concerned with their symptoms
after physical disorders have been
ruled out or when their response to
their physical disorder is unusually
intense.
For example, after a heart
attack, they may completely
recover physically, but they
may continue to behave as
invalids or constantly worry
about having another heart
attack.
Symptoms

People with somatic symptom disorder are preoccupied with their physical
symptoms, particularly how serious they may be.

People with somatic symptom disorder worry excessively about the

symptoms and their possible catastrophic consequences. Their worry is out
of proportion to the symptoms.

People may become dependent on others, demanding help and emotional

support and becoming angry when they feel their needs are not being met.

When their doctor tries to reassure them, they often think that the doctor is
not taking their symptoms seriously. Often dissatisfied with their medical
care, they typically go from one doctor to another or seek treatment from
several doctors at the same time.
Diagnostic Criteria

Have symptoms that worry

them excessively and/or
disrupt their daily life

Constantly think about how

serious their symptoms are

Are extremely anxious about

their health or the symptoms

Spend an excessive amount

of time and energy on the
symptoms or health concerns
 This disorder may be missed
in older people because
certain symptoms, such as
fatigue or pain, are
considered part of aging or
because worry about
symptoms is considered
understandable in older
people, who usually have
several medical problems
and take many drugs.
Illness Anxiety Disorder

people are excessively

preoccupied and worried about
the possibility of having or getting
a serious illness.

People may become overly anxious

because they misinterpret
insignificant physical symptoms or
normal bodily functions (such as
awareness of the heart's beating).
Symptoms

People are so preoccupied with the idea that they

are or might become ill that they become very
distressed and unable to function. As a result,
personal relationships and work performance
deteriorate.

People who are excessively concerned about the

symptoms themselves may have somatic symptom
disorder. If people with illness anxiety disorder have a
physical disorder, their anxiety is out of proportion to
the seriousness of the disorder.
Symptoms

Some people examine themselves

repeatedly. For example, they may check
their pulse repeatedly to see if their heart
beat is regular. They are easily frightened by
new bodily sensations.

Some people with illness anxiety disorder

seek medical care frequently. Others are
too anxious to seek it.
Diagnosis

A doctor's evaluation
Doctors suspect illness anxiety disorder when
people are overly anxious about whether or
not they have a serious disorder. Doctors do
a thorough evaluation to determine
whether a physical disorder is present.
Doctors also evaluate people for depression
and other mental health disorders.
Illness Anxiety Disorder
Diagnostic Criteria

A. Preoccupation with having or acquiring a serious illness.

B. Somatic symptoms are not present or, if present, are only

mild in intensity. If another medical condition is present or
there is a high risk for developing a medical condition (e.g.,
strong family history is present), the preoccupation is clearly
excessive or disproportionate.

C. There is a high level of anxiety about health, and the

individual is easily alarmed about personal health status.
D. The individual performs excessive health-related
behaviors (e.g., repeatedly checks his or her body for signs
of illness) or exhibits maladaptive avoidance (e.g., avoids
doctor appointments and hospitals).

E. Illness preoccupation has been present for at least 6

months, but the specific illness that is feared may change
over that period of time.

F. The illness-related preoccupation is not better explained

by another mental disorder, such as somatic symptom
disorder, panic disorder, generalized anxiety disorder,
body dysmorphic disorder, obsessive-compulsive disorder,
or delusional disorder, somatic type.
Conversion Disorder (functional
neurological symptom disorder

Conversion disorder is a form of

somatization, in which mental
factors are expressed as physical
symptoms.
Conversion Disorder (functional neurological symptom disorder

Conversion disorder is thought to be caused

by mental factors, such as stress and conflict,
which people with this disorder experience as
(convert into) physical symptoms.
Symptoms

The symptoms of
conversion disordersuch
as paralysis of an arm or
leg or loss of sensation in
a part of the body
suggest nervous system
dysfunction. Other
symptoms may resemble
a seizure or involve
problems with thinking,
difficulty swallowing, or
loss of one of the special
senses, such as vision or
hearing.
Diagnosis
A. One or more symptoms of altered voluntary
motor or sensory function
B. Clinical findings provide evidence of
incompatibility between the symptoms and
recognized neurological or medical conditions.
C. The symptom or deficit is not better explained
by another medical or mental disorder .
D. The symptom or deficit causes clinically
significant distress or impairment in social ,
occupational, or other important areas of
functioning or warrants medical evaluation.
Psychological Factors affecting Other
Medical Conditions
People's attitudes or
behavior can negatively
affect any disorder (such as
diabetes mellitus, heart
disease, or migraines) or
symptom (such as pain).
Attitudes and behavior can
make a disorder or
symptoms worse, sometimes
resulting in hospitalization or
a visit to an emergency
department.
For example, severe stress can temporarily
weaken the heart, or chronic work-related
stress can increase the risk of high blood
pressure. The risk of suffering, death, or
disability due to the disorder can be
increased.
Factors that can worsen a medical condition include the
following:

Denying the significance or severity of

symptoms
Denying the need for treatment
Not following the prescribed treatment plan
Not getting the recommended tests
Factitious Disorder

is pretending to have or
producing physical or
psychological symptoms
for no apparent external
reason.
Symptoms

People with factitious disorder imposed on

self may report physical symptoms that
suggest a particular disorder, such as chest
pain that resembles a heart attack.

They often know a lot about the disorder

they are pretending to havefor example,
that pain from a heart attack may spread
from the chest to the left arm or jaw.
Cont.

They may change medical records to

provide evidence that they have a disorder.
Sometimes they do something to themselves
to produce the symptom. For example, they
may prick a finger and put the blood in a
urine specimen. Or they may inject bacteria
under their skin to produce a fever and
sores.
Factitious Disorder Imposed on Self

A. Falsification of physical or psychological

signs or symptoms , or introduction of injury
or disease , associated with identified
deception.
B. The individual presents himself or herself to
others as ill, impaired , or injured
C. The Deceptive behavior is evident even in
the absence of obvious external rewards.
D. The Behavior is not better explained by
another mental disorder , such as delusional
disorder or another psychotic disorder.
Factitious Disorder Imposed on Another

A. Falsification of physical or psychological

signs or symptoms , or induction of injury or
disease, in another , associated with
identified deception .
B. The individual presents another individual (
victim to others as ill , impaired , or injured
C. The deceptive behavior is evident even in
the absence of obvious external rewards.
D. The behavior is not better explained by
another mental disorder , such as delusional
disorder or another psychotic disorder.
 Other Specified Somatic Symptom and Related Disorder

This category applies to presentations in which symptoms

characteristic of a somatic symptom and related disorder that cause
clinically significant distress or impairment in social, occupational, or
other important areas of functioning predominate but do not meet the
full criteria for any of the disorders in the somatic symptom and
related disorders diagnostic class.
Examples of presentations that can be specified using the other
specified designation include the following:
1. Brief somatic symptom disorder: Duration of symptoms is less than
6 months.
2. Brief illness anxiety disorder: Duration of symptoms is less than 6
months.
3. Illness anxiety disorder without excessive health-related behaviors:
Criterion D for illness anxiety disorder is not met.
4. Pseudocyesis: A false belief of being pregnant that is associated with
objective signs and reported symptoms of pregnancy.

Unspecified Somatic Symptom and Related Disorder

This category applies to presentations in which symptoms
characteristic of a somatic symptom and related disorder that
cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the
disorders in the somatic symptom and related disorders
diagnostic class. The unspecified somatic symptom and related
disorder category should not be used unless there are decidedly
unusual situations where there is insufficient information to
make a more specific diagnosis.