Somatic Disorders

Somatic symptom disorder, also known as hypochondriasis, is a condition in which individuals feel extremely distressed about their health and have excessive thoughts, feelings, and behaviors relating to their physical symptoms. 

A diagnosis of somatic symptom disorder requires at least one of the following symptoms:

• Extreme and persistent thoughts about the seriousness of one’s symptoms.
• Persistently high level of anxiety about one’s health or symptoms.
• Excessive time and energy devoted to the symptoms or health concerns.

To be classified as a disorder, the symptoms typically persist for more than 6 months, although any one somatic symptom may not be continuously present. Different degrees of somatic symptom disorders may be diagnosed. These include:

• Mild, if only one of the three main symptoms is present
• Moderate, if two or more of the symptoms are present
• With predominant pain, if the somatic symptoms mostly involve pain
• Persistent, if there are severe symptoms, marked impaired, and long duration (more than 6 months)
• Severe, if two or more main symptoms are present with multiple somatic complaints

Somatic symptom disorder must be differentiated from nonpsychiatric medical conditions, especially disorders that show symptoms that are not easily diagnosed. These include AIDS, endocrinopathies, myasthenia gravis, multiple sclerosis, degenerative diseases of the nervous system, and lupus.

Patients with somatic symptom disorder often resist psychiatric treatment. However, they may accept therapy that focuses on stress reduction and education in coping with chronic illness. Group psychotherapy is often beneficial, in part because of the social support it provides. Other types of therapy that may be helpful include insight-oriented psychotherapy, behavior therapy, cognitive therapy, and hypnosis.

Pharmacotherapy may help treat a person with somatic symptom disorder only when the patient has an underlying drug-responsive condition, such as an anxiety disorder or depressive disorder.

Illness anxiety disorder is a newer diagnosis that applies to individuals who are preoccupied with being sick or with developing a disease of some kind. It is a variant of somatic symptom disorder (hypochondriasis). However, somatic symptoms are either not present, or present at a mild degree. If another medical condition is present or if there is a high risk for developing a medical condition (e.g., strong family history is present) the preoccupation is clearly excessive.

A diagnosis for illness anxiety disorder also requires the following factors:

• A high level of anxiety about one’s health with the individual easily alarmed about personal health status
• Excessive health-related behaviors (e.g., repeatedly checks is or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
• Illness-related preoccupation has been present for at least 6 months, but the feared illness may change over that period of time.
• 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.

As with somatic symptom disorder, patients with illness anxiety disorder often resist psychiatric treatment. However, they may accept therapy that focuses on stress reduction and education in coping with chronic illness. Group psychotherapy is often beneficial, in part because of the social support it provides. Other types of therapy that may be helpful include insight-oriented psychotherapy, behavior therapy, cognitive therapy, and hypnosis.

Pharmacotherapy may help alleviate the anxiety generated by the fear the patient has about illness, especially if it is one that is life-threatening.

Conversion disorder, also called functional neurological symptom disorder, is an illness of one or more symptoms that affect voluntary motor functions (e.g., breathing or walking) or sensory functions (e.g., touch, pressure, temperature, pain.)

A diagnosis of conversion disorder requires the following factors:

• There is a mismatch between the symptom(s) and any recognized neurological or medical conditions the individual may have.
• The symptoms are not better explained by another medical or mental disorder.
• The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

A diagnosis of conversion order may be specified with any of the following symptom types:

• With weakness or paralysis
• With abnormal movement (e.g., tremor, dystonic movement, involuntary muscle movements, gait disorder)
• With swallowing problems
• With speech problems
• With attacks or seizures
• With anesthesia or sensory loss
• With special sensory symptom (e.g., visual, olfactory, of hearing problem)
• With mixed symptoms

Yes, in fact, there is a diagnosis for “psychological factors affecting other medical conditions.” This diagnosis is given when a medical symptom or condition (other than a mental disorder) is present, with psychological or behavioral factors adversely affecting the medical condition in one of the following ways:

• The psychological or behavioral factors have influenced the course of the medical condition, contributing to its development, exacerbation or delayed recovery.
• The factors interfere with the treatment of the medical condition (e.g., poor adherence).
• The factors constitute well-established health risks for the individual.
• The factors influence the underlying condition, causing or exacerbating symptoms, or requiring medical attention.

The diagnosis also requires that the psychological and behavioral factors are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, post-traumatic stress disorder).

Factitious disorder is a mental disorder in which someone deceives others by appearing sick, by purposely getting sick, or by self-injury. Factitious disorder can also happen when a person falsely presents another individual, such as a family member, as being ill, injured or impaired.

Factitious Disorder Imposed on Self

A diagnosis of factitious disorder “imposed on self” is based on:

• Falsification of physical or psychological signs or symptoms, or purposely becoming ill, as an act of deception.
• The individual presents himself or herself to others as ill, impaired, or injured.
• The deceptive behavior is evident even in the absence of obvious external rewards.
• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Factitious Disorder Imposed on Another

A diagnosis of factitious disorder “imposed on another” is based on:

• Falsification of another person’s injury or disease, including physical or psychological symptoms, through deception.
• The individual presents another person to others as ill, impaired, or injured.
• The deceptive behavior is evident even in the absence of obvious external rewards.
• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

A person be diagnosed with “other specified somatic symptom and related disorder” if the individual has somatic type symptoms that cause significant distress or impairment in social, occupational, or other important areas of functioning but the symptoms do not meet the full criteria for any of the other somatic symptom and related disorders (e.g., illness anxiety disorder, conversion disorder, factitious disorder).

Examples of situations where this “other specified” diagnosis may be used include:

• Brief somatic symptom disorder, with symptoms lasting less than 6 months.
• Brief illness anxiety disorder, with symptoms lasting less than 6 months.
• Illness anxiety disorder without excessive health-related behaviors.
• Pseudocyesis – a false belief of being pregnant that is associated with objective signs and reported symptoms or pregnancy.

The diagnosis of “other specified somatic symptom and related disorder” may be used if an individual has somatic type symptoms that cause significant distress or impairment in social, occupational, or other important areas of functioning but the symptoms do not meet the full criteria for any of the other somatic symptom and related disorders (e.g., illness anxiety disorder, conversion disorder, factitious disorder). This diagnosis is used only in unusual situations where there is insufficient information to make a more specific diagnosis.