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{{Infobox medical condition (new)
| name = Somatic symptom disorder
| synonyms = Somatoform disorder, somatization disorder
|
| symptoms = [[Maladaptation|Maladaptive]] thoughts, feelings, and behaviors in response to chronic physical symptoms.<ref name=merck/>
| complications = [[Executive functions|Reduced functioning]], [[unemployment]], financial stress, and [[Interpersonal relationship|interpersonal]] difficulties.
| title="Content added">, not always, begins in childhood
| duration = At least
| causes = Heightened awareness of bodily sensations and the tendency to misinterpret bodily sensations.<ref name=afp/>
| risks = [[Child neglect|Childhood neglect]] and [[child abuse|abuse]], chaotic lifestyle, history of [[Substance abuse|substance]] and [[alcohol abuse]], and [[psychosocial]] stressors.<ref name=personality/>
| diagnosis = [[Psychiatric assessment]].<ref name=StatPearls/>
| differential = [[Adjustment disorder]], [[body dysmorphic disorder]], [[Obsessive–compulsive disorder|obsessive-compulsive disorder]], [[conversion disorder]], and [[Hypochondriasis|illness anxiety disorder]].<ref name=StatPearls/>
| treatment = [[Cognitive behavioral therapy|Cognitive-behavioral therapy]],<ref name=Psychopharmacotherapy/> [[psychiatric medication]], and [[Interpersonal therapy|brief psychodynamic interpersonal psychotherapy]].<ref name="PIT"/>
| medication = [[Selective serotonin reuptake inhibitor]]
| prognosis = Often chronic but can be managed with the proper treatment.<ref name=StatPearls/>
| frequency = About
}}
'''Somatic symptom disorder''', also known as '''somatoform disorder''', or '''somatization disorder''', is defined by one or more chronic physical symptoms that coincide with excessive and [[Maladaptation|maladaptive]] thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not
Manifestations of somatic symptom disorder are variable; symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms as rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing [[Chronic condition|chronic illness]] or medical condition.<ref name=mayo/>
Several studies have found a high rate of comorbidity with [[
The cause of somatic symptom disorder is unknown
==Signs and
Somatic symptom disorder can be detected by an ambiguous and often inconsistent history of symptoms that are rarely relieved by medical treatments. Additional signs of
Manifestations of
Those suffering from
Somatic symptoms disorder pertains to how an individual interprets and responds to symptoms as opposed to the symptoms themselves. Somatic symptom disorder can occur even in those who have an underlying [[Chronic condition|chronic illness]] or medical condition.<ref name=mayo/> When a somatic symptom disorder coexists with another medical ailment,
===Comorbidities===
Most research that looked at additional [[Mental disorder|mental illnesses]] or self-reported psychopathological symptoms among those with
In studies evaluating different physical ailments, 41.5% of
===Complications===
[[
==Causes==
Somatic symptoms can stem from a heightened awareness of sensations in the body, alongside the tendency to interpret those sensations as [[Disease|ailments]]. Studies suggest that risk factors of somatic symptoms include [[Child neglect|childhood neglect]], [[sexual abuse]], a chaotic lifestyle, and a history of
===Psychological===
Evidence suggests that along with more broad factors such as early [[childhood trauma]] or [[Attachment theory|insecure attachment]], negative psychological factors including [[Exaggeration|catastrophizing]], [[negative affectivity]], [[Rumination (psychology)|rumination]], [[Avoidance coping|avoidance]], [[Hypochondriasis|health anxiety]], or a poor [[Self-concept|physical self-concept]] have a significant impact on the shift from unproblematic somatic symptoms to a severely debilitating somatic symptom disorder.<ref name=empiricalevidence/>
===Psychosocial===
[[Psychosocial]] stresses and [[Social norm|cultural norms]] influence how
Those raised in environments where expressing emotions during stages of development is discouraged face the highest risk of
Traumatic life events may cause the development of somatic symptom disorder. Most people with somatic symptom disorder originate from [[Dysfunctional family|dysfunctional]] homes. A [[Meta-analysis|meta-analysis study]] revealed a connection between
===Physiological===
The [[Hypothalamic–pituitary–adrenal axis|hypothalamo pituitary adrenal axis]] (HPA) has a crucial role in [[Fight-or-flight response|stress response]]. While the [[Hypothalamic–pituitary–adrenal axis|HPA axis]] may become more active with
It has been suggested that [[Inflammation|proinflammatory]] processes may have a role in somatic symptom disorder, such as an increase of non-specific somatic symptoms and sensitivity to painful [[Stimulus (physiology)|stimuli]].<ref name=proinflammatory>{{cite journal|first1=Winfried|last1=Rief|first2=Anika|last2=Hennings|first3=Sabine|last3=Riemer|first4=Frank|last4=Euteneuer|title=Psychobiological differences between depression and somatization
[[Pain]] is a multifaceted experience, not just a sensation. While [[nociception]] refers to afferent [[Neurotransmission|neural activity]] that transmits [[Sense|sensory information]] in response to
===Neuroimaging evidence===
Some literature reviews of cognitive–affective neuroscience on somatic symptom disorder suggested that [[catastrophization]] in patients with somatic symptom disorders tends to present a greater vulnerability to pain. The relevant brain regions include the dorsolateral prefrontal, insular, rostral anterior cingulate, premotor, and parietal cortices.<ref name="pmid18496475">{{cite journal | last1=Stein | first1=Dan J. | last2=Muller | first2=Jacqueline | title=Cognitive-Affective Neuroscience of Somatization Disorder and Functional Somatic Syndromes: Reconceptualizing The Triad of Depression-Anxiety-Somatic Symptoms | journal=CNS Spectrums | volume=13 | issue=5 | date=2008 | issn=1092-8529 | doi=10.1017/S1092852900016540 | pages=379–384| pmid=18496475 }}</ref><ref name="pmid19553880">{{cite journal | last1=García-Campayo | first1=Javier | last2=Fayed | first2=Nicolas | last3=Serrano-Blanco | first3=Antoni | last4=Roca | first4=Miquel | title=Brain dysfunction behind functional symptoms: neuroimaging and somatoform, conversive, and dissociative disorders | journal=Current Opinion in Psychiatry | volume=22 | issue=2 | date=2009 | issn=0951-7367 | doi=10.1097/YCO.0b013e3283252d43 | pages=224–231| pmid=19553880 }}</ref>
===Genetic===
==Diagnosis==
Because those with somatic syndrome disorder typically have
Specific tests, such as [[Thyroid function tests|thyroid function]] assessments, [[Drug test|urine drug screens]], restricted
===Somatic Symptom Scale
{{main|Somatic Symptom Scale - 8}}
[[Somatic Symptom Scale - 8|The Somatic Symptom Scale
On a five-point scale, respondents rate how much [[Gastrointestinal disease|stomach or digestive issues]], [[Back pain|back discomfort]], pain in the legs, arms, or [[Arthralgia|joints]], [[
===DSM-5===
The fifth edition of the [[Diagnostic and Statistical Manual of Mental Disorders]] ([[DSM-5]]) modified the entry titled "somatoform disorders" to "somatic symptom and related disorders",
The
The
===International Classification of Diseases===
The [[ICD-11]] classifies somatic symptoms as "Bodily distress disorder". Bodily distress disorder is characterized by the presence of
===Differential diagnosis===
Somatic syndrome disorder's widespread, non-specific symptoms may conceal and mimic the manifestations of other medical disorders, making diagnosis and therapy challenging. [[Adjustment disorder]], [[body dysmorphic disorder]], [[Obsessive–compulsive disorder|obsessive-compulsive disorder]], and [[Hypochondriasis|illness anxiety disorder]] may all exhibit excessive and exaggerated emotional and behavioral responses. Other functional diseases with unknown [[etiology]], such as [[fibromyalgia]] and [[irritable bowel syndrome]], tend not to present with excessive thoughts, feelings, or [[Maladaptation|maladaptive]] behavior.<ref name=StatPearls/>
Somatic symptom disorder overlaps with
==Treatment==
Early [[Psychiatry|psychiatric treatment]] is advised. Evidence suggests that [[Selective serotonin reuptake inhibitor|SSRIs]] and [[Serotonin–norepinephrine reuptake inhibitor|SNRIs]] can lower pain perception.<ref name=Psychopharmacotherapy/>
[[Cognitive behavioral therapy|Cognitive-behavioral therapy]] has been linked to significant improvements in patient-reported function and somatic symptoms, a reduction in health-care expenses, and a reduction in symptoms of
CBT can help in some of the following ways:<ref name=":0">{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/basics/treatment/con-20124065|title=Somatic symptom disorder Treatments and drugs |work=Mayo Clinic|access-date=2017-04-19|language=en|url-status=live|archive-url=https://web.archive.org/web/20170419104953/http://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/basics/treatment/con-20124065|archive-date=2017-04-19}}</ref>
* Learn to reduce [[Stress (biology)|stress]]
* Learn to cope with physical symptoms
* Learn to deal with
* Improve quality of life
* Reduce preoccupation with symptom
(ECT) has been used in treating somatic symptom disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT.<ref name="pmid3042587">{{cite journal | last1=Zorumski | first1=Charles F. | last2=Rubin | first2=Eugene H. | last3=Burke | first3=William J. | title=Electroconvulsive Therapy for the Elderly: A Review | journal=Psychiatric Services | volume=39 | issue=6 | date=1988 | issn=1075-2730 | doi=10.1176/ps.39.6.643 | pages=643–647| pmid=3042587 }}</ref> Overall, psychologists recommend addressing a common difficulty in patients with somatic symptom disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner.<ref name = Kenny>{{cite journal |last1=Egan | first1=Jonathan | last2=Kenny |first2= Maeve| date = February 2011 | title = Somatization disorder: What clinicians need to know | journal = The Irish Psychologist | volume = 37 | issue = 4 | pages = 93–96 |url=http://www.lenus.ie/hse/bitstream/10147/121822/1/SomatizationDis.pdf | access-date = 9 December 2011 }}</ref>
==Outlook==
Somatic symptom disorder is typically persistent, with symptoms that wax and wane. Chronic limitations in general function, substantial psychological impairment, and a reduction in quality of life are all common.<ref name=StatPearls/> Some investigations
==Epidemiology==
Somatic symptom disorder affects 5% to 7% of the general population, with a higher female representation, and can arise throughout childhood, adolescence, or adulthood. Evidence suggests that the emergence of prodromal symptoms often begins in childhood and that symptoms fitting the criteria for somatic symptom disorder are common during adolescence. A community study of adolescents found that 5% had persistent distressing physical symptoms paired with psychological concerns.<ref name=uptodate>{{cite web|access-date=2023-08-05|title=Somatic symptom disorder: Epidemiology and clinical presentation |url=https://
There are cultural differences in the prevalence of somatic symptom disorder. For example, somatic symptom disorder and symptoms were found to be significantly more common in [[Puerto Rico]].<ref>{{cite journal | last1=Canino | first1=G. | last2=Bird | first2=H. | last3=Rubio-Stipec | first3=M. | last4=Bravo | first4=M. | title=The epidemiology of mental disorders in the adult population of Puerto Rico | journal=Puerto Rico Health Sciences Journal | volume=16 | issue=2 | date=1997 | issn=0738-0658 | pmid=9285988 | pages=117–124}}</ref> In addition the diagnosis is also more prevalent among African Americans and those with less than a high school education or lower socioeconomic status.<ref name="pmid16899963">{{cite journal | last1=Noyes | first1=Russell | last2=Stuart | first2=Scott | last3=Watson | first3=David B. | last4=Langbehn | first4=Douglas R. | title=Distinguishing between Hypochondriasis and Somatization Disorder: A Review of the Existing Literature | journal=Psychotherapy and Psychosomatics | volume=75 | issue=5 | date=2006 | issn=0033-3190 | doi=10.1159/000093948 | pages=270–281| pmid=16899963 }}</ref>
There is usually co-morbidity with other psychological disorders, particularly [[mood disorders]] or [[anxiety disorders]].<ref name=dsm/><ref>{{cite journal | last1=Lieb | first1=Roselind | last2=Meinlschmidt | first2=Gunther | last3=Araya | first3=Ricardo | title=Epidemiology of the Association Between Somatoform Disorders and Anxiety and Depressive Disorders: An Update | journal=Psychosomatic Medicine | volume=69 | issue=9 | date=2007 | issn=0033-3174 | doi=10.1097/PSY.0b013e31815b0103 | pages=860–863| pmid=18040095 }}</ref> Research also showed comorbidity between somatic symptom disorder and [[personality disorder]]s, especially [[Antisocial personality disorder|antisocial]], [[Borderline personality disorder|borderline]], [[Narcissistic personality disorder|narcissistic]], [[Histrionic personality disorder|histrionic]], [[Avoidant personality disorder|avoidant]], and [[Dependent personality disorder|dependent]] personality disorder.<ref>{{cite journal | last1=Bornstein | first1=Robert F. | last2=Gold | first2=Stephanie H. | title=Comorbidity of Personality Disorders and Somatization Disorder: A Meta-analytic Review | journal=Journal of Psychopathology and Behavioral Assessment | volume=30 | issue=2 | date=2008 | issn=0882-2689 | doi=10.1007/s10862-007-9052-2 | pages=154–161}}</ref>
About 10-20 percent of female first degree relatives also have somatic symptom disorder and male relatives have increased rates of alcoholism and sociopathy.<ref>{{cite book | last1=Stern | first1=T.A. | last2=Rosenbaum | first2=J.F. | last3=Fava | first3=M. | last4=Biederman | first4=J. | last5=Rauch | first5=S.L. | title=Massachusetts General Hospital Comprehensive Clinical Psychiatry | publisher=Elsevier Health Sciences | series=Sandoz Lectures in Gerontology | year=2008 | isbn=978-0-323-07691-3 | url=https://books.google.com/books?id=Wgs0f00plZwC | access-date=2024-07-14 | page=323}}</ref>
==History==
During the 17th century, knowledge of the [[central nervous system]] grew, giving rise to the notion that numerous inexplicable illnesses could be linked to the brain. [[Thomas Willis]], widely regarded as the father of [[neurology]], recognized
[[Wilhelm Stekel]], a German [[Psychoanalysis|psychoanalyst]], was the first to introduce the term
==Controversy==
Somatic symptom disorder has long been a contentious diagnosis because it was based solely on negative criteria, namely the absence of a medical explanation for the presenting physical problems. As a result, any person suffering from a poorly understood illness may meet the criteria for this psychological diagnosis, regardless of whether they exhibit psychiatric symptoms in the traditional sense.<ref name=DSM-5guide>{{cite book | last=Morrison
===Misdiagnosis===
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==See also==
* [[Conversion Disorder]]
* [[Jurosomatic illness]]
* [[Munchausen syndrome]]
* [[Nocebo]]
* [[Psychosomatic medicine]]
* [[Psychoneuroimmunology]]
* [[Functional neurological disorder]]
==References==
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