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{{Infobox medical condition (new)
| name = Somatic symptom disorder
| synonyms = Somatoform disorder, somatization disorder
| field = [[Psychiatry]], [[psychology]]
| symptoms = [[Maladaptation|Maladaptive]] thoughts, feelings, and behaviors in response to chronic physical symptoms.<ref name=merck/>
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}}
'''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 deliberately produced or [[Feigned disease|feigned]], and they may or may not coexist with a known medical ailment.<ref name=merck/>
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/>
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[[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 stimuli that may cause [[Tissue (biology)|tissue damage]], pain is a conscious experience requiring [[Cerebral cortex|cortical]] activity and can occur in the absence of nociception.<ref name=biosocial/> Those with somatic symptoms are thought to exaggerate their somatic symptoms through choice perception and perceive them in accordance with an ailment. This idea has been identified as a [[Cognition|cognitive]] style known as "somatosensorial amplification".<ref name=somatosensorialamplification>{{cite journal|first1=A. J.|last1=Barsky|title=Amplification, somatization, and the somatoform disorders|journal=Psychosomatics |date=1992 |issn=0033-3182|pages=28–34|volume=33|issue=1|pmid=1539100|doi=10.1016/S0033-3182(92)72018-0|doi-access=free}}</ref> The term "[[central sensitization]]" has been created to describe the [[Neuroscience|neurobiological]] notion that those predisposed to somatization have an overly sensitive [[neural network]]. Harmless and mild [[Stimulus (physiology)|stimuli]] stimulate the [[Nociception|nociceptive]] specific [[posterior grey column|dorsal horn cells]] after [[central sensitization]]. As a result, pain is felt in response to stimuli that would not typically cause pain.<ref name=biosocial/>
===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 | vauthors = Stein DJ, Muller J | 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 | pages = 379–384 | date = May 2008 | pmid = 18496475 | doi = 10.1017/S1092852900016540 | s2cid = 9660237 }}</ref><ref name="pmid19553880">{{cite journal | vauthors = García-Campayo J, Fayed N, Serrano-Blanco A, Roca M | title = Brain dysfunction behind functional symptoms: neuroimaging and somatoform, conversive, and dissociative disorders | journal = Current Opinion in Psychiatry | volume = 22 | issue = 2 | pages = 224–231 | date = March 2009 | pmid = 19553880 | doi = 10.1097/YCO.0b013e3283252d43 | s2cid = 34380841 }}</ref>
===Genetic===
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Specific tests, such as [[Thyroid function tests|thyroid function]] assessments, [[Drug test|urine drug screens]], restricted blood studies, and minimal [[Medical imaging|radiological imaging]], may be conducted to rule out somatization because of medical issues.<ref name=StatPearls/>
===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]], [[headache]]s, [[chest pain]] or [[shortness of breath]], [[dizziness]], [[Fatigue|feeling tired or having low energy]], and [[Insomnia|trouble sleeping]] impacted them in the preceding seven days. Ratings are added together to provide a sum score that ranges from 0 to 32 points.<ref name=sss8/>
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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/> Because the somatic symptomatic may have a low threshold for [[Adverse effect|adverse reactions]], medication should be started at the lowest possible dose and gradually increased to produce a [[therapeutic effect]].<ref name=StatPearls/>
[[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 depression.<ref name="Liu Gill Teodorczuk Li 2019 pp. 98–112">{{cite journal | last1=Liu | first1=Jing | last2=Gill | first2=Neeraj S. | last3=Teodorczuk | first3=Andrew | last4=Li | first4=Zhan-jiang | last5=Sun | first5=Jing | title=The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials | journal=Journal of Affective Disorders | publisher=Elsevier BV | volume=245 | year=2019 | issn=0165-0327 | doi=10.1016/j.jad.2018.10.114 | pages=98–112| pmid=30368076 | hdl=10072/380915 | s2cid=53113252 | hdl-access=free }}</ref><ref>{{Cite journal|title=Non-pharmacological Interventions for Somatoform Disorders and Medically Unexplained Physical Symptoms (MUPS) in Adults|last1=N|first1=van Dessel|last2=M|first2=den Boeft|date=2014-11-01|language=en|pmid=25362239|last3=Jc|first3=van der Wouden|last4=M|first4=Kleinstäuber|last5=Ss|first5=Leone|last6=B|first6=Terluin|last7=Me|first7=Numans|last8=He|first8=van der Horst|last9=H|first9=van Marwijk|journal=The Cochrane Database of Systematic Reviews|issue=11|pages=CD011142|doi=10.1002/14651858.CD011142.pub2|pmc=10984143}}</ref><ref name=Psychopharmacotherapy/> CBT aims to help patients realize their ailments are not catastrophic and to enable them to gradually return to activities they previously engaged in, without fear of "worsening their symptoms". Consultation and collaboration with the [[primary care physician]] also demonstrated some effectiveness.<ref name=Kurt>{{cite journal | vauthors = Kroenke K | title = Efficacy of treatment for somatoform disorders: a review of randomized controlled trials | journal = Psychosomatic Medicine | volume = 69 | issue = 9 | pages = 881–888 | date = December 2007 | pmid = 18040099 | doi = 10.1097/PSY.0b013e31815b00c4 | s2cid = 28344833 }}</ref><ref name="pmid3084975">{{cite journal | vauthors = Smith GR, Monson RA, Ray DC | title = Psychiatric consultation in somatization disorder. A randomized controlled study | journal = The New England Journal of Medicine | volume = 314 | issue = 22 | pages = 1407–1413 | date = May 1986 | pmid = 3084975 | doi = 10.1056/NEJM198605293142203 }}</ref> Furthermore, brief [[Interpersonal psychotherapy|psychodynamic interpersonal psychotherapy]] (PIT) for patients with somatic symptom disorder has been proven to improve the physical quality of life in patients with many, difficult-to-treat, medically unexplained symptoms over time<ref name=PIT>Sattel H, Lahmann C, Gundel H, Guthrie E, Kruse J, Noll-Hussong M, Ohmann C, Ronel J, Sack M, Sauer N, Schneider G, Henningsen P. Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial. The British Journal of Psychiatry. 2012;200(1):60-7.</ref>
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>
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* 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 | vauthors = Zorumski CF, Rubin EH, Burke WJ | title = Electroconvulsive therapy for the elderly: a review | journal = Hospital & Community Psychiatry | volume = 39 | issue = 6 | pages = 643–647 | date = June 1988 | pmid = 3042587 | doi = 10.1176/ps.39.6.643 }}</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 |vauthors=Kenny M, Egan J| 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==
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==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://medilib.ir/uptodate/show/109552|website=medilib.ir}}</ref> In the primary care patient population, the rate rises to around 17%.<ref name=StatPearls/> Patients with functional illnesses such as fibromyalgia, irritable bowel syndrome, and [[chronic fatigue syndrome]] have a greater prevalence of somatic symptom disorder. The reported frequency of somatic symptom disorder, as defined by DSM-5 criteria, ranges from 25 to 60% among these patients.<ref name=uptodate/>
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| vauthors = Canino G, Bird H, Rubio-Stipec M, Bravo M |title= The epidemiology of mental disorders in the adult population of Puerto Rico |journal= Revista Interamericana de Psicologia. |volume=34 |issue=1X |pages= 29–46 |year=2000}}</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 | vauthors = Noyes R, Stuart S, Watson DB, Langbehn DR | title = Distinguishing between hypochondriasis and somatization disorder: a review of the existing literature | journal = Psychotherapy and Psychosomatics | volume = 75 | issue = 5 | pages = 270–281 | date = 2006 | pmid = 16899963 | doi = 10.1159/000093948 | s2cid = 38387817 }}</ref>
There is usually co-morbidity with other psychological disorders, particularly [[mood disorders]] or [[anxiety disorders]].<ref name=dsm/><ref>{{cite journal | vauthors = Lieb R, Meinlschmidt G, Araya R | title = Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: an update | journal = Psychosomatic Medicine | volume = 69 | issue = 9 | pages = 860–863 | date = December 2007 | pmid = 18040095 | doi = 10.1097/psy.0b013e31815b0103 | s2cid = 25319341 }}</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| vauthors = Bornstein RF, Gold SH |title=Comorbidity of personality disorders and somatization disorder: A meta-analytic review |journal=Journal of Psychopathology and Behavioral Assessment |volume=30 |issue=2 |pages=154–161 |year=2008 |doi=10.1007/s10862-007-9052-2|s2cid=143736408 }}</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| vauthors = Stern T |title=Massachusetts General Hospital comprehensive clinical psychiatry|url=https://archive.org/details/massachusettsgen00mdth_150|url-access=limited|year=2008|publisher=Mosby/Elsevier|location=Philadelphia, PA|isbn=9780323047432|page=[https://archive.org/details/massachusettsgen00mdth_150/page/n336 323]|edition=1st}}</ref>
==History==
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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 hysteria in women and hypochondria in males as brain disorders. [[Thomas Sydenham]] contributed significantly to the belief that hysteria and hypochondria are mental rather than physical illnesses. The term "English Malady" was used by [[George Cheyne (physician)|George Cheyne]] to denote that hysteria and hypochondriasis are brain and/or mind-related disorders.<ref name=biosocial/>
[[Wilhelm Stekel]], a German [[Psychoanalysis|psychoanalyst]], was the first to introduce the term somatization, and [[Paul Briquet]] was the first to characterize what is now known as Somatic symptom disorder.<ref name=biosocial/> [[Paul Briquet|Briquet]] reported respondents who had been unwell for most of their lives and complained of a variety of symptoms from various organ systems. Despite many appointments, hospitalizations, and tests, symptoms continue.<ref>{{Cite web|url=https://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Somatization.pdf|title=Briquet's Syndrome (somatization disorder, DSM-IV- TR #300.81)}}</ref>
==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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