SOMATIC SYMPTOM AND
RELATED DISORDERS
By Dr. Noor Abdulameer
INTRODUCTION
Somatic symptom and related disorders are mental
health disorders characterized by an intense focus on
physical (somatic) symptoms that causes significant
distress and/or interferes with daily functioning.
 in somatic symptom disorders, mental factors are
expressed as physical symptoms—a process called
somatization
 (somatic—from soma, the Greek word for body
 the person's main concern is with physical symptoms, such
as pain, weakness, fatigue, nausea, or other bodily
sensations.
 The person may or may not have a medical disorder that
causes or contributes to the symptoms. However, when a
medical disorder is present, a person with somatic
symptom or a related disorder responds to it excessively.
CLASSIFICATION ACCORDING TO DSMV
1.
2.
3.
4.
5.
6.
- Somatic Symptom Disorder.
- Illness Anxiety Disorder.
- Functional Neurological Symptom Disorder.
- Psychological Factors Affecting Other Medical
Conditions.
- Factitious Disorder.
- Other Specified Somatic Symptom and Related
Disorder
SOMATIC SYMPTOM DISORDER
Somatic symptom disorder, also known as hypochondriasis
The diagnostic criteria for Somatic Symptom Disorder noted in DSM
5 are:
1. One or more somatic symptoms that are distressing or result in
significant disruption of daily life.
2. Excessive thoughts, feelings, or behaviours related to the somatic
symptoms or associated health concerns as manifested by at least
one of the following:
A.
B.
C.
Disproportionate and persistent thoughts about the
seriousness of one’s symptoms.
Persistently high level of anxiety about health or symptoms.
Excessive time and energy devoted to these symptoms or health
concerns.
3. Although any one somatic symptom may not be continuously
present, the state of being symptomatic is persistent (typically more
than 6 months).
MANAGEMENT
Establish regular visits with a single primary
care physician in order to minimize unnecessary
testing and procedures.
 Gradually begin to address psychological issues
with psychotherapy.
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ILLNESS ANXIETY DISORDE
The diagnostic criteria for Illness Anxiety Disorder noted in DSM 5 are:
1.
Preoccupation with having or acquiring a serious illness.
2.
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.
3.
There is a high level of anxiety about health, and the individual is
easily alarmed about personal health status.
4.
The individual performs excessive health-related behaviours (e.g.,
repeatedly checks his or her body for signs of illness) or exhibits
maladaptive avoidance (e.g, avoids doctor appointments and
hospitals).
5.
Illness preoccupation has been present for at least 6 months, but the
specific illness that is feared may change over that period of time.
6.
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, obsessivecompulsive disorder, or delusional disorder, somatic type.
Care-seeking type: Medical care, including
physician visits or undergoing tests and
procedures, is frequently used.
Care-avoidant type: Medical care is rarely used.
The important distinction between Illness Anxiety
Disorder and Somatic Symptom Disorder is that
with the former, the individual’s distress emanates
not primarily from the physical complaint itself but
rather from his or her anxiety about the meaning,
significance, or cause of the complaint.
MANAGEMENT
Cognitive-behavioral therapy
 Schedule regular visits to one primary care
physician.
 Treat comorbid disorders (e.g., depression), if
present.
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CONVERSION DISORDER (FUNCTIONAL
NEUROLOGICAL SYMPTOM DISORDER)
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Patients with conversion disorder (also known
as functional neurological symptom disorder )
present with neurological symptoms that
cannot be fully explained by a neurological
condition.
Motivation is unconscious; symptoms are not
intentionally produced (as opposed to factitious
disorders)
Unlike in somatic symptom disorder, patients
with conversion disorder may be calm and
unconcerned when describing their symptoms
(this is referred to as “la belle indifference”).
DIAGNOSIS OF CONVERSION DISORDER
The diagnostic criteria for Conversion Disorder noted in
DSM 5 are:
1.
2.
3.
4.
One or more symptoms of altered voluntary motor or
sensory function.
Clinical findings provide evidence of incompatibility
between the symptom and recognized neurological
or medical conditions.
The symptom or deficit is not better explained by
another medical or mental disorder.
The symptom or deficit causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning or warrants
medical evaluation.
DIFFERENTIAL DIAGNOSIS.
The most common conditions are described below.
1. Paralysis. It is inconsistent and does not follow motor pathways.
Spastic paralysis, clonus, and cogwheel rigidity are also absent in
conversion disorder.
2. Ataxia. Movements are bizarre in conversion disorder. In organic
lesions leg may be dragged and circumduction not possible. Astasia–
abasia is an inconsistency patterned, unsteady gait that does not
cause the patient with conversion disorder to fall or sustain injury.
3. Blindness. No pupillary response is seen in true neurologic blindness
(except note that occipital lobe lesions can produce cortical blindness
with intact pupillary response). Tracking movements are also absent
in true blindness. Monocular diplopia, triplopia, and tunnel vision can
be conversion complaints. Ophthalmologists use tests with distorting
prisms and colored lenses to detect hysterical blindness.
4. Deafness. Loud noise will awaken sleeping patient with conversion
disorder but not patient with organic deafness. Audiometric tests
reveal varying responses in conversion.
5. Sensory. On examination, reported sensory loss
does not follow anatomic distribution of
dermatomes, that is, hemisensory loss, which stops
at midline, or glove-and-stocking anesthesia in
conversiondisorder
6. Hysterical. Pain most often relates to head, face,
back, and abdomen.
No organic cause for pain in evidence.
7. Pseudoseizures. Incontinence, loss of motor
control, and tongue biting are rare in
pseudoseizures; an aura usually is present in
organic epilepsy. Look for abnormal
electroencephalogram (EEG); however,
EEG results are abnormal in 10% to 15% of the
normal adult population. Babinski’s sign occurs in
organic seizure and postictal state but not in
conversion seizures.
DIFFERENCES BETWEEN SEIZURE AND
PSEUDOSEIZURE
TREATMENT
Resolution of the conversion disorder
symptom is usually spontaneous, although it is
probably facilitated by insight-oriented supportive
or behavior therapy.
Pharmacologic: These include benzodiazepines
for anxiety and muscular tension; antidepressants
or serotonergic agents for obsessive rumination
about symptoms.
PROGNOSIS
Factors which favour a good prognosis include:
 High intelligence
 Good premorbid function
 Acute onset
 Clear stressor as a precipitant
FACTITIOUS DISORDER
It is defined as intentional report and
misrepresentation of symptoms, or self-infliction
of physical signs of symptoms, of medical or
mental disorders.
 The only apparent objective is to assume the role
of a patient without an external incentive.
 Hospitalization is often a primary objective and a
way of life.
 The disorders have a compulsive quality, but the
behaviors are deliberate and voluntary, even if they
cannot be controlled.
 Also known as Munchausen syndrome.

FACTITIOUS DISORDER
DSM5 diagnostic criteria of factitious disorder
1. Falsification of physical or psychological signs
or symptoms, or induction of injury or disease,
associated with identified deception.
2. The individual presents himself or herself to
others as ill, impaired, or injured.
3. The deceptive behavior is evident even in the
absence of obvious external rewards.
4. The behavior is not better explained by another
mental disorder, such as delusional disorder or
another psychotic disorder.
Of two types:
1. Factitious disorder imposed on self
- Previously known as Munchhausen syndrome.
- Individuals intentionally falsify physical signs and
symptoms, even through self-harm (e.g.,
injecting insulin ), to assume the role of a patient.
2. Factitious disorder imposed on another
- Previously known as Münchhausen syndrome by
proxy.
- Patients intentionally produce symptoms in
someone else (usually their child or aging parent).
- Type of child or elder abuse.
MANAGEMENT
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Confront the patient in a non-threatening
manner.
Avoid unnecessary referral to avoid
unnecessary procedures.
Treat the perpetrator (if imposed on self or on
another).
Psychotherapy and/or parenting classes
Assess for comorbid conditions.
Monitor pharmacotherapy intake.
Treat the victim (if imposed on another).
Provide a safe place from the perpetrator (e.g.,
call child protective services).
Psychotherapy, depending on the child's age
Exclude other forms of abuse or neglect if
suspected.
Thanks