Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 25-07: Somatic Symptom Disorders (Abnormal Illness Behaviors) + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Prominent physical symptoms may involve one or more organ systems and are associated with distress and/or impairment Sometimes able to correlate symptom development with psychosocial stresses Combination of biogenetic and developmental patterns +++ General Considerations ++ This diagnostic grouping includes conversion disorder, hypochondriasis, and somatic symptom disorder Vulnerability in an organ system and exposure to family members with somatization problems are thought to interact in the development of symptoms +++ Demographics ++ Conversion disorder is more common in lower socioeconomic classes and certain cultures Somatic symptom disorder usually occurs before age 30 and is ten times more common in women + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ A precipitating emotional event often precedes somatic symptoms Conversion disorder Psychic conflict is converted into physical neurologic symptoms The somatic symptom is often paralysis The dysfunction may have symbolic meaning (eg, arm paralysis in marked anger so the individual cannot use the arm to strike someone) Somatic symptom disorder Multiple physical complaints are referable to several organ systems Anxiety, panic disorder, and depression are often present Preoccupation with medical and surgical issues often precludes other life activities Patients have often undergone multiple surgeries and have evidence of long-standing symptoms Multiple symptoms that frequently change and have eluded diagnosis by three or more physicians support this diagnosis +++ Differential Diagnosis ++ Depression must be considered in any patient with a condition judged to be somatoform Factitious disorders, which differ from this grouping in that symptom production is intentional Intoxication states + Diagnosis Download Section PDF Listen +++ +++ Diagnostic Procedures ++ In conversion disorder with pseudoseizures, video-electroencephalography may be necessary to rule out epilepsy Since all somatic disorders are diagnoses of exclusion, a workup sufficient to rule out physical illness is required + Treatment Download Section PDF Listen +++ +++ Medications ++ Medications should not be prescribed in place of frequent appointments +++ Therapeutic Procedures ++ Behavioral therapy Biofeedback can be helpful in training patients to recognize symptoms and learn countermaneuvers that provide relief Psychotherapy Psychological intervention by the primary clinician should focus on pragmatic changes Analytic approaches focused on exploration of early experiences often fail, since patients do not relate these to their current distress Cognitive-behavioral therapy has been shown to be an effective treatment for somatoform disorders by reducing physical symptoms, psychological distress and disability Group therapy sometimes allows ventilation, improves coping, and focuses on interpersonal adjustment Conversion disorder is sometimes helped by hypnosis or amobarbital interviews Social therapeutic procedures Family members should attend appointments to learn how best to live with the patient Peer support groups can encourage patients to accept and live with their problem Communication with employers may be necessary to encourage long-term interest in the employee/patient + Outcome Download Section PDF Listen +++ +++ Follow-Up ++ Regular appointments are helpful. These should be brief and not contingent on symptoms Care should be consolidated under a primary clinician, with consultants for evaluation only Ongoing reevaluation is important Somatic symptom disorders may coexist with physical illness, which can be overlooked +++ Prognosis ++ Intervention is most successful when instituted before chronicity develops + References Download Section PDF Listen +++ + +den Boeft M et al. How should we manage adults with persistent unexplained physical symptoms? BMJ. 2017 Feb 8;356:j268. [PubMed: 28179237] + +Henningsen P. Management of somatic symptom disorder. Dialogues Clin Neurosci. 2018 Mar;20(1):23–31. [PubMed: 29946208] + +Liu J et al. The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: a meta-analysis of randomized controlled trials. J Affect Disord. 2019 Feb 15;245:98–112. [PubMed: 30368076]