Somatic symptom disorder

Disorder manifested by persistent somatic symptoms present for at least six months that disrupt patient’s daily life.

Diagnostic and Statistical Manual of Mental Disorders (DCM-5) SSD.

Characterized by multiple medically unexplained physical symptoms, there is serious enough to significantly interfere with the patient’s ability to perform daily activities.

Symptoms may or may not be associated with another medical condition.

Diagnosis used to require a certain number of symptoms to be present from other symptom groups: pain, gastrointestinal, sexual/reproductive, and pseudo-neurological.

Process recognizes that mind and body cannot be separated.

Felt to be a purely psychiatric crisis.

Associated with persistent somatic symptoms present for at least six months that disrupt patients daily life.

Symptoms are significantly distressing or destructive to daily life and accompanied by excessive thoughts, feelings, or behaviors.

Prevalence is 6%.

Prevalence in primary care offices is approximately 10%.

Patients with SSD have higher rates of medical care use, more tests, procedures, and hospitalizations and other groups of patients.

Criteria is that the somatic symptoms must be significantly disruptive to daily life and accompanied by excessive thoughts, feelings, or behaviors.

Associated with chronic symptomatology that is distressing and

Characterized by widespread pain and fatigue.

Medically unexplained symptoms are not necessary for a somatic symptom disorder diagnosis and they may or may not be associated with an identifiable physical condition.

Acknowledges that underlying mechanisms of the symptoms are in most cases unknown.

Many of the symptoms are usually accompanied by excessive emotional reactions, and a psychiatric component is usually apparent and establishes need for psychiatric care.

Diagnosis includes the findings of: a persistent attachment to the belief that an organic illness is present with negative clinical assessments, a multiplicity of symptoms, vagueness and ambiguity of symptoms, denial of any connection between psychosocial distress and the patient’s somatic distress. expression of disappointment that physicians have that satisfactorily diagnosed their disease, and or disappointment with negative test results.

New diagnostic perspective for SSD realizes that some patients with physical conditions such as heart disease may experience disproportionate and excessive thoughts, feelings, and behaviors related to illness and they qualify, as well for, for the same diagnosis.

Patients with SSD miss significantly more time from work than control groups.

The degree of disability is equal to or greater than that associated with many other chronic medical disorders.

A screening tool commonly used is the Patient Health Questionnaire 15-item Somatic Symptom Severity Screen

Stomach pain

Back pain

Pain in the arms, legs, or joints

Menstrual cramps are of the problems with periods


Chest pain


Fainting spells

Feeling the heart pounding or racing

Shortness of breath

Pain or problems during sexual intercourse

Constipation, loose bowels, or diarrhea

Nausea, gas, or indigestion

Feeling tired or having low energy

Trouble sleeping

In the above 13 the score is or for not bothered, 1 for bothered a little, and 2 for bothered alot and for the last 2, 0 for not at all, 1 for several days, and greater than half the days the score is 2.

PHQ-15 scores of five, 10, and 15 represent low, medium, and high somatic symptom severity, respectively.

Patients with somatic symptom disorder have symptoms which are difficult to ameliorate.

Physical symptoms in patients are less responsive to treatment when disease is absent than when disease is present.

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