SOMATIC SYMPTOMS

SOMATIC SYMPTOM DISORDER

CONVERSION & PAIN
DISORDER
BODY DYSMORPHIC DISORDER
SOMATIZATION DISORDER

SOMATIC
SYMPTOM
DISORDER
SITI NUR BAITI BINTI SHAIK KHAMARUDIN
012013100196

OUTLINE
Introduction
Epidemiology
Etiology
Diagnosis
Clinical features
Differential diagnosis
Course and prognosis
Treatment

INTRODUCTION
Somatic symptom disorder, also known as
hypochondriasis, is characterized by 6 or more
months of
a general and non-delusional preoccupation
(concern) with fears of having or the idea that
one has a serious disease based on the persons
misinterpretation of bodily symptoms.

This preoccupation causes significant distress &

impairment
Not accounted for by another psychiatric/medical
disorder
Some has poor insight about the presence of this
disorder.

EPIDEMIOLOGY
4-6% up to 15% reports.
Men and women are equally affected.
Onset of symptoms at any age, commonly
appears in 20-30s.
Common among blacks than whites.
In 3% of medical students, usually in first 2
years but transient.

ETIOLOGY
(A)Patients augment and amplify somatic
sensation due to:
Low thresholds for physical discomfort
Low tolerance of physical discomfort
E.g., normal person perceives as abdominal pressure
but SSD patient sees as abdominal pain.
Focus on bodily symptoms, misinterpret and become
alarmed (faulty cognitive scheme).

(B)Symptoms are viewed as a request for

admission to the sick role:
Sick role offers an escape that allows a patient to
avoid noxious obligation, postpone unwelcome
challenges and to be excused from usual duties &
obligation.

(C)80% may have co-existing

depressive/anxiety disorders.
(D)Psychodynamic school of thought:
Aggressive and hostile wishes towards
others are transferred into physical
complaints

The anger originates in past disappointments,

rejection and losses.
But expressed in present by soliciting the help
and concern of others, reject as ineffective.

(E)Viewed as a defense against guilt, a sense

of innate badness, an expression of low selfesteem and sign of excessive self-concern.

As deserved punishment for past wrongdoing

(real/imaginary) & sense of wickedness and
sinfulness.

DIAGNOSIS

DIAGNOSIS
Preoccupied with false belief that they have a
serious disease based on their misinterpretation of
physical signs/sensation.
Belief must last at least 6 months despite the
absence of pathological findings on medical &
neurological examination.
Belief cannot have intensity of delusion
(delusional disorder) and cannot be restricted to
distress about appearance (body dysmorphic
disorder).
Symptoms must be sufficiently intense to cause
emotional distress or impair ones ability to
function in important area of life.
Clinicians may specify the presence of poor
insight:

CLINICAL FEATURES
1) Patients with SSD believe that they have a serious disease
that has not been detected , cannot be persuaded by
contrary.
2) They maintain a belief and might transfer to another
disease as time progresses:
Despite -ve lab tests and appropriate reassurance.
Belief is not sufficiently fixed to be delusion.

3) Often accompanied by symptoms of depression &

anxiety.
4) Transient manifestation can occur after a major stress,
most commonly death & serious illness thats been
resolved:
Response to external stress generally remit after stress is
resolved.

5) If < 6 months, diagnose as other specified somatic

symptom and related disorders in DSM-5 (pg 166).

DIFFERENTIAL DIAGNOSIS
1) Must be differentiated from non-psychiatric medical
conditions:
Especially disorders showing not necessarily easily diagnosed
symptoms (eg, AIDS, endocrinopathies, Myasthenia Gravis,
Multiple Sclerosis, SLE)

2) Differentiated from Illness Anxiety Disorder

By emphasis on fear of having a disease rather than concern
about may symptoms.
Fewer symptoms complaints in IAD, primarily concerned about
being sick.

3) Conversion disorder
Acute, generally transient, involves a symptom rather than a
particular disease.

4) Body dysmorphic disorder

Wish to appear normal, but believe
that others notice that they are not
Those in SSD seek out attention for
presumed disease

5) Co-existing depressive &

anxiety disorders
6) Panic disorder
) Careful history uncovers classic
symptoms of panic attack

7) Delusional disorder
) Delusional intensity + psychotic
symptoms

8) Factitious disorder
) With physical symptoms

9) Malingering
) SSD patients do actually
experience, they dont stimulate.

COURSE & PROGNOSIS

Course is usually episodic:
From months to years, separated by equally long
quiescent periods.

One third to one half of all patients eventually

improve significantly.
Good prognosis is associated with:
High socioeconomic status, treatment-responsive
anxiety/depression
Sudden onset of symptoms
Absence of personality disorder
Absence of related non-psychiatry medical condition.

Most children recover by late adolescence or early

adulthood.

TREATMENT
1. Psychotherapy
- Group psychotherapy
- Provide social support and social interaction
that can reduce the anxiety
- Individual insight-oriented psychotherapy
- Hypnosis and behaviour therapy
- To induce relaxation
2. Pharmacotherapy
Given when the patient have comorbid anxiety
and depressive disorder
If the somatic symptoms secondary to another
primary mental disorder

REFERENCE
Benjamin James Sadock, et al. Somatic
Symptom Disorder. Kaplan & Sadocks
Synopsis of Psychiatry. 2015; 13.2:
468-471.
Somatic Symptom and Related
Disorder. Desk Reference to the
Diagnostic Criteria from DSM-5. 161162