Somatoform Disorder

Somatizers generate 9 times the average medical cost
Despite medical attention, somatizers highly disabled
Physicians report frustration in treating somatizers
1. Lack sense of effectiveness
2. Patient does not fit into standard diagnoses
3. Patient does not fit into standard office schedule

Sensory amplification
1. Preoccupation with disease focuses on body Sensations
2. Normal variations in senses interpreted as abnormal
3. Exacerbates anxiety and panic, as well as discomfort
Identified patient within a dysfunctional family
1. Family dysfunction transferred to the patient
2. Patient's "illness" stabilizes family
3. Other family member's anxiety relieved
Need to be sick
1. Patient pursues sick role to relieve stressors
2. Not the same as Malingering or faking symptoms
  1. Somatizing Patient unaware of symptom generation
Dissociation
1. Activation of Pain Sensation without physical pain

Conversion Disorder
1. At least one symptom altered voluntary motor or sensory function inconsistent with known condition
Factitious Disorder
1. Falsification of physical or psychological symptoms or induced injury or disease in self or another
2. Unlike Malingering, not for personal gain
Illness Anxiety Disorder (previously part of Hypochondriasis)
1. Preoccupation with either contracting or having a serious medical disorder
2. Includes care-seeking subtype and care-avoidant subtype
Body Dysmorphic Disorder
Pain Disorder
1. Now included in Somatic Symptom Disorder
2. Predominant pain (previously known as Pain Disorder)

At least one somatic symptom that is distressing or significantly disrupting life
At least one of the following excessive thoughts, feelings or behaviors related to somatic symptoms
1. Disproportionate and persistent thoughts about the seriousness of one's own symptoms
2. Persistently high level of anxiety about health or symptoms
3. Excessive time and energy devoted to these symptoms or health concerns
Symptomatic state persists regardless for at least 6 months (even if one symptom is not continuously present)
Additional characteristics
1. Predominant pain (previously known as Pain Disorder)
2. Persistent (severe with marked Impairment for >6 months)
3. Severity
  1. Mild
    1. Only 1 symptom from the excessive thoughts, feelings or behaviors list
  2. Moderate
    1. Two or more symptoms from the excessive thoughts, feelings or behaviors list
  3. Severe
    1. Two or more symptoms from the excessive thoughts, feelings or behaviors list AND
    2. Multiple Somatic Complaints OR one very severe somatic symptom
References
1. (2013) DSM-V, APA, p. 311

Diagnosis
DSM-IV Somatization Disorder (old diagnostic criteria, more restrictive than DSM-V)

Must meet criteria for a Somatoform Disorder
1. Unexplained physical symptoms
2. Not due to condition of Secondary Gain (Malingering or Factitious Disorder)
3. Causes dysfunction
Specific criteria for Somatization Disorder
1. Chronic course of symptoms longer than 2 years
2. Unexplained physical symptom onset before age 30 years
3. Vague or exaggerated physical symptoms dispersed over multiple organ symptoms
  1. See Somatization Symptoms
  2. Gastrointestinal (at least 2 symptoms)
  3. Pain (at least 4 symptoms)
  4. Neurologic or pseudoneurologic (at least one symptom)
  5. Sexual (at least one symptom)
4. Other diagnostic clues suggestive of Somatization
  1. Prior non-diagnostic extensive diagnostic testing
  2. Dissatisfaction with previous physicians

Organic disease (exclude completely before making Somatization diagnosis)
Other mental health conditions
Reported symptoms adopted by patient for Secondary Gain
1. Factitious Disorder (Adoption of physical symptoms for unconscious internal gain)
2. Malingering (Purposeful feigning of physical symptoms for external gain)

Up to 25% of those with acute somatic symptoms develop into chronic somatic illness