Somatic Symptom and Related Disorders

Figure 1. Those with somatic symptom disorders often seek continued medical care despite no medical explanations for the symptoms.

A somatic symptom disorder, formerly known as a somatoform disorder, is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder (e.g., panic disorder).

In people who have been diagnosed with a somatic symptom disorder, medical test results are either normal or do not explain the person’s symptoms, and history and physical examination do not indicate the presence of a known medical condition that could cause them, though the DSM-5 cautions that this alone is not sufficient for diagnosis. The patient must also be excessively worried about their symptoms, and this worry must be judged to be out of proportion to the severity of the physical complaints themselves. A diagnosis of somatic symptom disorder requires that the subject have recurring somatic complaints for at least six months.

Symptoms are sometimes similar to those of other illnesses and may last for years. Usually, the symptoms begin appearing during adolescence, and patients are diagnosed before the age of 30 years. Symptoms may occur across cultures and gender. Other common symptoms include anxiety and depression. However, since anxiety and depression are also very common in persons with confirmed medical illnesses, it remains possible that such symptoms are a consequence of the physical impairment, rather than a cause. Somatic symptom disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms). Somatic symptom disorder is difficult to diagnose and treat.

Illness Anxiety Disorder

Figure 2. Formerly known as hypochondria, illness anxiety disorder is characterized by a preoccupation and concern with developing a medical condition.

The excessive worries and thoughts of a presumed and nonexistent illness, which was known as hypochondriasis in DSM-4, is now under the umbrella of the somatic symptom disorders. Diagnosis of somatic symptom disorder requires at least one somatic symptom that is causing a significant disruption of the patient’s life with significant actions and emotions that result in high anxiety level or excessive time consumption. Illness anxiety disorder (IAD) does not typically involve somatic symptoms, meaning that individuals do not experience any specific physical ailment, but instead, they are preoccupied with concern about developing a severe medical condition.

The DSM-5 encompasses two types of patients with illness anxiety disorder: care-seeking type and care-avoidant type. Since patients with illness anxiety disorder (IAD) emanate their distress and anxiety not primarily from the physical complaint itself but rather from their anxiety about the meaning, significance, and cause of the complaint, they remain unsatisfied with the reassurance of the physicians. Illness anxiety disorder (IAD) can cause a huge burden on the resources of health care facilities and on health care providers.^[1][/footnote]

In one case study published in 2016, a 73-year-old Saudi man started visiting the primary health care center around 25 years ago. With concerns about having cancer, the patient continuously visited the hospital, which ended up costing over $170,000. Throughout this period, the patient was exposed to extensive unnecessary imaging studies and laboratory tests that had effects on his life in all aspects with such concerns. Five years ago, a family doctor put an end to that by directing the patient on the right path. The doctor made several actions; most importantly, he directed the patient to CBT, which significantly improved a range of hypochondriacal beliefs and attitudes. This patient’s case demonstrates the fundamental importance of a proper health system that limits such patients from abusing the health system and depleting medical resources.^[2]