Somatic Symptom Disorder

Somatic Symptom Disorder and Related Illnesses

Somatic symptom disorder is categorized as having strong distress over physical symptoms causing impairments in daily life. The physical symptoms are real but the anxiety that comes with it is disproportional to the issue. SSD is a relatively new diagnosis, being first introduced in the 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition replacing the previous Somatization Disorder. There are a variety of disorders that resemble SSD but there are still key distinguishing features separating them. 

Somatization Disorder was introduced in the DSM III under the somatoform disorders, characterized by physical symptoms with no explanation. As put in an article from the National Library of Medicine, “Symptoms are not intentional, contrasting it with factitious disorder or malingering”(Kallivayalil and Punnoose). Those with this are hypervigilent to bodily sensations and their symptoms are amplified cognitively. In the DSM IV, somatoform disorders included Somatization Disorder, conversion disorder, body dysmorphic disorder, and hypochondriasis. The diagnostic criteria for Somatization Disorder was more extensive in requirements compared to Somatic Symptom Disorder. For example, there was a minimum of four symptoms pertaining to different areas or functions of the body. In addition to two gastrointestinal symptoms, one sexual symptom(such as pain and vomiting during pregnancy), along with one pseudoneurological symptom. 

It also required there to be no known cause for the physical symptoms(American Psychiatric Association), meaning those physically disabled could not be diagnosed. This was abandoned in the updated diagnosis of Somatic Symptoms Disorder. A study published by Cambridge University Press in 2021 found that “Two-thirds of adolescent SSD patients had at least one medical condition”(Löwe et al.). Further, they found “In a study assessing somatic conditions in patients with SSD, 28.8% had asthma, 23.1% had a circulatory condition, and 13.5% had gout, rheumatism or arthritis” (Löwe et al.). This shows physically disabled people can have SSD and their symptoms are real. The updated diagnosis of Somatic Symptom Disorder only requires excessive concern for at least one symptom lasting over six months, interfering with daily life, along with the severity of the symptom(s). In an article from the Cleveland Clinic, “People with somatic symptom disorder are often unaware of their underlying mental health condition and believe that they have serious physical ailments”(Cleveland Clinic). The physical symptoms experienced by those with SSD take a great toll on their mental health even when they believe they are physically sick. SSD affects those who have it in both mental and physical regards.

There are also other disorders that may resemble Somatic Symptom Disorder such as Illness Anxiety Disorder, Health OCD, Conversion Disorder, and Munchausen Syndrome/Factitious Disorder. Illness Anxiety Disorder, replaced hypochondriasis in the DSM-5, is characterized by excessive anxiety about being or becoming sick. Both IAD and SSD experience a high amount of anxiety surrounding heath. Still, as found in a 2017 study of comorbidity and correlation of both SSD and IAD, “Compared to IAD, SSD was categorized by more severe health anxiety, somatic symptoms, depression, and higher health service use, and higher rates of major depressive disorder, panic disorder and agoraphobia”(Newby et al.). Those with Illness Anxiety Disorder do not experience physical symptoms whereas those with Somatic Symptom Disorder do. With SSD the anxiety comes from the presence of symptoms such as pain and fatigue, although with IAD the worry is more so from the possibility of illness. 

Health and contamination OCD is also compared to both IAD and SSD but it is categorized by persistent rituals to overcome distress caused by intrusive thoughts. This distress can lead to agoraphobia and even becoming housebound(Stoddard). Another related disorder is Conversion disorder, now named Functional Neurologic Disorder, which is a condition that causes uncontrollable physical symptoms for no physiological reason(previously called hysteria). It is linked to an issue in how the brain processes information and sends it out to the body(Booth). There are two types: Psychogenic Nonepileptic Seizures, seizures caused by a high amount of stress, and Functional Movement Disorder, which affects mobility. The cause of this condition is unknown. 

Lastly, Munchausen Syndrome/Factitious Disorder. This mental health condition occurs when someone purposely hurts themselves to get attention. Those with this condition are aware they are not actually ill or hurt but they intentionally sabotage themselves to gain sympathy. The diagnostic criteria includes: Falsifying physical or psychological disease, presenting as ill or injured to others, and deceptive behavior without external reward(Cleveland Clinic). A related disorder it is commonly confused with is Munchausen Syndrome by proxy. This occurs when someone of power(like a parent) intentionally hurts someone weaker than them(like a child). They do this so they can gain attention and sympathy from the public using their victim. This disorder is different from the rest because it is intentional and the person is aware of their behavior. 

Somatic Symptom Disorder is a valid disorder but it can still be misdiagnosed. For example, In 2018 a 57-year-old woman was hospitalized in the Department of Psychiatry, at Sir Run Run Shaw Hospital because of persistent pain lasting over a year with no abnormalities found in tests including a cervical MRI, chest CT scan, and abdominal ultrasounds. She was diagnosed with somatic symptom disorder and treated with hypnotic drugs. With the medications her pain subsided but even with this, it was not enough. “After 4 months of treatment with 60 mg of duloxetine enteric-coated capsules twice daily and hypnotic drugs, the symptoms were obviously alleviated but not completely relieved and there was a significant weight loss of about 5 kg”(Yao). She then went to the hospital where they took x-rays and a bone marrow aspiration. The results found she was actually suffering from multiple myeloma. She was misdiagnosed with Somatic Symptom Disorder for six months before being able to find the source of her pain. 

In conclusion, there are many disorders that may present themselves similarly to Somatic Symptom Disorder and it is important to understand the differences between them. It is important to listen to your body and understand the symptoms you feel. Being a good advocate for yourself is crucial to your health. Mental illness may be an explanation to symptoms but physical health should be taken into account as well in a diagnosis. 

Works Cited

Booth, Stephanie. “Conversion Disorder: Causes, Symptoms, and Treatment.” WebMD, 2 January 2024, https://www.webmd.com/mental-health/what-is-conversion-disorder 

Cleveland Clinic. “Munchausen Syndrome: Symptoms, Treatment & Definition.” Cleveland Clinic, 23 Nov. 2020, my.clevelandclinic.org/health/diseases/9833-munchausen-syndrome-factitious-disorder-imposed-on-self 

Cleveland Clinic. “Somatic Symptom Disorder: What It Is, Symptoms & Treatment.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17976-somatic-symptom-disorder-in-adults

Kallivayalil, Roy Abraham, and Varghese P Punnoose. “Understanding and managing              somatoform disorders: Making sense of non-sense.” Indian journal of psychiatry vol. 52,Suppl 1 (2010): S240-5.

            doi:10.4103/0019-5545.69239

https://pmc.ncbi.nlm.nih.gov/articles/PMC3146190/#sec1-1 

Löwe, Bernd, et al. “Somatic Symptom Disorder: A Scoping Review on the Empirical Evidence of a New Diagnosis.” Psychological Medicine, vol. 52, no. 4, 15 November 2021. Cambridge University Press, https://www.cambridge.org/core/journals/psychological-medicine/article/somatic-symptom-disorder-a-scoping-review-on-the-empirical-evidence-of-a-new-diagnosis/25B7921C514E9B42280B6A7376289729.

Newby, Jill M., et al. “DSM-5 Illness Anxiety Disorder and Somatic Symptom Disorder: Comorbidity, Correlates, and Overlap with DSM-IV Hypochondriasis.” Journal of Psychosomatic Research, vol. 101, no. 1, Oct. 2017, pp. 31–37, https://doi.org/10.1016/j.jpsychores.2017.07.010. 

Stoddard, Grant. “Illness Anxiety Disorder vs. OCD.” NOCD, 12 Mar. 2023, www.treatmyocd.com/what-is-ocd/info/related-symptoms-conditions/illness-anxiety-disorder-vs-ocd. 

 Substance Abuse and Mental Health Services Administration. “Table 3.31, DSM-IV to DSM-5 Somatic Symptom Disorder Comparison.” Nih.gov, Substance Abuse and Mental Health Services Administration (US), June 2016, www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t31/. 

Yao, Jiashu, et al. “Multiple Myeloma, Misdiagnosed As Somatic Symptom Disorder: A Case Report.” Frontiers, 30 October 2018, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00557/full.