eMedicine Specialties > Psychiatry > Psychosomatic

Somatoform Disorders: Differential Diagnoses & Workup

Author: William R Yates, MD, Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa
Contributor Information and Disclosures

Updated: Feb 4, 2008

Differential Diagnoses

Acute Respiratory Distress Syndrome
Gastritis, Acute
Addison Disease
Goiter
Adjustment Disorders
Goiter, Diffuse Toxic
Adrenal Crisis
HIV Disease
Alcoholism
Hyperaldosteronism, Primary
Amphetamine-Related Psychiatric Disorders
Hypercalcemia
Anaphylaxis
Hyperparathyroidism
Androgen Excess
Hyperprolactinemia
Anorexia Nervosa
Hypersensitivity Reactions, Delayed
Asthma
Hypersensitivity Reactions, Immediate
Atrial Fibrillation
Inhalant-Related Psychiatric Disorders
Atrial Tachycardia
Injecting Drug Use
Attention Deficit Hyperactivity Disorder
Insomnia
Autistic Spectrum Disorders
Irritable Bowel Syndrome
Body Dysmorphic Disorder
Lyme Disease
Brief Psychotic Disorder
Malingering
Bulimia
Meningitis
Caffeine-Related Psychiatric Disorders
Multifocal Atrial Tachycardia
Cannabis Compound Abuse
Obsessive-Compulsive Disorder
Cardiogenic Shock
Obstructive Sleep Apnea-Hypopnea Syndrome
Delirium
Panic Disorder
Delirium Tremens
Personality Disorders
Delusional Disorder
Phobic Disorders
Depression
Premenstrual Dysphoric Disorder
Diabetic Ketoacidosis
Primary Hypersomnia
Digitalis Toxicity
Primary Insomnia
Dissociative Disorders
Schizophrenia
Dysthymic Disorder
Schizophreniform Disorder
Esophageal Motility Disorders
Shared Psychotic Disorder
Esophageal Spasm
Sleep Disorders
Euthyroid Hyperthyroxinemia
Stimulants
Factitious Disorder
Thyroiditis, Subacute
Fibromyalgia
Tourette Syndrome
Folic Acid Deficiency
Unstable Angina
Food Poisoning

Other Problems to Be Considered

Somatoform disorders must be differentiated from medical illnesses as well as from other psychiatric conditions; consider medical conditions that cause vague and diffuse symptoms. Also, consider somatization as part of a mood or anxiety disorder.

Cerebrovascular accident
Encephalopathy
Dialysis encephalopathy
Hepatic encephalopathy
Hypertensive encephalopathy, uremic
Goiter, chronic
Toxic hallucinogens
Heroin abuse
Lyme borreliosis
Multiple sclerosis

Workup

Laboratory Studies

  • If indicated, specific studies used to rule out somatization due to general medical conditions include the following:
    • Thyroid function studies - Thyroid stimulating hormone (TSH) at 0.4-10 mIU/L and thyroxine at 5.0-12.5 ng/dL
    • Pheochromocytoma screen - Urine catecholamines, homovanillic acid (HVA) 2-12 mg per 24 hours, vanillylmandelic acid (VMA) 2-7 mg per 24 hours, metanephrines less than 1.6 mg per 24 hours, and norepinephrine plus epinephrine less than 100 mcg per 24 hours
    • Urine drug screen - Including cannabis, amphetamine, hallucinogens, cocaine, opioids, benzodiazepines
    • Blood studies - To screen for occult alcoholism
    • Psychological testing - Minnesota Multiphasic Personality Inventory (MMPI) may provide insight into the likelihood of a somatoform disorder. (Negative MMPI studies should encourage further pursuit of a medical cause for the symptoms.)

Imaging Studies

  • Imaging studies are not routinely used in diagnosing the somatoform disorders. However, functional MRI may be of use in the diagnosis of some conditions such as unexplained visual loss.
  • Imaging studies may be helpful to rule out unexplained physical symptoms due to a medical disorder.

Procedures

  • Avoid invasive diagnostic procedures and aggressive surgical assessment.

More on Somatoform Disorders

Overview: Somatoform Disorders
Differential Diagnoses & Workup: Somatoform Disorders
Treatment & Medication: Somatoform Disorders
Follow-up: Somatoform Disorders
Multimedia: Somatoform Disorders
References

References

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Further Reading

Keywords

somatization, body dysmorphic disorder, conversion disorder, hypochondriasis, somatization disorder, somatoform disorder NOS, somatoform disorder not otherwise specified, unexplained physical symptoms

Contributor Information and Disclosures

Author

William R Yates, MD, Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa
William R Yates, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Academy of Family Physicians, and American Psychiatric Association
Disclosure: Forest Laboratories Grant/research funds Other

Medical Editor

Mohammed A Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System
Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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