Somatic Symptom Disorders Clinical Presentation

Updated: Apr 23, 2019
  • Author: William R Yates, MD, MS; Chief Editor: Glen L Xiong, MD  more...
  • Print
Presentation

History

History and symptoms vary depending on the specific somatic symptom disorder diagnosis.

The manner in which patients respond to a standardized review of systems differs in those with medically unexplained symptoms and in those with psychiatric disease. The review of systems offers information beyond the actual systems review, and may be useful in the identification of somatization. [12]

Somatic Symptom Disorder

Somatic symptom disorder replaces somatization disorder with the following criteria:

  • At least one somatic symptom that results in significant disruption in everyday life

  • Significant actions, thoughts, or feelings about the symptoms

  • Somatic symptom actions, thoughts, or feelings are excessively time consuming, out of proportion to the degree of seriousness, or accompanied by a high level of anxiety

Next:

Physical

Perform a comprehensive physical examination to rule out physical causes for the patient's somatic complaints. A detailed focus on specific systems (eg, neurological) may be necessary based on the specific complaint.

Include a full mental status examination. A patient with somatic symptom disorder typically displays the following on an examination.

  • Appearance - Normal

  • Attitude and behavior - Attitude is appropriate and behavior demonstrates a preoccupation with physical symptoms and complaints

  • Mood - Mildly anxious and depressed

  • Affect - Full range and appropriate

  • Thought disorder - None, although thoughts are limited to issues around physical symptoms

  • Hallucinations - None

  • Delusions - None

  • Obsessions - None

  • Compulsions - None

  • Attention - Within normal range

  • Memory - Within normal range

  • Concentration - Within normal range

  • Orientation - Oriented to time, place, and person

  • Insight and judgment - Insight appears limited in that nonmedical causes of symptoms are not considered; judgment appears unimpaired

  • Suicidal and homicidal ideation - No evidence of such

Previous
Next:

Causes

No definitive causes for most of the somatic symptom disorders have been established.

Genetic and environmental influences appear to contribute to somatization. Somatic symptom disorders have been linked to internalizing genetic risk factors and share genetic overlap with other mental disorders, including eating disorders. [13] Research suggests a possible genetic component to the development of somatic symptom disorder syndromes. [3]

Somatization may involve abnormalities in tryptophan catabolism, resulting in lower serum tryptophan levels than controls. This finding is limited to the research domain at present and is not a diagnostic test. [14]

Children raised in homes with a high degree of parental somatization may model somatization. Sexual abuse may be associated with an increased risk of somatization later in life. Poor ability to express emotions (alexithymia) may result in somatization. Somatic symptom disorder may be related to a reduced threshold for tactile and pain perception. [15]

Psychodynamic causes for unexplained physical symptoms date back to Freud, who coined the term "conversion disorder". Freud viewed some unexplained neurologic symptoms as a result of conversion of intrapsychic distress into physical symptoms.

Attitudes of caregivers may have a profound affect upon the course of somatic symptom disorder in children. One study demonstrated that adolescent children of parents who accepted the validity of a somatic symptom disorder diagnosis were nearly 20 times more likely to recover compared to those of parents who rejected or only partially accepted a somatic symptom Disorder diagnosis. [16]

Psychiatric comorbidity

Alcohol and drug abuse are common in patients with somatic symptom disorders. Patients may attempt to treat their somatic pain with alcohol or other drugs.

Additionally, alcohol or drug intoxication or withdrawal may induce somatic symptoms of unclear etiology, unless the physician considers the potential role of substances.

Anxiety disorders and mood disorders commonly include physical symptoms as part of the presentation. Ruling out a primary anxiety disorder or mood disorder is key before reviewing the role of somatic symptom disorders.

Previous