Somatic Symptom Disorders Workup

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

Screening Tests

The PHQ-15, WI-7, and SAIB are useful screening instruments to detect persons at risk for somatic symptom disorder, and a combination of these three instruments slightly improves diagnostic accuracy. Their use in routine care will lead to improved detection rates for somatic symptom disorder. [17] The PHQ-15, WI-7, and SAIB are useful screening instruments for detecting somatic symptom disorder as described in the DSM-5. [17] The SSS-8 is an abbreviated PHQ-15 that has been demonstrated to be a reliable and valid self-report measure for somatic symptom burden. [18]

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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 somatic symptom disorder. (Negative MMPI studies should encourage further pursuit of a medical cause for the symptoms.)

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Imaging Studies

Imaging studies are not routinely used in diagnosing the somatic symptom disorders. However, functional MRI may be of use in the diagnosis of some conditions such as unexplained visual loss. [19] Imaging studies also may be helpful to rule out unexplained physical symptoms due to a medical disorder.

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Procedures

Avoid invasive diagnostic procedures and aggressive surgical assessment.

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