DSM 5 diagnostic criteria for somatic symptom disorder – Introduction
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) marks the first significant revision of the publication since the DSM-IV in 1994.
Changes to the DSM were largely informed by advancements in neuroscience, clinical and public health need, and identified problems with the classification system and criteria put forth in the DSM-IV.
Three requirements fulfill the diagnostic criteria for somatic syndrome disorders (SSDs) according to the American Psychiatric Association’s 2013 DSM-5:
- Somatic symptom(s) that cause significant distress or disruption in daily living
- One or more thoughts, feelings, and/or behaviors that are related to the somatic symptom(s) which are persistent, excessive, associated with a high level of anxiety, and results in the devotion of excessive time and energy
- Symptoms lasting for more than 6 months
Much of the decision-making was also driven by a desire to ensure better alignment with the International Classification of Diseases and its upcoming 11th edition (ICD-11).
It is anticipated that this collaborative spirit between the American Psychiatric Association (APA) and the World Health Organization (WHO) will continue as the DSM-5 is updated further, bringing the field of psychiatry even closer to a singular, cohesive nosology.
What are the DSM 5 diagnostic criteria for somatic symptom disorder?
- A. One or more somatic symptoms that are distressing or result in significant disruption of daily life
- B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
- 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms
- 2. Persistently high level of anxiety about health or symptoms
- 3. Excessive time and energy devoted to these symptoms or health concerns
- C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Specify if:
- With predominant pain (previously known as pain disorder): If the main symptom is pain.
- Persistent: Symptoms last for more than 6 months.
- Mild, Moderate, or Severe: Based on the number of symptoms and the extent of distress and impairment.
It is important to note that the diagnosis of Somatic Symptom Disorder requires a thorough evaluation by a healthcare professional, such as a psychiatrist or psychologist. The professional will assess the symptoms, duration, impact on daily life, and rule out other medical and mental health conditions that may better explain the symptoms.
What is Somatic Symptom Disorder?
Somatic symptom disorder (SSD) arises from a heightened awareness of various bodily sensations, which are combined with an inclination to interpret these sensations as indicative of medical illness.
While the etiology of SSD is unclear, studies have investigated risk factors including childhood neglect, sexual abuse, chaotic lifestyle, and history of alcohol and substance abuse.
The prevalence of somatic symptom disorder (SSD) is estimated to be 5% to 7% of the general population, with higher female representation (female-to-male ratio 10:1), and can occur in childhood, adolescence, or adulthood.
The prevalence increases to approximately 17% of the primary care patient population.
The prevalence is likely higher in certain patient populations with functional disorders, including fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome
Somatic symptom disorder is likely more prevalent in females versus males.
DSM 4 to DSM 5 Somatic Symptom Disorder Comparison
| DSM-IV | DSM-5 |
|---|---|
| Name: Somatization Disorder | Name: Somatic Symptom Disorder |
| Disorder Class: Somatoform Disorders | Disorder Class: Somatic Symptom and Related Disorder |
| A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning. | B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:Disproportionate and persistent thoughts about the seriousness of one’s symptoms.Persistently high level of anxiety about health or symptoms.Excessive time and energy devoted to these symptoms or health concerns. |
| C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). | |
| B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis, or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting) | A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. |
| C. Either (1) or (2):after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings | DROPPED |
| D. The symptoms are not intentionally feigned or produced (as in factitious disorder or malingering). | DROPPED |
| Specify if:With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.Specify if:Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).Specify current severity:Mild: Only one of the symptoms specified in Criterion B is fulfilled.Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom). |
Somatic symptom disorder (SSD) is a recently defined diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).
It is the manifestation of one or more physical symptoms accompanied by excessive thoughts, emotion, and/or behavior related to the symptom, which causes significant distress and/or dysfunction.
These symptoms may or may not be explained by a medical condition. The two major changes to the DSM-IV criteria included eliminating the requirement that somatic symptoms be organically unexplained and adding the requirement that certain psychobehavioral features have to be present to justify the diagnosis.
The new criteria also eliminated somatization disorder, undifferentiated somatoform disorder, hypochondriasis, and pain disorder from the previous definitions.
These revisions were intended to increase the relevance of SSD and its use in the primary care setting.
If the somatic symptoms predominantly involve pain, the specifier “with predominant pain” is added. Severity (mild, moderate, or severe) is also specified.
If the symptoms are severe and there is marked impairment with duration more than 6 months, the specifier “persistent” is added.
There are multiple associated features that may be present in conjunction with somatic symptom disorder.
It is more common in those with lower education level and lower socioeconomic status, those who are unemployed, as well as those individuals who have experienced a recent traumatic life event and/or have a past history of sexual abuse.
The individuals often have concurrent medial and/or psychiatric diagnoses.
The personality trait of neuroticism is associated with greater number of somatic symptoms. The disorder is associated with marked impairment of health status.
There may be increased attention focused on somatic symptoms, attribution of normal bodily sensations to physical illness (sometimes with catastrophizing), worry about illness, and fear that any physical activity may damage the body.
The individual may repeatedly check their body for abnormalities, seek medical help and reassurance repeatedly, and avoid physical activity. Somatic symptom disorder is associated with depressive disorders, and therefore there is an increased suicide risk.
It is unclear whether somatic symptom disorder has an independent association with suicide risk.
Somatic Symptom Disorder (SSD) is a mental health condition characterized by excessive and distressing physical symptoms that cannot be fully explained by a medical condition. Individuals with SSD have persistent thoughts, feelings, and behaviors related to these symptoms, causing significant distress and impairment in daily functioning. The symptoms are real and often cause genuine suffering, but the excessive focus on them and the distress associated with them are disproportionate to any medical findings.
Key features of somatic symptom disorder include:
- Excessive Concern: Individuals with SSD experience excessive and disproportionate worry or preoccupation with their physical symptoms, often fearing the worst-case scenarios and interpreting them as a sign of serious illness.
- Chronic Distress: The symptoms cause significant distress and impairment in daily functioning, leading to frequent doctor visits, excessive health-related research, and disruptions in work, social relationships, or other areas of life.
- Persistent Symptoms: The symptoms may be chronic and may vary in nature, ranging from pain, gastrointestinal issues, fatigue, to other physical complaints. The symptoms are real to the individual, but they cannot be fully explained by an identified medical condition.
- Disproportionate Focus: Individuals with SSD may excessively focus on their bodily sensations and interpret them as highly meaningful and significant, often attributing them to serious underlying diseases.
- Illness Anxiety: People with SSD may have heightened health anxiety, excessively worrying about the possibility of having a severe or undiagnosed medical condition.
It’s important to note that individuals with SSD are not intentionally feigning or faking symptoms; their distress is genuine. The condition is classified as a somatic symptom and related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the primary diagnostic manual used by mental health professionals.
The diagnosis of somatic symptom disorder requires careful evaluation by a healthcare professional, usually a psychiatrist or psychologist, who will assess the pattern and severity of symptoms and rule out any underlying medical causes.
Treatment for somatic symptom disorder typically involves a combination of psychotherapy and, in some cases, medication. Cognitive-behavioral therapy (CBT) is a commonly used approach that helps individuals recognize and challenge distorted beliefs about their symptoms, manage anxiety, and develop healthier coping strategies. Other psychotherapeutic approaches, such as acceptance and commitment therapy (ACT) or psychodynamic therapy, may also be beneficial. Medications, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed in some cases to address associated anxiety or depression.
Management of Somatic Symptom Disorder typically involves a comprehensive approach that may include:
- Therapy: Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can help individuals identify and manage stressors, thoughts, and behaviors related to the symptoms.
- Medication: In some cases, medication may be prescribed to manage co-existing conditions like anxiety or depression.
- Education: Education about the nature of the condition and its psychological aspects can be helpful in empowering individuals to cope effectively.
- Supportive Care: Supportive care from healthcare professionals and understanding from family and friends can contribute to a positive outcome.
If you or someone you know is experiencing persistent physical symptoms causing significant distress, it’s essential to seek evaluation and support from qualified mental health professionals or healthcare providers. They can conduct a thorough assessment and develop a personalized treatment plan to address the specific needs and challenges of Somatic Symptom Disorder.
