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).
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. 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 is likely more prevalent in females versus males. 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.