DSM 5 diagnostic criteria for somatic symptom disorder

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.

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.

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

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.

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.

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.

DSM 4 to DSM 5 Somatic Symptom Disorder Comparison

DSM-IVDSM-5
Name: Somatization DisorderName: Somatic Symptom Disorder
Disorder Class: Somatoform DisordersDisorder 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 findingsDROPPED
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).

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