Somatic symptom and related disorders
Alerts and Notices
Synopsis
Historically, this group had included a repeating pattern of "medically unexplained symptoms" starting before age 30 and involving several organ systems. Although such symptoms are frequently present (particularly in conversion disorder), this is no longer considered the central feature since patients can have accompanying medical diagnoses.
The major diagnosis of this group, somatic symptom disorder, is characterized by distressing symptoms accompanied by abnormal thoughts, feelings, and behaviors in response to those symptoms.
Patients may frequently change physicians and may relocate to do so, in an attempt to obtain further workup after extensive testing does not determine a medical diagnosis (as may occur in illness anxiety disorder or conversion disorder) or even to avoid detection (as may occur in factitious disorder).
These disorders are common in medical practice and may be difficult to recognize on initial assessment. They tend to be lifelong disorders with waxing and waning severity. A consistent, supportive doctor-patient relationship is essential for therapeutic effect.
Codes
ICD10CM:F45.21 – Hypochondriasis
F45.9 – Somatoform disorder, unspecified
SNOMEDCT:
31297008 – Somatoform disorder
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
This is a group of disorders; as such, each can be in the differential diagnosis of the others:- Somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder
- Factitious disorder
- Psychological factors affecting other medical conditions
- Other specified somatic symptom and related disorder (this includes pseudocyesis, the false belief of being pregnant)
- Unspecified somatic symptom and related disorder
- Depression
- Anxiety
- Adjustment disorder
- Delusional disorder
- Generalized anxiety disorder
- Panic disorder
- Malingering
- Dissociative disorders
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Therapy
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References
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Last Reviewed:02/03/2021
Last Updated:02/03/2021
Last Updated:02/03/2021