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Somatic symptom and related disorders
Other Resources UpToDate PubMed

Somatic symptom and related disorders

Contributors: Abhijeet Waghray MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

Somatoform disorders encompass several disorders all linked by the presence of prominent somatic symptoms associated with significant stress and impairment. This group of disorders includes somatic symptom disorder, illness anxiety disorder, conversion disorder (functional neurological symptom disorder), factitious disorder, psychological factors affecting other medical conditions, and other / unspecified somatic symptom and related disorder.

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

Look For

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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
Other diagnoses to consider outside of the group:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:02/04/2021
Last Updated:02/04/2021
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Somatic symptom and related disorders
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Somatic symptom and related disorders : Anxiety, Pain out of proportion to exam findings, Recurring episodes or relapses
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