I. Epidemiology

  1. Prevalence: 5-7% in United States
  2. Women predominate by a factor of 10:1

II. Background

  1. Somatizers generate 9 times the average medical cost
  2. Despite medical attention, somatizers highly disabled
  3. Physicians report frustration in treating somatizers
    1. Lack sense of effectiveness
    2. Patient does not fit into standard diagnoses
    3. Patient does not fit into standard office schedule

III. Pathophysiology

  1. Sensory amplification
    1. Preoccupation with disease focuses on body sensations
    2. Normal variations in senses interpreted as abnormal
    3. Exacerbates anxiety and panic, as well as discomfort
  2. Identified patient within a dysfunctional family
    1. Family dysfunction transferred to the patient
    2. Patient's "illness" stabilizes family
    3. Other family member's anxiety relieved
  3. Need to be sick
    1. Patient pursues sick role to relieve stressors
    2. Not the same as Malingering or faking symptoms
      1. Somatizing Patient unaware of symptom generation
  4. Dissociation
    1. Activation of Pain Sensation without physical pain

IV. Types: Somatoform Disorders (or Somatic Symptom Disorder)

  1. Conversion Disorder
    1. At least one symptom altered voluntary motor or sensory function inconsistent with known condition
  2. Factitious Disorder
    1. Falsification of physical or psychological symptoms or induced injury or disease in self or another
    2. Unlike Malingering, not for personal gain
  3. Illness Anxiety Disorder (previously part of Hypochondriasis)
    1. Preoccupation with either contracting or having a serious medical disorder
    2. Includes care-seeking subtype and care-avoidant subtype
  4. Body Dysmorphic Disorder
  5. Pain Disorder
    1. Now included in Somatic Symptom Disorder
    2. Predominant pain (previously known as Pain Disorder)

V. Diagnosis: DSM-V Somatic Symptom Disorder (replaces Somatization Disorder)

  1. At least one somatic symptom that is distressing or significantly disrupting life
  2. At least one of the following excessive thoughts, feelings or behaviors related to somatic symptoms
    1. Disproportionate and persistent thoughts about the seriousness of one's own symptoms
    2. Persistently high level of anxiety about health or symptoms
    3. Excessive time and energy devoted to these symptoms or health concerns
  3. Symptomatic state persists regardless for at least 6 months (even if one symptom is not continuously present)
  4. Additional characteristics
    1. Predominant pain (previously known as Pain Disorder)
    2. Persistent (severe with marked Impairment for >6 months)
    3. Severity
      1. Mild
        1. Only 1 symptom from the excessive thoughts, feelings or behaviors list
      2. Moderate
        1. Two or more symptoms from the excessive thoughts, feelings or behaviors list
      3. Severe
        1. Two or more symptoms from the excessive thoughts, feelings or behaviors list AND
        2. Multiple Somatic Complaints OR one very severe somatic symptom
  5. References
    1. (2013) DSM-V, APA, p. 311

VI. Diagnosis: DSM-IV Somatization Disorder (old diagnostic criteria, more restrictive than DSM-V)

  1. Must meet criteria for a Somatoform Disorder
    1. Unexplained physical symptoms
    2. Not due to condition of Secondary Gain (Malingering or Factitious Disorder)
    3. Causes dysfunction
  2. Specific criteria for Somatization Disorder
    1. Chronic course of symptoms longer than 2 years
    2. Unexplained physical symptom onset before age 30 years
    3. Vague or exaggerated physical symptoms dispersed over multiple organ symptoms
      1. See Somatization Symptoms
      2. Gastrointestinal (at least 2 symptoms)
      3. Pain (at least 4 symptoms)
      4. Neurologic or pseudoneurologic (at least one symptom)
      5. Sexual (at least one symptom)
    4. Other diagnostic clues suggestive of Somatization
      1. Prior non-diagnostic extensive diagnostic testing
      2. Dissatisfaction with previous physicians

VII. Diagnosis: Evaluation Scales

VIII. Differential Diagnosis

  1. Organic disease (exclude completely before making Somatization diagnosis)
  2. Other mental health conditions
    1. Major Depression
    2. Generalized Anxiety Disorder
    3. Panic Disorder
    4. Chemical Dependency
  3. Reported symptoms adopted by patient for Secondary Gain
    1. Factitious Disorder (Adoption of physical symptoms for unconscious internal gain)
    2. Malingering (Purposeful feigning of physical symptoms for external gain)

IX. Risk Factors

  1. See Somatization Risk Factors
  2. Underlying mental health condition
  3. History of physical abuse or sexual abuse

X. Definition

  1. Emotional distress experienced as physical symptoms

XI. Symptoms

XIV. Precautions

  1. Reassess for underlying medical condition

XV. Management

XVI. Prognosis

  1. Up to 25% of those with acute somatic symptoms develop into chronic somatic illness

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Ontology: Hysteria (C0020701)

Definition (MSH) Historical term for a chronic, but fluctuating, disorder beginning in early life and characterized by recurrent and multiple somatic complaints not apparently due to physical illness. This diagnosis is not used in contemporary practice.
Definition (CSP) behavior exhibiting excessive or uncontrollable emotion, such as fear or panic; mental disorder characterized by emotional excitability and sometimes by amnesia or a physical deficit, such as paralysis, or a sensory deficit, without an organic cause.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D007046
ICD9 300.10
ICD10 F44
SnomedCT 268629005, 191712003, 62448009, 191719007, 44376007, 89239005
French HYSTERIE, Hystérie, non précisée, Hystérie
English HYSTERIA, Hysteria unspecified, Hysteria, unspecified, SOMATIZATION DISORDER <HYSTERIA>, hysteria, hysteria (diagnosis), SOMATIZATION DISORDER HYSTERIA, Hysteria NOS, Hysteria [Disease/Finding], hysterical disorder, Hysteria unspecified (disorder), Hysteria (finding), Hysteria NOS (disorder), Hysterical disorder, Hysterical disorder, NOS, Hysteria
Portuguese HISTERIA, Histeria NE, Histeria
Spanish HISTERIA, Histeria no especificada, histeria (hallazgo), histeria, SAI, histeria no especificada (trastorno), histeria no especificada, histeria, SAI (trastorno), histeria, trastorno histérico, Histeria
German HYSTERIE, Hysterie, unspezifisch, Hysterie
Dutch niet-gespecificeerde hysterie, hysterie, Hysterie
Italian Isteria non specificata, Isteria
Japanese ヒステリー、詳細不明, ヒステリーショウサイフメイ, ヒステリー, ヒステリー, ヒステリー性ノイローゼ, ヒステリー反応, ヒステリー性神経症
Swedish Hysteri
Czech hysterie, Hysterie, Hysterie, blíže neurčená
Finnish Hysteria
Russian ISTERICHESKIE NEVROZY, ISTERIIA, ИСТЕРИЧЕСКИЕ НЕВРОЗЫ, ИСТЕРИЯ
Croatian HISTERIJA
Polish Histeria, Nerwice histeryczne
Hungarian Hysteria, Hysteria, nem meghatározott
Norwegian Hysteri

Ontology: Psychophysiologic Disorders (C0033931)

Definition (MSH) A group of disorders characterized by physical symptoms that are affected by emotional factors and involve a single organ system, usually under AUTONOMIC NERVOUS SYSTEM control. (American Psychiatric Glossary, 1988)
Definition (CSP) characterized by physical symptoms and demonstrable structural or physiological changes in which emotional factors are believed to play a major etiologic role.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D011602
ICD10 F45.9
SnomedCT 191985004, 37057007
English Psychophysiologic Disorders, Psychophysiological Disorder, Psychophysiological Disorders, Psychosomatic Disorders, Psychophysiologic Disorder, Psychosomatic Disorder, psychosomatic disorder, Psychosomatic disease, PSYCHOSOMATIC DIS, PSYCHOPHYSIOL DIS, psychophysiologic disorder, psychophysiological dysfunction, Psychosomatic disorder NOS, Psychophysiologic Disorders [Disease/Finding], illness psychosomatic, illnesses psychosomatic, diseases psychosomatic, psychophysiologic disorders, psychosomatic disease, psychosomatic illness, psychophysiological disorders, psychosomatic disorders, psychophysiological disorder, disease psychosomatics, Psychosomatic disorder NOS (disorder), Psychosomatic disorder (diagnosis), psychiatric diagnosis or condition psychosomatic disorder, Psychophysiologic disorder, Psychosomatic disorder, Psychophysiologic disorder (finding), dysfunction; psychophysiological, Psychophysiologic disorder, NOS, Psychosomatic disorder, NOS, Psychophysiologic disorder NOS
Italian Malattia psicosomatica, Disturbi psicosomatici, Disturbi psicofisiologici
Swedish Psykosomatiska sjukdomar
Japanese シンシンショウ, 心身症, 心理生理的障害, 心身相関の障害, 精神生理障害, 精神身体学的障害, 精神身体異常, 精神身体症, 精神身体的異常, 精神身体障害
Czech psychosomatické nemoci, psychofyziologické poruchy, Psychosomatické onemocnění
Finnish Psykofysiologiset häiriöt
Russian PSIKHOSOMATICHESKIE RASSTROISTVA, PSIKHOFIZIOLOGICHESKIE RASSTROISTVA, ПСИХОСОМАТИЧЕСКИЕ РАССТРОЙСТВА, ПСИХОФИЗИОЛОГИЧЕСКИЕ РАССТРОЙСТВА
Croatian PSIHOFIZIOLOŠKI POREMEĆAJI
Polish Zaburzenia psychosomatyczne, Zaburzenia psychofizjologiczne
Hungarian Psychosomatikus betegség
Norwegian Psykosomatiske sykdommer, Psykosomatiske forstyrrelser
Spanish trastorno psicosomático, SAI (trastorno), trastorno psicosomático, SAI, trastorno psicofisiológico (hallazgo), trastorno psicofisiológico, trastorno psicosomático, Enfermedad psicosomática, Trastornos Psicofisiológicos, Trastornos Psicosomáticos
Dutch functiestoornis; psychofysiologisch, psychosomatische ziekte, Psychofysiologische storing, Psychofysiologische storingen, Psychosomatische storingen, Storing, psychofysiologische
Portuguese Doença psicossomática, Transtornos Psicofisiológicos, Transtornos Psicossomáticos
French Maladie psychosomatique, Troubles psychophysiologiques, Troubles psychosomatiques
German Psychosomatische Erkrankung, Psychophysiologische Störungen, Psychosomatische Störungen

Ontology: Undifferentiated somatoform disorder (C0041672)

Concepts Mental or Behavioral Dysfunction (T048)
ICD9 300.82
ICD10 F45.1
SnomedCT 231514002, 192432001, 18393005
DSM4 300.81
English Undifferentiated Somatoform Disorder, Undifferent somatoform disord, Undiff somatoform disrdr, Undifferentiated psychosomatic disorder, undifferentiated somatoform disorder, undifferentiated somatoform disorder (diagnosis), somatoform disorder undifferentiated, Undifferentiated somatoform disorder, Undifferentiated somatoform disorder (disorder), disorder; psychosomatic, undifferentiated, disorder; somatoform, undifferentiated
German Undifferenzierte Somatisierungsstoerung
Korean 미분화형 신체형 장애
Dutch stoornis; psychosomatisch, ongedifferentieerd, stoornis; somatoform, ongedifferentieerd, Ongedifferentieerde somatoforme stoornis
Spanish trastorno somatomorfo indiferenciado (trastorno), trastorno somatomorfo indiferenciado

Ontology: Somatization Disorder (C0520482)

Definition (PSY) Pattern of recurring polysymptomatic somatic complaints resulting in medical treatment or impaired daily function. Usually begins before age 30 and extends over a period of years.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D013001
ICD9 300.81
ICD10 F45.0
SnomedCT 397826007, 9514005, 60368009, 191743005, 192431008, 154892001, 397795007, 397923000
DSM4 300.81
English Briquet Syndrome, Somatization Disorder, Somatization Disorders, Syndrome, Briquet, SOMATIZATION DIS, somatization disorder (diagnosis), somatization disorder (Briquet's syndrome), somatization disorder, Briquets syndrome, Briquet syndrome, briquet's disorder, somatization disorders, Disorder;somatisation, briquet syndrome, briquet's syndrome, briquets syndrome, disorder somatization, disorders somatisation, Briquet's disorder (finding), Briquet's disorder, Polysomatizing disorder, Somatization disorder, Briquet's syndrome, Somatisation disorder, Briquet's syndrome (disorder), Polysomatising disorder, Polysomatizing disorder (disorder), Somatization disorder (disorder), disorder; somatization, Briquet, somatization; disorder, Somatization disorder [Ambiguous], somatisation disorder
Italian Disturbo da somatizzazione, Sindrome di Briquet, Disturbo di somatizzazione
French Trouble de somatisation, Somatisation, Syndrome de Briquet
Spanish Trastorno de somatización, Trastorno de Somatización, síndrome de Briquet (hallazgo), trastorno de polisomatización, síndrome de Briquet (trastorno), síndrome de Briquet, trastorno de somatización (trastorno), trastorno de somatización, trastorno polisomatizante (trastorno), trastorno polisomatizante, Trastorno por somatización, Síndrome de Briquet
Japanese 身体化障害, ブリケ症候群, ブリケショウコウグン, シンタイカショウガイ
Portuguese Transtorno de Somatização, Perturbação de somatização, Síndrome de Briquet
German Somatisierungserscheinungen, Somatisierungsstoerung, Briquet-Syndrom
Czech Somatizační porucha, Briquetův syndrom, somatizační porucha
Korean 신체화 장애
Hungarian Szomatizációs zavar, Briquet-szindróma, Somatisatiós zavar, Briquet-syndroma
Norwegian Somatoform autonom dysfunksjon, Somatiseringslidelse, Briquets sykdom, Somatiseringsforstyrrelse
Dutch somatisatie; stoornis, stoornis; somatisatie, somatisatiestoornis, Briquet-syndroom, Somatisatiestoornis