The video below is the section for Somatic Symptom Disorder from Part 6 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 6, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Somatic Symptom Disorder
NARRATIVE DEFINITION:
Somatic Symptom and Related Disorders are characterized by prominent somatic symptoms associated with distress and impairment, and more often encountered in primary care and other medical settings than in psychiatric and other mental health settings. A characteristic distinctive of all somatic symptom and related disorders is that the diagnosis is often less about the physical complaints, and more about the way they are presented and interpreted.
Affective, cognitive, and behavioral components are incorporated into the criteria for somatic symptoms disorders provide a more comprehensive and truer reflection of the clinical picture. This group of disorders overlap significantly with mental disorders formerly diagnosed under the umbrella of Somatoform Disorders, but the conceptualization, descriptions and diagnostic categories are quite different from those.
The diagnosis of Somatic Symptom Disorder is characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life, coupled with excessive thoughts, feelings or behaviors related to the symptoms or health concerns.
Even if any one somatic symptom is not present on a continuous basis, the state of being symptomatic is persistent, typically lasting more than 6 months.
The DSM-5 offers specifiers of “with predominant pain” for individuals whose somatic symptoms predominantly involve pain, and “persistent,” when there are severe symptoms, marked impairment, and long duration (more than 6 months). Excessive thoughts, feelings, or behaviors, and health concerns present in the disorder can be manifested by (a) disproportionate and persistent thoughts about the seriousness of one’s symptoms, and/or (b) persistently high level of anxiety about health or symptoms, and/or (c) excessive time and energy devoted to these symptoms and health concerns.
Specifiers for current severity are: Mild (if only one of the manifestations of excessive concern is present), Moderate (when two or more manifestations of excessive concern are fulfilled), or Severe (if two or more manifestations of excessive concern are fulfilled, in addition to multiple somatic complaints, or the presence of one very severe somatic symptom.
Risk factors for developing somatic symptoms disorder include personality trait of negative affectivity, and environmental factors such as few years of formal education, low socioeconomic status, or recent experience of stressful events. Prevalence is unknown, but estimated to be around 5% to 7% in the general adult population, with females tending to report more somatic symptoms than do males. The development of the disorder is associated with marked impairment of health status.
Somatic symptoms are abundant in many “culture-bound syndromes with similar somatic symptoms, impairment found in research around the world. Seeking treatment for multiple somatic symptoms in general medical clinics is a worldwide phenomenon and occurs at similar rates among ethnic groups in the same country. The differences in somatic symptoms among cultures and ethnic groups are related to variations in linguistic and other cultural factors, and have been described as “idioms of distress.”
FLASHCARD:
Somatic Symptom Disorder
1. Prominent somatic symptoms with distress and impairment, encountered most often in primary care and medical settings
2. Diagnosis less often about physical complaints, and more about way they are presented and interpreted
3. Cognitive, affective and behavioral components incorporated into criteria
4. Specifiers:
A. “With Predominant Pain:” symptoms predominately involve pain
B. “Persistent:” severe symptoms, marked impairment, long duration (more than six months)
Severity Specifiers:
A. Mild: only one concern present
B. Moderate: two or more concerns presented
C. Severe: two or more concerns presented, multiple somatic complaints
5. Risk factors: personality traits, negative affectivity, less education, low socioeconomic status, stressful events
6. Prevalence: 5-7% in adults; females more frequently report
QUESTION:
Stacy, age 42, claims that for 10 months she has lower back pain, inner gastrointestinal troubles, and a slight discomfort in her in her forehead. She has been to three different physicans and although she continually says these symptoms exist, the physicans claim otherwise. Her symptoms more than likely point to
ANSWERS:
A. Acute Anxiety Disorder
B. Somatic Symptom Disorder
C. Generalized Anxiety Disorder
D. Functional Neurololgical Symptom Disorder
RATIONALE:
The correct answer is B. Acute Stress Disorder is an Anxiety Disorder that can develop in individuals who have been exposed to a traumatic event in which there is the threat or experience of death, serious injury, or risk to the physical integrity of the individual and/or others, which makes answer A incorrect. Individuals diagnosed with Generalized Anxiety Disorder (GAD) demonstrate excessive worry and anxiety surrounding a variety of topics (e.g., work, school, health) for at least six months, making answer C false, Conversion Disorder (also known as Functional Neurological Symptom Disorder) occurs when an individual develops symptoms affecting voluntary motor or sensory functions. Although the impairments in functioning are suggestive of a neurological condition, they are etiologically related to psychological rather than medical factors, making answer D false.