From the Guidelines
The four major somatoform disorders are Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder, and Factitious Disorder. These disorders are recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as distinct somatic symptom and related disorders 1. Somatic Symptom Disorder involves excessive thoughts, feelings, or behaviors related to physical symptoms that cause significant distress. Illness Anxiety Disorder (formerly hypochondriasis) is characterized by excessive worry about having or developing a serious illness despite minimal or no symptoms. Conversion Disorder features neurological symptoms like blindness, paralysis, or seizures that cannot be explained by medical conditions and appear to be psychological in origin. Factitious Disorder involves deliberately feigning or producing physical or psychological symptoms for the purpose of assuming the sick role. Some key features of these disorders include:
- Significant impairment in psychosocial functioning, such as relationships with family or friends, academic or occupational difficulties 1
- Symptoms that are not associated with material gain, nor are they intentionally produced, distinguishing them from factitious disorders or malingering 1
- A high prevalence in both adult and pediatric populations, with somatic symptom and related disorders contributing significantly to healthcare usage and costs 1 Treatment for these disorders typically involves a combination of:
- Cognitive-behavioral therapy to address underlying psychological issues
- Psychoeducation to help patients understand their conditions and manage symptoms
- Medication, in some cases, to address underlying anxiety or depression 1 Regular follow-up with both mental health professionals and primary care providers is crucial to manage these conditions effectively while avoiding unnecessary medical procedures, as seen in patients with PNES who may undergo extensive medical testing before receiving an accurate diagnosis and appropriate referrals 1.
From the Research
Somatoform Disorders
The somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms. Some of the major somatoform disorders include:
- Somatization disorder: involving multisystem physical symptoms 2
- Conversion disorder: voluntary motor or sensory function symptoms 2
- Pain disorder: pain with strong psychological involvement 2
- Hypochondriasis: fear of having a life-threatening illness or condition 2
Characteristics and Treatment
These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing 2. Treatment success can be enhanced by discussing the possibility of a somatoform disorder with the patient early in the evaluation process, limiting unnecessary diagnostic and medical treatments, focusing on the management of the disorder rather than its cure, using appropriate medications and psychotherapy for comorbidities, maintaining a psychoeducational and collaborative relationship with patients, and referring patients to mental health professionals when appropriate 2. Cognitive-behavioral therapy (CBT) has been found to be effective in treating somatoform disorders, including somatization disorder, hypochondriasis, and body dysmorphic disorder 3, 4, 5, 6.