Somatic symptom disorder
Other namesSomatoform disorder, somatization disorder
SpecialtyPsychiatry, psychology
SymptomsMaladaptive thoughts, feelings, and behaviors in response to chronic physical symptoms.[1]
ComplicationsReduced functioning, unemployment, financial stress, and interpersonal difficulties.
Usual onsetOften, not always, begins in childhood.[2]
DurationAt least six months.[3]
CausesHeightened awareness of bodily sensations and the tendency to misinterpret bodily sensations.[4]
Risk factorsChildhood neglect and abuse, chaotic lifestyle, history of substance and alcohol abuse, and psychosocial stressors.[5]
Diagnostic methodPsychiatric assessment.[2]
Differential diagnosisAdjustment disorder, body dysmorphic disorder, obsessive-compulsive disorder, conversion disorder, and illness anxiety disorder.[2]
TreatmentCognitive-behavioral therapy,[6] psychiatric medication, and brief psychodynamic interpersonal psychotherapy.[7]
MedicationSelective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors.[6]
PrognosisOften chronic but can be managed with the proper treatment.[2]
FrequencyAbout 13–23% of the general population.[8]

Somatic symptom disorder, also known as somatoform disorder, or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.[1]

Manifestations of somatic symptom disorder are variable; symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms as rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing chronic illness or medical condition.[9]

Several studies have found a high rate of comorbidity with major depressive disorder, generalized anxiety disorder, and phobias.[10] Somatic symptom disorder is frequently associated with functional pain syndromes like fibromyalgia and IBS.[11] Somatic symptom disorder typically leads to poor functioning, interpersonal issues, unemployment or problems at work, and financial strain as a result of excessive health-care visits.[9]

The cause of somatic symptom disorder is unknown. Symptoms may result from a heightened awareness of specific physical sensations paired with a tendency to interpret these experiences as signs of a medical ailment.[2] The diagnosis is controversial, as people with a medical illness can be mislabeled as mentally ill. This is especially true for women, who are more often dismissed when they present with physical symptoms.[12]

Signs and symptoms

Somatic symptom disorder can be detected by an ambiguous and often inconsistent history of symptoms that are rarely relieved by medical treatments. Additional signs of somatic symptom disorder include interpreting normal sensations for medical ailments, avoiding physical activity, being disproportionately sensitive to medication side effects, and seeking medical care from several physicians for the same concerns.[2]

Manifestations of somatic symptom disorder are highly variable. Recurrent ailments usually begin before the age of 30; most patients have many somatic symptoms, while others only experience one. The severity may fluctuate, but symptoms rarely go away completely for long periods of time.[1] Symptoms might be specific, such as regional pain and localized sensations, or general, such as fatigue, muscle aches, and malaise.[9]

Those suffering from somatic symptom disorder experience recurring and obsessive feelings and thoughts concerning their well-being. Common examples include severe anxiety regarding potential ailments, misinterpreting normal sensations as indications of severe illness, believing that symptoms are dangerous and serious despite lacking medical basis, claiming that medical evaluations and treatment have been inadequate, fearing that engaging in physical activity will harm the body, and spending a disproportionate amount of time thinking about symptoms.[9]

Somatic symptoms disorder pertains to how an individual interprets and responds to symptoms as opposed to the symptoms themselves. Somatic symptom disorder can occur even in those who have an underlying chronic illness or medical condition.[9] When a somatic symptom disorder coexists with another medical ailment, people overreact to the ailment's adverse effects. They may be unresponsive toward treatment or unusually sensitive to drug side effects. Those with somatic symptom disorder who also have another physical ailment may experience significant impairment that is not expected from the condition.[1]

Comorbidities

Most research that looked at additional mental illnesses or self-reported psychopathological symptoms among those with somatic symptom disorder identified significant rates of comorbidity with depression and anxiety, but other psychiatric comorbidities were not usually looked at.[2] Major depression, generalized anxiety disorder, and phobias were the most common concurrent conditions.[10]

In studies evaluating different physical ailments, 41.5% of people with semantic dementia, 11.2% of subjects with Alzheimer's disease,[13] 25% of female patients suffering from non-HIV lipodystrophy,[14] and 18.5% of patients with congestive heart failure[15] fulfilled somatic symptom disorder criteria. 25.6% of fibromyalgia patients met the somatic symptom disorder criteria exhibited higher depression rates than those who did not.[11] In one study, 28.8% of those with somatic symptom disorder had asthma, 23.1% had a heart condition, and 13.5% had gout, rheumatoid arthritis, or osteoarthritis.[16][17]

Complications

Alcohol and drug abuse are frequently observed, and sometimes used to alleviate symptoms, increasing the risk of dependence on controlled substances.[18] Other complications include poor functioning, problems with relationships, unemployment or difficulties at work, and financial stress due to excessive hospital visits.[9]

Causes

Somatic symptoms can stem from a heightened awareness of sensations in the body, alongside the tendency to interpret those sensations as ailments. Studies suggest that risk factors of somatic symptoms include childhood neglect, sexual abuse, a chaotic lifestyle, and a history of substance and alcohol abuse.[4][5] Psychosocial stressors, such as unemployment and reduced job performance, may also be risk factors.[2][19] There could also be a genetic element. A study of monozygotic and dizygotic twins found that genetic components contributed 7% to 21% of somatic symptoms, with the remainder related to environmental factors.[20] In another study, various single nucleotide polymorphisms were linked to somatic symptoms.[2]

Psychological

Evidence suggests that along with more broad factors such as early childhood trauma or insecure attachment, negative psychological factors including catastrophizing, negative affectivity, rumination, avoidance, health anxiety, or a poor physical self-concept have a significant impact on the shift from unproblematic somatic symptoms to a severely debilitating somatic symptom disorder.[17] Those who experience more negative psychological characteristics may regard medically unexplained symptoms to be more threatening and, therefore, exhibit stronger cognitive, emotional, and behavioral awareness of such symptoms.[21] In addition, evidence suggests that negative psychological factors have a significant impact on the impairments and behaviors of people suffering from somatic symptom disorder, as well as the long-term stability of such symptoms.[22][23][24]

Psychosocial

Psychosocial stresses and cultural norms influence how patients present to their physicians. American and Koreans engaged in a study to measure somatization within the cultural context. It was discovered that Korean participants used more body-related phrases while discussing their connections with stressful events and experienced more sympathy when asked to read texts using somatic expressions when discussing their emotions.[25]

Those raised in environments where expressing emotions during stages of development is discouraged face the highest risk of somatization.[25] In primary care settings, studies indicated that somaticizing patients had much greater rates of unemployment and decreased occupational functioning than non-somaticizing patients.[4]

Traumatic life events may cause the development of somatic symptom disorder. Most people with somatic symptom disorder originate from dysfunctional homes. A meta-analysis study revealed a connection between sexual abuse and functional gastrointestinal syndromes, chronic pain, non-epileptic seizures, and chronic pelvic pain.[25]

Physiological

The hypothalamo pituitary adrenal axis (HPA) has a crucial role in stress response. While the HPA axis may become more active with depression, there is evidence of hypocortisolism in somatization.[26] In somatic disorder, there is a negative connection between elevated pain scores and 5-hydroxy indol acetic acid (5-HIAA) and tryptophan levels.[25]

It has been suggested that proinflammatory processes may have a role in somatic symptom disorder, such as an increase of non-specific somatic symptoms and sensitivity to painful stimuli.[27] Proinflammatory activation and anterior cingulate cortex activity have been shown to be linked in those who experienced stressful life events for an extended period of time. It is further claimed that increased activity of the anterior cingulate cortex, which acts as a bridge between attention and emotion, leads to increased sensitivity of unwanted stimuli and bodily sensations.[28]

Pain is a multifaceted experience, not just a sensation. While nociception refers to afferent neural activity that transmits sensory information in response to stimuli that may cause tissue damage, pain is a conscious experience requiring cortical activity and can occur in the absence of nociception.[25] Those with somatic symptoms are thought to exaggerate their somatic symptoms through choice perception and perceive them in accordance with an ailment. This idea has been identified as a cognitive style known as "somatosensorial amplification".[29] The term "central sensitization" has been created to describe the neurobiological notion that those predisposed to somatization have an overly sensitive neural network. Harmless and mild stimuli stimulate the nociceptive specific dorsal horn cells after central sensitization. As a result, pain is felt in response to stimuli that would not typically cause pain.[25]

Neuroimaging evidence

Some literature reviews of cognitive–affective neuroscience on somatic symptom disorder suggested that catastrophization in patients with somatic symptom disorders tends to present a greater vulnerability to pain. The relevant brain regions include the dorsolateral prefrontal, insular, rostral anterior cingulate, premotor, and parietal cortices.[30][31]

Genetic

Genetic investigations have suggested modifications connected to the monoaminergic system, in particular, may be relevant while a shared genetic source remains unknown. Researchers take into account the various processes involved in the development of somatic symptoms as well as the interactions between various biological and psychosocial factors.[25] Given the high occurrence of trauma, particularly throughout childhood, it has been suggested that the epigenetic changes could be explanatory.[32] Another study found that the glucocorticoid receptor gene (NR3C1) is hypomethylated in those with somatic symptom disorder and in those with depression.[25]

Diagnosis

Because those with somatic syndrome disorder typically have comprehensive previous workups, minimal laboratory testing is encouraged. Excessive testing increases the possibility of false-positive results, which may result in further interventions, associated risks, and greater expenses. While some practitioners order tests to reassure patients, research shows that diagnostic testing fails to alleviate somatic symptoms.[2]

Specific tests, such as thyroid function assessments, urine drug screens, restricted blood studies, and minimal radiological imaging, may be conducted to rule out somatization because of medical issues.[2]

Somatic Symptom Scale – 8

Main article: Somatic Symptom Scale - 8

The Somatic Symptom Scale – 8 (SSS-8) is a short self-report questionnaire that is used to evaluate somatic symptoms. It examines the perceived severity of common somatic symptoms.[33] The SSS-8 is a condensed version of the well-known Patient Health Questionnaire-15 (PHQ-15).[34]

On a five-point scale, respondents rate how much stomach or digestive issues, back discomfort, pain in the legs, arms, or joints, headaches, chest pain or shortness of breath, dizziness, feeling tired or having low energy, and trouble sleeping impacted them in the preceding seven days. Ratings are added together to provide a sum score that ranges from 0 to 32 points.[33]

DSM-5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) modified the entry titled "somatoform disorders" to "somatic symptom and related disorders", and modified other diagnostic labels and criteria.[35]

The DSM-5 criteria for somatic symptom disorder includes "one or more somatic symptoms which are distressing or result in substantial impairment of daily life". Additional criteria, often known as B criteria, include "excessive thoughts, feelings, or behaviors regarding somatic symptoms or corresponding health concerns manifested by disproportionate and persistent thoughts about the severity of one's symptoms". It continues: "Although any one somatic symptom might not be consistently present, one's state of being symptomatic is continuous (typically lasting more than 6 months)."[3]

The DSM includes five distinct descriptions for somatic symptom disorder. These include somatic symptom disorder with predominant pain, formally referred to as pain disorder, as well as classifications for mild, moderate, and severe symptoms.[3]

International Classification of Diseases

The ICD-11 classifies somatic symptoms as "Bodily distress disorder". Bodily distress disorder is characterized by the presence of distressing bodily symptoms and excessive attention devoted to those symptoms. The ICD-11 further specifies that if another health condition is causing or contributing to the symptoms, the level of attention must be clearly excessive in relation to the nature and course of the condition.[36]

Differential diagnosis

Somatic syndrome disorder's widespread, non-specific symptoms may conceal and mimic the manifestations of other medical disorders, making diagnosis and therapy challenging. Adjustment disorder, body dysmorphic disorder, obsessive-compulsive disorder, and illness anxiety disorder may all exhibit excessive and exaggerated emotional and behavioral responses. Other functional diseases with unknown etiology, such as fibromyalgia and irritable bowel syndrome, tend not to present with excessive thoughts, feelings, or maladaptive behavior.[2]

Somatic symptom disorder overlaps with illness anxiety disorder and conversion disorder. Illness anxiety disorder is characterized by an obsession with having or developing a dangerous, undetected medical ailment, despite the absence of bodily symptoms. Conversion disorder may present with one or more symptoms of various sorts. Motor symptoms involve weakness or paralysis; aberrant movements including tremor or dystonic movements; abnormal gait patterns; and abnormal limb posture. The presenting symptom in conversion disorder is loss of function, but in somatic symptom disorder, the emphasis is on the discomfort that specific symptoms produce. Conversion disorder often lacks the overwhelming thoughts, feelings, and behaviors that characterize somatic symptom disorder.[3]

Treatment

Rather than focusing on treating the symptoms, the key objective is to support the patient in coping with symptoms, including both physical symptoms and psychological/behavioral (such as health anxiety and harmful behaviors).[2]

Early psychiatric treatment is advised. Evidence suggests that SSRIs and SNRIs can lower pain perception.[6] Because the somatic symptomatic may have a low threshold for adverse reactions, medication should be started at the lowest possible dose and gradually increased to produce a therapeutic effect.[2]

Cognitive-behavioral therapy has been linked to significant improvements in patient-reported function and somatic symptoms, a reduction in health-care expenses, and a reduction in symptoms of depression.[37][38][6] CBT aims to help patients realize their ailments are not catastrophic and to enable them to gradually return to activities they previously engaged in, without fear of "worsening their symptoms". Consultation and collaboration with the primary care physician also demonstrated some effectiveness.[39][40] Furthermore, brief psychodynamic interpersonal psychotherapy (PIT) for patients with somatic symptom disorder has been proven to improve the physical quality of life in patients with many, difficult-to-treat, medically unexplained symptoms over time[7]

CBT can help in some of the following ways:[41]

(ECT) has been used in treating somatic symptom disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT.[42] Overall, psychologists recommend addressing a common difficulty in patients with somatic symptom disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner.[43]

Outlook

Somatic symptom disorder is typically persistent, with symptoms that wax and wane. Chronic limitations in general function, substantial psychological impairment, and a reduction in quality of life are all common.[2] Some investigations suggest people can recover; the natural history of the illnesses implies that around 50% to 75% of patients with medically unexplained symptoms improve, whereas 10% to 30% deteriorate. Fewer physical symptoms and better baseline functioning are stronger prognostic indicators. A strong, positive relationship between the physician and the patient is crucial, and it should be accompanied by frequent, supportive visits to avoid the temptation to medicate or test when these interventions are not obviously necessary.[4]

Epidemiology

Somatic symptom disorder affects 5% to 7% of the general population, with a higher female representation, and can arise throughout childhood, adolescence, or adulthood. Evidence suggests that the emergence of prodromal symptoms often begins in childhood and that symptoms fitting the criteria for somatic symptom disorder are common during adolescence. A community study of adolescents found that 5% had persistent distressing physical symptoms paired with psychological concerns.[44] In the primary care patient population, the rate rises to around 17%.[2] Patients with functional illnesses such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome have a greater prevalence of somatic symptom disorder. The reported frequency of somatic symptom disorder, as defined by DSM-5 criteria, ranges from 25 to 60% among these patients.[44]

There are cultural differences in the prevalence of somatic symptom disorder. For example, somatic symptom disorder and symptoms were found to be significantly more common in Puerto Rico.[45] In addition the diagnosis is also more prevalent among African Americans and those with less than a high school education or lower socioeconomic status.[46]

There is usually co-morbidity with other psychological disorders, particularly mood disorders or anxiety disorders.[3][47] Research also showed comorbidity between somatic symptom disorder and personality disorders, especially antisocial, borderline, narcissistic, histrionic, avoidant, and dependent personality disorder.[48]

About 10-20 percent of female first degree relatives also have somatic symptom disorder and male relatives have increased rates of alcoholism and sociopathy.[49]

History

Somatization is an idea that physicians have been attempting to comprehend since the dawn of time. The Egyptians and Sumerians were reported to have utilized the notions of melancholia and hysteria as early as 2600 BC. For many years, somatization was used in conjunction with the terms hysteria, melancholia, and hypochondriasis.[50][25]

During the 17th century, knowledge of the central nervous system grew, giving rise to the notion that numerous inexplicable illnesses could be linked to the brain. Thomas Willis, widely regarded as the father of neurology, recognized hysteria in women and hypochondria in males as brain disorders. Thomas Sydenham contributed significantly to the belief that hysteria and hypochondria are mental rather than physical illnesses. The term "English Malady" was used by George Cheyne to denote that hysteria and hypochondriasis are brain and/or mind-related disorders.[25]

Wilhelm Stekel, a German psychoanalyst, was the first to introduce the term somatization, and Paul Briquet was the first to characterize what is now known as Somatic symptom disorder.[25] Briquet reported respondents who had been unwell for most of their lives and complained of a variety of symptoms from various organ systems. Despite many appointments, hospitalizations, and tests, symptoms continue.[51] Somatic symptom disorder was later dubbed "Briquet Syndrome" in his honor. Over time, the concept of hysteria was used in place of a personality or character type, conversion responses, phobia, and anxiety to accompany psychoneuroses, and its incorporation in everyday English as a negative word led to a distancing from this concept.[25]

Controversy

Somatic symptom disorder has long been a contentious diagnosis because it was based solely on negative criteria, namely the absence of a medical explanation for the presenting physical problems. As a result, any person suffering from a poorly understood illness may meet the criteria for this psychological diagnosis, regardless of whether they exhibit psychiatric symptoms in the traditional sense.[52][12]

Misdiagnosis

In the opinion of Allen Frances, chair of the DSM-IV task force, the DSM-5's somatic symptom disorder brings with it a risk of mislabeling a sizable proportion of the population as mentally ill.

Millions of people could be mislabeled, with the burden falling disproportionately on women, because they are more likely to be casually dismissed as 'catastrophizers' when presenting with physical symptoms.[12]

See also

References

  1. ^ a b c d "Somatic Symptom Disorder — Psychiatric Disorders". Merck Manuals Professional Edition. Retrieved 2023-08-01.
  2. ^ a b c d e f g h i j k l m n o p D'Souza, Ryan S.; Hooten, W. M. (January 2023). "Somatic Symptom Disorder". Somatic Syndrome Disorders. Treasure Island (FL): StatPearls Publishing. PMID 30335286 – via PubMed.
  3. ^ a b c d e Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Washington DC: American Psychiatric Association. 2013. pp. 354–372. ISBN 978-0-89042-555-8.
  4. ^ a b c d Kurlansik, Stuart L.; Maffei, Mario S. (1 January 2016). "Somatic Symptom Disorder". American Family Physician. 93 (1): 49–54. ISSN 1532-0650. PMID 26760840.
  5. ^ a b Rost, K. M.; Akins, R. N.; Brown, F. W.; Smith, G. R. (September 1992). "The comorbidity of DSM-III-R personality disorders in somatization disorder". General Hospital Psychiatry. 14 (5): 322–326. doi:10.1016/0163-8343(92)90066-j. ISSN 0163-8343. PMID 1521787.
  6. ^ a b c d Somashekar, Bettahalasoor; Jainer, Ashok; Wuntakal, Balaji (February 2013). "Psychopharmacotherapy of somatic symptoms disorders". International Review of Psychiatry. 25 (1): 107–115. doi:10.3109/09540261.2012.729758. ISSN 0954-0261. PMID 23383672. S2CID 25646632.
  7. ^ a b Sattel, H.; Lahmann, C.; Gündel, H.; Guthrie, E.; Kruse, J.; Noll-Hussong, M.; Ohmann, C.; Ronel, J.; Sack, M.; Sauer, N.; Schneider, G.; Henningsen, P. (2012). "Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial". British Journal of Psychiatry. 200 (1). Royal College of Psychiatrists: 60–67. doi:10.1192/bjp.bp.111.093526. ISSN 0007-1250. PMID 22075651.
  8. ^ Sauer, Karoline S.; Witthöft, Michael; Rief, Winfried (2023). "Somatic Symptom Disorder and Health Anxiety". Neurologic Clinics. 41 (4). Elsevier BV: 745–758. doi:10.1016/j.ncl.2023.02.009. ISSN 0733-8619. PMID 37775202. S2CID 258266448.
  9. ^ a b c d e f "Somatic symptom disorder — Symptoms and causes". Mayo Clinic. Retrieved 2023-08-01.
  10. ^ a b Brown, F. W.; Golding, J. M.; Smith, G. R. (July 1990). "Psychiatric comorbidity in primary care somatization disorder". Psychosomatic Medicine. 52 (4): 445–451. doi:10.1097/00006842-199007000-00006. ISSN 0033-3174. PMID 2399295. S2CID 30954374.
  11. ^ a b Häuser, Winfried; Bialas, Patric; Welsch, Katja; Wolfe, Frederick (June 2015). "Construct validity and clinical utility of current research criteria of DSM-5 somatic symptom disorder diagnosis in patients with fibromyalgia syndrome". Journal of Psychosomatic Research. 78 (6): 546–552. doi:10.1016/j.jpsychores.2015.03.151. ISSN 1879-1360. PMID 25864805.
  12. ^ a b c Frances A (2013). "The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill". BMJ. 346: f1580. doi:10.1136/bmj.f1580. PMID 23511949. S2CID 206897269.
  13. ^ Gan, Joanna J.; Lin, Andrew; Samimi, Mersal S.; Mendez, Mario F. (November 2016). "Somatic Symptom Disorder in Semantic Dementia: The Role of Alexisomia". Psychosomatics. 57 (6): 598–604. doi:10.1016/j.psym.2016.08.002. ISSN 1545-7206. PMID 27647568.
  14. ^ Calabrò, Pasquale Fabio; Ceccarini, Giovanni; Calderone, Alba; Lippi, Chita; Piaggi, Paolo; Ferrari, Federica; Magno, Silvia; Pedrinelli, Roberto; Santini, Ferruccio (August 2020). "Psychopathological and psychiatric evaluation of patients affected by lipodystrophy". Eating and Weight Disorders: EWD. 25 (4): 991–998. doi:10.1007/s40519-019-00716-6. ISSN 1590-1262. PMID 31144218. S2CID 169040646.
  15. ^ Guidi, Jenny; Rafanelli, Chiara; Roncuzzi, Renzo; Sirri, Laura; Fava, Giovanni A. (March 2013). "Assessing psychological factors affecting medical conditions: comparison between different proposals". General Hospital Psychiatry. 35 (2): 141–146. doi:10.1016/j.genhosppsych.2012.09.007. ISSN 1873-7714. PMID 23122485.
  16. ^ Newby, Jill M.; Hobbs, Megan J.; Mahoney, Alison E. J.; Wong, Shiu Kelvin; Andrews, Gavin (October 2017). "DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis". Journal of Psychosomatic Research. 101: 31–37. doi:10.1016/j.jpsychores.2017.07.010. ISSN 1879-1360. PMID 28867421.
  17. ^ a b Löwe, Bernd; Levenson, James; Depping, Miriam; Hüsing, Paul; Kohlmann, Sebastian; Lehmann, Marco; Shedden-Mora, Meike; Toussaint, Anne; Uhlenbusch, Natalie; Weigel, Angelika (March 2022). "Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis". Psychological Medicine. 52 (4): 632–648. doi:10.1017/S0033291721004177. ISSN 0033-2917. PMC 8961337. PMID 34776017.
  18. ^ Hasin, Deborah; Katz, Hila (December 2007). "Somatoform and substance use disorders". Psychosomatic Medicine. 69 (9): 870–875. doi:10.1097/PSY.0b013e31815b00d7. ISSN 1534-7796. PMID 18040097. S2CID 1280316.
  19. ^ Harris, Ashley M.; Orav, E. John; Bates, David W.; Barsky, Arthur J. (February 2009). "Somatization increases disability independent of comorbidity". Journal of General Internal Medicine. 24 (2): 155–161. doi:10.1007/s11606-008-0845-0. ISSN 1525-1497. PMC 2629001. PMID 19031038.
  20. ^ Kato, Kenji; Sullivan, Patrick F.; Pedersen, Nancy L. (May 2010). "Latent class analysis of functional somatic symptoms in a population-based sample of twins". Journal of Psychosomatic Research. 68 (5): 447–453. doi:10.1016/j.jpsychores.2010.01.010. ISSN 1879-1360. PMC 2858068. PMID 20403503.
  21. ^ Mewes, Ricarda (2022). "Recent developments on psychological factors in medically unexplained symptoms and somatoform disorders". Frontiers in Public Health. 10. doi:10.3389/fpubh.2022.1033203. ISSN 2296-2565. PMC 9672811. PMID 36408051.
  22. ^ Klaus, Kristina; Rief, Winfried; Brähler, Elmar; Martin, Alexandra; Glaesmer, Heide; Mewes, Ricarda (November 2015). "Validating psychological classification criteria in the context of somatoform disorders: A one- and four-year follow-up". Journal of Abnormal Psychology. 124 (4): 1092–1101. doi:10.1037/abn0000085. ISSN 1939-1846. PMID 26280303.
  23. ^ Martin, Alexandra; Rief, Winfried (September 2011). "Relevance of cognitive and behavioral factors in medically unexplained syndromes and somatoform disorders". The Psychiatric Clinics of North America. 34 (3): 565–578. doi:10.1016/j.psc.2011.05.007. ISSN 1558-3147. PMID 21889679.
  24. ^ Rief, Winfried; Mewes, Ricarda; Martin, Alexandra; Glaesmer, Heide; Braehler, Elmar (September 2010). "Are psychological features useful in classifying patients with somatic symptoms?". Psychosomatic Medicine. 72 (7): 648–655. doi:10.1097/PSY.0b013e3181d73fce. ISSN 1534-7796. PMID 20368474. S2CID 86067.
  25. ^ a b c d e f g h i j k l Çetin, Şahabettin; Varma, Gülfizar Sözer (2021). "Somatic Symptom Disorder: Historical Process and Biopsychosocial Approach" (PDF). Psikiyatride Güncel Yaklaşımlar — Current Approaches in Psychiatry. 13 (4): 790–804. doi:10.18863/pgy.882929.
  26. ^ Tak, Lineke M.; Rosmalen, Judith G. M. (1 May 2010). "Dysfunction of stress responsive systems as a risk factor for functional somatic syndromes" (PDF). Journal of Psychosomatic Research. 68 (5): 461–468. doi:10.1016/j.jpsychores.2009.12.004. ISSN 0022-3999. PMID 20403505. S2CID 7334435.
  27. ^ Rief, Winfried; Hennings, Anika; Riemer, Sabine; Euteneuer, Frank (May 2010). "Psychobiological differences between depression and somatization". Journal of Psychosomatic Research. 68 (5): 495–502. doi:10.1016/j.jpsychores.2010.02.001. ISSN 1879-1360. PMID 20403510.
  28. ^ Harrison, Neil A.; Brydon, Lena; Walker, Cicely; Gray, Marcus A.; Steptoe, Andrew; Critchley, Hugo D. (1 September 2009). "Inflammation causes mood changes through alterations in subgenual cingulate activity and mesolimbic connectivity". Biological Psychiatry. 66 (5): 407–414. doi:10.1016/j.biopsych.2009.03.015. ISSN 1873-2402. PMC 2885494. PMID 19423079.
  29. ^ Barsky, A. J. (1992). "Amplification, somatization, and the somatoform disorders". Psychosomatics. 33 (1): 28–34. doi:10.1016/S0033-3182(92)72018-0. ISSN 0033-3182. PMID 1539100.
  30. ^ Stein, Dan J.; Muller, Jacqueline (2008). "Cognitive-Affective Neuroscience of Somatization Disorder and Functional Somatic Syndromes: Reconceptualizing The Triad of Depression-Anxiety-Somatic Symptoms". CNS Spectrums. 13 (5): 379–384. doi:10.1017/S1092852900016540. ISSN 1092-8529. PMID 18496475.
  31. ^ García-Campayo, Javier; Fayed, Nicolas; Serrano-Blanco, Antoni; Roca, Miquel (2009). "Brain dysfunction behind functional symptoms: neuroimaging and somatoform, conversive, and dissociative disorders". Current Opinion in Psychiatry. 22 (2): 224–231. doi:10.1097/YCO.0b013e3283252d43. ISSN 0951-7367. PMID 19553880.
  32. ^ Frodl, T. (2016). "Do (epi)genetics impact the brain in functional neurologic disorders?". Functional Neurologic Disorders. Handbook of Clinical Neurology. Vol. 139. pp. 157–165. doi:10.1016/B978-0-12-801772-2.00014-X. ISBN 9780128017722. ISSN 0072-9752. PMID 27719836.
  33. ^ a b Gierk, Benjamin; Kohlmann, Sebastian; Kroenke, Kurt; Spangenberg, Lena; Zenger, Markus; Brähler, Elmar; Löwe, Bernd (1 March 2014). "The Somatic Symptom Scale–8 (SSS-8): A Brief Measure of Somatic Symptom Burden". JAMA Internal Medicine. 174 (3): 399–407. doi:10.1001/jamainternmed.2013.12179. ISSN 2168-6106. PMID 24276929.
  34. ^ Kroenke, Kurt; Spitzer, Robert L.; Williams, Janet B. W. (March 2002). "The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms". Psychosomatic Medicine. 64 (2): 258–266. doi:10.1097/00006842-200203000-00008. ISSN 0033-3174. PMID 11914441. S2CID 28701848.
  35. ^ Rief, Winfried; Martin, Alexandra (28 March 2014). "How to Use the New DSM-5 Somatic Symptom Disorder Diagnosis in Research and Practice: A Critical Evaluation and a Proposal for Modifications". Annual Review of Clinical Psychology. 10 (1): 339–367. doi:10.1146/annurev-clinpsy-032813-153745. ISSN 1548-5943. PMID 24387234.
  36. ^ International Classification of Diseases (11 ed.). Geneva, Switerzland: World Health Organization. 25 May 2019. p. 449. Retrieved 3 July 2023.
  37. ^ Liu, Jing; Gill, Neeraj S.; Teodorczuk, Andrew; Li, Zhan-jiang; Sun, Jing (2019). "The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials". Journal of Affective Disorders. 245. Elsevier BV: 98–112. doi:10.1016/j.jad.2018.10.114. hdl:10072/380915. ISSN 0165-0327. PMID 30368076. S2CID 53113252.
  38. ^ N, van Dessel; M, den Boeft; Jc, van der Wouden; M, Kleinstäuber; Ss, Leone; B, Terluin; Me, Numans; He, van der Horst; H, van Marwijk (2014-11-01). "Non-pharmacological Interventions for Somatoform Disorders and Medically Unexplained Physical Symptoms (MUPS) in Adults". The Cochrane Database of Systematic Reviews (11): CD011142. doi:10.1002/14651858.CD011142.pub2. PMC 10984143. PMID 25362239.
  39. ^ Kroenke, Kurt (2007). "Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials". Psychosomatic Medicine. 69 (9): 881–888. doi:10.1097/PSY.0b013e31815b00c4. ISSN 0033-3174.
  40. ^ Smith, G. Richard; Monson, Roberta A.; Ray, Debby C. (1986-05-29). "Psychiatric Consultation in Somatization Disorder". New England Journal of Medicine. 314 (22): 1407–1413. doi:10.1056/NEJM198605293142203. ISSN 0028-4793. PMID 3084975.
  41. ^ "Somatic symptom disorder Treatments and drugs". Mayo Clinic. Archived from the original on 2017-04-19. Retrieved 2017-04-19.
  42. ^ Zorumski, Charles F.; Rubin, Eugene H.; Burke, William J. (1988). "Electroconvulsive Therapy for the Elderly: A Review". Psychiatric Services. 39 (6): 643–647. doi:10.1176/ps.39.6.643. ISSN 1075-2730. PMID 3042587.
  43. ^ Egan, Jonathan; Kenny, Maeve (February 2011). "Somatization disorder: What clinicians need to know" (PDF). The Irish Psychologist. 37 (4): 93–96. Retrieved 9 December 2011.
  44. ^ a b "Somatic symptom disorder: Epidemiology and clinical presentation". UpToDate. Retrieved 2023-08-05.
  45. ^ Canino, G.; Bird, H.; Rubio-Stipec, M.; Bravo, M. (1997). "The epidemiology of mental disorders in the adult population of Puerto Rico". Puerto Rico Health Sciences Journal. 16 (2): 117–124. ISSN 0738-0658. PMID 9285988.
  46. ^ Noyes, Russell; Stuart, Scott; Watson, David B.; Langbehn, Douglas R. (2006). "Distinguishing between Hypochondriasis and Somatization Disorder: A Review of the Existing Literature". Psychotherapy and Psychosomatics. 75 (5): 270–281. doi:10.1159/000093948. ISSN 0033-3190. PMID 16899963.
  47. ^ Lieb, Roselind; Meinlschmidt, Gunther; Araya, Ricardo (2007). "Epidemiology of the Association Between Somatoform Disorders and Anxiety and Depressive Disorders: An Update". Psychosomatic Medicine. 69 (9): 860–863. doi:10.1097/PSY.0b013e31815b0103. ISSN 0033-3174. PMID 18040095.
  48. ^ Bornstein, Robert F.; Gold, Stephanie H. (2008). "Comorbidity of Personality Disorders and Somatization Disorder: A Meta-analytic Review". Journal of Psychopathology and Behavioral Assessment. 30 (2): 154–161. doi:10.1007/s10862-007-9052-2. ISSN 0882-2689.
  49. ^ Stern, T.A.; Rosenbaum, J.F.; Fava, M.; Biederman, J.; Rauch, S.L. (2008). Massachusetts General Hospital Comprehensive Clinical Psychiatry. Sandoz Lectures in Gerontology. Elsevier Health Sciences. p. 323. ISBN 978-0-323-07691-3. Retrieved 2024-07-14.
  50. ^ Sadock, Benjamin J.; Sadock, Virginia A.; Kaplan, Harold I. (2005). Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Philadelphia, Pa: Lippincott Williams & Wilkins. pp. 1800–1828. ISBN 0-7817-3434-7.
  51. ^ "Briquet's Syndrome (somatization disorder, DSM-IV- TR #300.81)" (PDF).
  52. ^ Morrison, James (2023-03-08). DSM-5-TR® Made Easy. New York: Guilford Publications. ISBN 978-1-4625-5134-7.

Further reading