Somatic Symptom and Related Disorders

A Somatic Symptom Disorder is a mental illness that involves a dysfunctional preoccupation with one or more physical symptoms. It is characterized by recurring and multiple physical complaints involving feelings of extreme anxiety about symptoms such as pain, shortness of breath, and fatigue. The disorder involves a significant focus on the physical symptoms that causes emotional distress and difficulties in activities of daily living. The clinician may be unable to link the somatic or bodily symptoms to an identifiable medical condition. 

These somatic symptoms can begin in childhood, adolescence, or adulthood but that typically begin before the age of 30. The complaints generally occur over a period of several years. The significant impairment in social, occupational, or other important areas of functioning often results in the individual seeking medical evaluation and treatment. The disorder may last for several years or for an entire lifetime. The individual perceives the physical symptoms as being very serious and is distressed beyond what would typically be expected. Although physical symptoms such as pain, fatigue, and shortness of breath actually may be present, the defining features of this disorder involve how the individual reacts to or feels about the reported symptoms. A specific cause has not been identified.

Illness Anxiety Disorder is a mental illness that formerly was known as somatoform disorder and prior to that as hypochondriasis—terms that are no longer in vogue. It involves excessive preoccupation with one’s health. It is characterized as a disorder in which the individual has no somatic or bodily symptoms but is preoccupied with perceiving or imagining or fearing the presence of a serious illness or with the possibility of acquiring a serious illness. The illness preoccupation has been present for at least 6 months, although the specific illness that the individual fears may change over that period of time. Distress about possible illnesses interferes with everyday activities. The condition can last a lifetime.

The reported symptoms are either not present or are quite mild. If another medical condition is present or if there is a high risk of developing a medical condition (e.g., there is a strong family history), the preoccupation is clearly excessive or disproportionate to the probable risk. The individual’s distress results not primarily from the physical complaint(s) but from anxiety about the meaning, significance, or cause of the complaints. Patients may make frequent, dramatic statements regarding their health. They exaggerate the impact of actual disorders and exhibit high levels of self-pity. Minor injuries trigger a dramatic response. Approximately two thirds of individuals with Illness Anxiety Disorder will exhibit at least one other comorbid form of psychopathology. An individual even may avoid going to doctor appointments or hospitals for fear of a potential diagnosis. 

Conversion Disorder is a mental illness that is categorized as a functional neurological system disorder or hysterical neurosis. The physical body responds to an individual’s perceived mental or emotional threat, and the emotional or mental crisis produces stress that converts to a physical problem. Conversion Disorder symptoms may occur due to psychological and emotional conflict or trauma. The symptoms begin suddenly after a stressful experience. The individual may even experience blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by illness or injury. 

Conversion disorder is more common in women, people of lower socioeconomic status, and those in the military. Most affected individuals first develop symptoms of Conversion Disorder during adolescence or adulthood. Reports are that individuals who convert their emotional problems into physical symptoms spend nine times the cost for healthcare as people who do not. In terms of employment, 82 percent of adults with Conversion Disorder stop working because of their condition. The exact cause of Conversion Disorder is as yet unknown.

A Factitious Disorder is a mental illness in which an individual pretends to be sick, either through self-injury or by making themselves sick in some other way. It is characterized by exaggerated or made-up symptoms of an illness, be they physical or psychiatric. It can be exhibited as a false belief. Pseudocyesis, for example, is a false belief of being pregnant due to misinterpretations of reported symptoms of pregnancy. A pathological need to be noticed and given sympathy may sometimes underlay the diagnosis.

The condition is usually one of intermittent episodes. Persistent unremitting episodes and single episodes are less common. In recurrent episodes, defined as two or more events of falsification of illness and/or induction of injury, the essential feature involves falsification of medical or psychological signs and symptoms.