Somatic symptom disorder: a diagnostic dilemma

Abstract

Somatic symptom disorder (SSD) is a diagnosis that was introduced with publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. It eliminated the diagnoses of somatisation disorder, undifferentiated somatoform disorder, hypochondriasis and pain disorder; most of the patients who previously received these diagnoses are now diagnosed in DSM-5 with SSD. The main feature of this disorder is a patient’s concern with physical symptoms for which no biological cause is found. It requires psychiatric assessment to exclude comorbid psychiatric disease. Failure to recognise this disorder may lead the unwary physician or surgeon to embark on investigations or diagnostic procedures which may result in iatrogenic complications. It also poses a significant financial burden on the healthcare service. Patients with non-specific abdominal pain have a poor symptomatic prognosis with continuing use of medical services. Proven treatments include cognitive behavioural therapy, mindfulness therapy and pharmacological treatment using selective serotonin reuptake inhibitors or tricyclic antidepressants. The authors describe the case of a 31-year-old woman with an emotionally unstable personality disorder and comorbid disease presenting to the emergency department with a 3-week history of left-sided abdominal and leg pain. Despite a plethora of investigations, no organic cause for her pain was found. She was reviewed by the multidisciplinary team including surgeons, physicians, neurologists and psychiatrists. A diagnosis of somatoform symptom disorder was subsequently rendered. As patients with SSD will present to general practice and the emergency department rather than psychiatric settings, this case provides a cautionary reminder of furthering the need for appropriate recognition of this condition.

Mental health burden of empty nose syndrome compared to chronic rhinosinusitis and chronic rhinitis

“…This new diagnosis of SSD includes the previous diagnoses of somatization disorder, undifferentiated somatoform disorder, hypochondriasis, and pain disorder, which were all individual in the DSM-4. 40,41 To fulfill the diagnostic criteria, the following must be present: excessive and disproportionate thoughts, feelings (anxiety or depression), or behaviors (excessive time and energy devoted to these symptoms or health concern) associated with the somatic symptom(s), such as pain or fatigue that cause psychological stress related to the health symptoms and cause distress in daily life. These are all major presenting characteristics seen in ENS patients.…”

Sağlık sisteminde ihmal edilen bir konu 'Bedensel Belirti Bozukluğu': Bir olgu sunumu

“…BBB genel toplumda oldukça sık görülmesine rağmen, tanı ve ayrıcı tanıda birtakım güçlüklere neden olabilmektedir [8,13]. Bu nedenle psikiyatri dışı hekimlerin bu tür ruhsal bozukluklar konusunda duyarlı olmaları önem taşımaktadır.…”

“…Sağlık sistemi içinde önemli bir yüke sahiptirler. Çünkü bu hastalara çok sayıda girişimsel ve girişimsel olmayan tetkikler yapılmakta ve uygun olmayan tedaviler önerilmektedir [12,13]. Biz de bu olgu sunumunda son beş yılda çok fazla hekim başvurusu olan bir hastayı mevcut literatür bulguları eşliğinde tartışarak mevcut yazına katkı sunmayı amaçladık…”

Somatic symptoms with psychogenic or psychiatric background

“…[ 2 3 4 ] Diagnosis is possible only after the comprehensive exclusion of other conceivable organic medical conditions or mental illnesses. [ 5 6 ] The correct diagnosis of SSD is important not only to treat patients with anxiolytics but also to avoid overlooking non-psychotic diseases that can otherwise be treated with proper therapeutic interventions. However, till date, the characteristics of somatic symptoms in patients with psychogenic backgrounds and those with non-psychogenic diseases have not been studied sufficiently.…”