Somatic symptom disorder

What it is

Somatic symptom disorder is characterized by numerous physical complaints that cannot be explained by any medical condition and that involve most of the organ systems. The earlier name is given two ways and the two disagree: formerly called somatization disorder in one place, previously called hypochondriasis in another. It usually begins in the teens or twenties, and it affects mostly women.

The line that separates it from illness anxiety disorder is whether physical symptoms are present. If the patient is preoccupied with being sick or with contracting a disease without having physical symptoms, the diagnosis is illness anxiety disorder and not somatic symptom disorder. No real symptoms points to illness anxiety disorder; lots of physical symptoms plus worry points to somatic symptom disorder.

How it presents

The medical history is imprecise or inaccurate, and the patient is vague about past medical evaluations while the medical record itself is extensive. Symptoms are multiple and unexplained, and they begin in the late teenage years.

• Multiple unexplained physical symptoms.
• Insistence on surgical procedures, including asking to be referred for surgical evaluation.
• An imprecise or inaccurate medical history.
• Common abuse of alcohol, narcotics, or other drugs.

A typical record holds multiple normal blood and imaging tests, several surgical procedures that have failed to alleviate the symptoms, and frequent requests for refills of narcotic analgesics.