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Somatic symptom disorder

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Somatic symptom disorder

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Somatic symptom disorder

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USMLE® Step 1 style questions USMLE

4 questions
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A 17-year-old girl presents to her primary care physician to evaluate right leg weakness for two weeks. The patient states, “I can’t lift my right leg, and it feels numb too. I haven’t been able to walk or go to school because of my symptoms.” The patient's parent states, “I don’t know what’s wrong. I know school has been hard this year with her applying to college, but all of this just came out of the blue.” The patient is otherwise healthy and neither uses illicit substances nor consumes alcohol. Vital signs are within normal limits. The patient has 2+ symmetric reflexes in the bilateral lower extremities on physical examination. Plantar reflex testing results in flexion of the big toe bilaterally. While the patient lies supine, the physician places a hand under the right heel; when asked to lift the left leg against resistance, the patient exerts downward pressure with the right heel. Further history gathering is most likely to reveal which of the following?  

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Content Reviewers:

Rishi Desai, MD, MPH

Contributors:

Tanner Marshall, MS

Somatic symptom disorder, which used to be called somatization or somatoform disorder, involves physical symptoms that aren’t explained by any known physical or mental disorder; in other words, their origins are unknown.

That said, individuals aren’t “faking” their symptoms; these symptoms are very real and often made worse by the fact that they cannot be scientifically explained.

This is pretty different from situations where an individual with a factitious disorder might fake an illness or injury in order to get attention.

A diagnosis of somatic symptom disorder requires that individuals experience some set of unexplained physical symptoms, called somatic symptoms, for a period of at least 6 months.

The symptoms experienced by individuals with this disorder can be incredibly varied, encompassing anything from pain to gastrointestinal problems to sexual symptoms.

Although the somatic symptoms being experienced are chronic, the exact location, kind, and severity of the symptoms typically changes over time.

The one symptom that does often persist over time is chronic pain, and because it’s persistent and has no clear underlying cause, it can be particularly hard to treat.

Somatic symptom disorder often leads to cognitive symptoms as well, with people having persistent thoughts and feelings about their symptoms, like worry and anxiety, and sometimes in particularly bad cases, catastrophic thoughts about death.

More often than not, it’s these cognitive symptoms felt in response to the physical symptoms, rather than the physical symptoms themselves, that are used as the basis for a diagnosis of somatic symptom disorder.

In fact, clinicians rate the severity of somatic symptom disorder based on the person’s experience with these cognitive symptoms, rather than the physical ones.

The condition is considered mild if there’s only one cognitive symptom, like ruminating a lot on the symptoms.

It would be considered moderate if there are two or more cognitive symptoms, like rumination and anxiety.

Summary
A somatic symptom disorder, formerly known as a somatoform disorder, is a category of mental disorder included in a number of diagnostic schemes of mental illness, including the Diagnostic and Statistical Manual of Mental Disorders, (latest version DSM-5) used by most mental health professionals in the United States. (Before DSM-5 this disorder was split into somatization disorder (Briquet's syndrome) and undifferentiated somatoform disorder.) The diagnosis requires physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder (e.g., panic disorder).