AssessmentsSomatic symptom disorder
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 25-year-old woman comes to the clinic because of abdominal, shoulder, and head pain for the past year. This is her first time being seen at this clinic, but she brings copies of her medical charts from 3 other clinics, all within the past year. She states that the three other physicians were unable to diagnose her, “even though they ran all kinds of laboratory tests and scans.” She states that she may be fired from her job for missing too many days at work to attend medical visits. She does not like to take pain medication and really wants to be diagnosed “before it is too late.” Temperature is 37.0°C (98.6°F), pulse is 70/min, respirations are 10/min, and blood pressure is 126/78 mm Hg. Physical examination shows no abnormalities. Routine laboratory studies are within normal limits. Which of the following is the most likely diagnosis?
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.