Somatic Symptom Disorder

Am Fam Physician. 2016 Jan 1;93(1):49-54.

Abstract

With the release of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., the diagnostic category previously known as somatoform disorders is now called somatic symptom and related disorders. The revisions were intended to increase their relevance in the primary care setting. The main feature of this disorder is a patient's concern with physical symptoms that he or she attributes to a nonpsychiatric disease. Primary care physicians often treat patients who manifest symptoms for which there are no biologic cause, and patients with somatic symptom disorder may be subjected to unnecessary testing and procedures. As a result, appropriate diagnosis is essential. Screening instruments are useful in determining the presence of somatic symptom disorder. It is important for the primary care physician to schedule regular appointments, establish a strong therapeutic alliance, acknowledge and legitimize the patient's symptoms, and limit diagnostic testing or referrals to subspecialists. Proven treatments include cognitive behavior therapy, mindfulness-based therapy, and pharmacotherapy. The use of selective serotonin reuptake inhibitors or tricyclic antidepressants has been effective in alleviating symptoms. Referral to a mental health professional may be necessary when treatment by the primary care physician is ineffective.

MeSH terms

  • Antidepressive Agents, Tricyclic / therapeutic use*
  • Cognitive Behavioral Therapy / standards*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Medically Unexplained Symptoms
  • Practice Guidelines as Topic*
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Somatoform Disorders / classification
  • Somatoform Disorders / diagnosis*
  • Somatoform Disorders / therapy*

Substances

  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors