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Summary Textbook of psychiatry - H12.1 Somatic symptom and related disorder
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Textbook of psychiatryH12.1 Somatic symptom and related disorders
In somatic symptom and related disorders, physical symptoms are the chief complaint
presented by patients. These physical symptoms can either be produced by a physical illness
or occur in the absence of any such illness (somatically unexplained physical symptoms,
SUPS).
The physical symptoms are accompanied by dysfunctional feelings, thoughts and behaviours.
The behaviours provide the focus for psychiatric diagnosis and treatment.
Classification of somatic symptom and related disorders:
Somatic symptom disorder
Illness anxiety disorder
Conversion disorder
Psychological factors affecting other medical conditions
SYNDROMES:
Somatic symptom disorder:
This can involve both unexplained/functional somatic syndromes (fibromyalgia, chronic
fatigue syndrome, etc.) and physical symptoms consistent with a disorder (diabetes).
Key point = the physical symptoms are accompanied by abnormal thoughts, feelings and
behaviours
The classic term = hypochondria no longer included in the current classification system as
there may be worrying with physical symptoms or without them.
Illness anxiety disorder (ziekteanststoornis):
The preoccupation with having or acquiring a serious illness.
There are extreme concerns about personal health and illness with excessive worrying about
physical sensations and their supposed consequences, accompanied by anxiety and concern,
, repeated body checking and frequent visits to the doctors. Conversely, some people avoid
the doctor for far too long.
Conversion disorder:
Functional changes in voluntary sensory or motor function. It is also referred to as
‘functional neurological symptom disorder’.
Pseudoneurological motor symptoms:
- Unexplained weakness or paralyses of a limb
- Inability to walk (abasia)
- Inability to stand (astasia)
- Dysphagia
- Loss of voice (aphonia)
- Unexplained neurological movement disorder (e.g. functional tremor)
Sensory pseudoneurological symptoms:
- Diminished sensation
- Diminished olfaction
- Sudden blindness
- Hearing loss
Pseudoepileptic seizures are also common.
Some patients present with a mixed presentation with a variety of these symptoms. The
neurological or movement symptoms are imcompatible with a known neurological or other
medical condition, as neurological tests show.
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