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Somatic symptom disorder

Background

Overview

Definition
Somatic symptom disorder, previously known as somatization disorder, is a mental health disorder characterized by multiple unexplained complaints.
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Pathophysiology
Somatic symptom disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders.
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Epidemiology
In the US, the prevalence of somatic symptom disorder is estimated at 6,000 per 100,000 population.
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Disease course
Symptoms include bodily complaints, such as pain in different locations of the body, from fatigue, or from perceived disturbances of the cardiovascular, gastrointestinal, or other organ functions.
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Prognosis and risk of recurrence
Somatic symptom disorder causes long-term disability in several patients, affecting QoL and work participation.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of somatic symptom disorder are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2016). ...
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Screening and diagnosis

Diagnostic criteria: as per AAFP 2016 guidelines, use the DSM-5 criteria to diagnose somatic symptom disorder.
DSM-5 diagnostic criteria for somatic symptom disorder
≥ 1 somatic symptoms that are distressing or cause significant disruption of daily life
Symptoms have been present for ≥ 6 months, although any one somatic symptom may not be continuously present
Disproportionate and persistent thoughts about the seriousness of symptoms.
Persistently high level of anxiety about health or symptoms
Excessive time and energy devoted to the symptoms or health concerns
Criteria not met
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Diagnostic investigations

Screening instruments: as per AAFP 2016 guidelines, consider using the Patient Health Questionnaire-15 or the Somatic Symptom Scale-8 to assess patients with suspected somatic symptom disorder.
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Medical management

Pharmacologic therapy
As per AAFP 2016 guidelines:
Consider using the following agents as first-line pharmacolic treatment for somatic symptom disorder:
amitriptyline
SSRIs
st. John's wort
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Avoid the use of other antidepressants (MAOIs, bupropion, anticonvulsants, and antipsychotics) for the treatment of somatic symptom disorder.
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Nonpharmacologic interventions

Psychotherapy: as per AAFP 2016 guidelines, consider offering CBT and mindfulness-based therapy for the treatment of somatic symptom disorder.
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