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|Classification and external resources|
|Classification and external resources|
A somatoform disorder is a mental disorder characterized by 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). In people who have a somatoform disorder, medical test results are either normal or do not explain the person's symptoms, and history and physical examination do not indicate the presence of a medical condition that could cause them. Patients with this disorder often become worried about their health because doctors are unable to find a cause for their symptoms. This may cause severe distress. Preoccupation with the symptoms may portray a patient's exaggerated belief in the severity of their ill-health. Symptoms are sometimes similar to those of other illnesses and may last for several years. Usually, the symptoms begin appearing during adolescence, and patients are diagnosed before the age of 30 years. Symptoms may occur across cultures and gender. Other common symptoms include anxiety and depression. In order for an individual to be diagnosed with somatoform disorder, they must have recurring somatic complaints for several continuous years.
Somatoform disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) – sufferers perceive their plight as real. Additionally, a somatoform disorder should not be confused with the more specific diagnosis of a somatization disorder. Various laboratory tests, physical examinations, and surgeries on these individuals show no evidence supporting the idea that these exaggerating symptoms are present. Mental disorders are treated separately from physiological or neurological disorders. Somatoform disorder is difficult to diagnose and treat since doing so requires psychiatrists to work with neurologists on patients with this disorder. Those that do not pass the diagnostic criteria for a somatoform disorder but still present physical symptoms are usually referred to as having "somatic preoccupation".
The somatoform disorders are actually a group of disorders, all of which fit the definition of physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause; as such, they are a diagnosis of exclusion. They are recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association as the following:
Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).
Additional proposed somatoform disorders are:
These disorders have been proposed because the recognized somatoform disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found:
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, defines somatization disorder as:
A. A history of many physical complaints beginning before age 30 years, occurring over several years, resulting in seeking treatment, or signiﬁcant impairment.
B. Each one of the following criteria must have been met, with individual symptoms occurring at any time:
1. Four pain symptoms (related to different sites or functions)
2. Two gastrointestinal symptoms (other than pain)
3. One sexual symptom (other than pain)
4. One "pseudoneurological" symptom (not limited to pain)
C. Either (1) or (2):
1. after appropriate investigation, each of the symptoms cannot be fully explained by a known general medical condition (GMC) or direct effects of a substance.
2. when there is a related GMC, the physical complaints or resulting impairment are in excess of what would be expected from the history, physical examination, or laboratory ﬁndings.
D. The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering).
In the opinion of Allen Frances, chair of the DSM-IV task force, the new somatic symptom disorder brings with it a risk of mislabeling a sizeable proportion of the population as mentally ill. “Millions of people could be mislabeled, with the burden falling disproportionately on women, because they are more likely to be casually dismissed as ‘catastrophizers’ when presenting with physical symptoms.”