According to the DSM-5, this condition is now referred to as Somatic Symptoms and Related Disorders. This category includes diagnoses of Somatic symptom Disorder, Illness Anxiety Disorder, Conversion Disorder, Factitious Disorder and a variety of other related conditions.

Somatic symptom disorder involves a person having a significant focus on physical symptoms, such as pain, weakness or shortness of breath that results in major distress and/or problems functioning. The individual has excessive thoughts, feelings and behaviors relating to the physical symptoms. The physical symptoms may or may not be associated with a diagnosed medical condition, but the person is experiencing symptoms and believes they are sick.

SOMATIC SYMPTOM DISORDER

♤ Symptoms

a). One or more somatic symptoms that are distressing or result in significant disruption of daily life.

b). Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

◇ Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

◇ Persistently high level of anxiety about health or symptoms.

◇ Excessive time and energy devoted to these symptoms or health concerns.

◇ Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

ILLNESS ANXIETY DISORDER (formerly HYPOCHONDRIAC)

♤ Symptoms

◇ Preoccupation with having or acquiring a serious illness.

◇ Somatic symptoms are not present or if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

◇ There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

◇ The individual performs excessive health-related behaviors (e.g. repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g. avoids doctor appointments and hospitals).

◇ Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

◇ The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, and generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER)

♤ Symptoms

◇ One or more symptoms of altered voluntary motor or sensory function.

◇ Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. ◇ The symptom or deficit is not better explained by another medical or mental disorder.

◇ The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

◇ The symptoms may be accompanied with weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, attacks or seizures, sensory loss, special sensory symptom

FACTITIOUS DISORDER

Previously Munchausen Syndrome or Factitious Disorder Imposed on Self Some behaviors present in an individual with factitious disorder include:

◇ Inconsistencies between patient history and medical observations.

◇ Vague details that seem plausible on the surface but that don’t hold up to scrutiny.

◇ Lengthy medical records with multiple admissions at different hospitals.

◇ Willingness to accept any discomfort and risk from many medical procedures, even surgery.

◇ Overdramatic or outlandish presentation of a factitious illness, or hostility when challenged.

For a diagnosis to be assigned the following criterion should be met:

a). The individual presents himself or herself to others as ill, impaired, or injured.

b). The deceptive behavior is evident even in the absence of obvious external rewards.

c). The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

● Factitious Disorder Imposed on another (Previously Factitious Disorder by Proxy)

People, usually caregivers, typically a parent, intentionally falsify or produce physical or psychological symptoms in a person under their care such as a child who is unable to contradict the caregiver's falsehoods or tell how the caregiver caused injury.

The caregiver falsifies a Disorder, for example by stating that children have been having fevers or vomiting at home when they actually have been well. Some caregivers may even injure the child with drugs or other agents or add blood or bacterial contaminants to urine specimens to simulate disease. The caregiver seeks medical care for the child and appears to be deeply concerned and protective. The child typically has a history of frequent hospitalizations, usually for a variety of nonspecific symptoms, but no firm diagnosis was made.

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception usually involves:

a). The individual presents another individual (victim) to others as ill, impaired, or injured.

b). The deceptive behavior is evident even in the absence of obvious external rewards.

c). The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL CONDITIONS

a). A medical symptom or condition (other than a mental disorder) is present.

b). Psychological or behavioral factors adversely affect the medical condition in one of the following ways:

◇ The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.

◇ The factors interfere with the treatment of the medical condition (e.g., poor adherence).

◇ The factors constitute additional well-established health risks for the individual.

◇ The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.

c). The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder)

● Unspecified Somatic Symptom and Related Disorders

This category is for the rare occasions where there are predominantly Somatic symptoms but there is insufficient Information to make a more specific diagnosis

● Other Specific Somatic Symptoms and Related Disorders

This describes situations in which Somatic symptoms occur for less than six months or may involve a specific condition called Pseudocyesis, which is a false belief that women have that they are pregnant. They have outward signs of pregnancy such as an expanding abdomen, feeling labor pains nausea, fetal movements, breast changes and cessation of the menstrual period.

■ Treatment

The goal of treatment is to improve your symptoms and your ability to function in daily life. Psychotherapy, also called talk therapy, can be helpful for somatic symptom disorder. Sometimes medications may be added, especially if you're struggling with feeling depressed.

Psychotherapy

Because physical symptoms can be related to psychological distress and a high level of health anxiety, psychotherapy — specifically, cognitive behavioral therapy (CBT) — can help improve physical symptoms. CBT can help a person:

• Examine and adapt your beliefs and expectations about health and physical symptoms.

• Learn how to reduce stress.

• Learn how to cope with physical symptoms.

• Reduce preoccupation with symptoms.

• Reduce avoidance of situations and activities due to uncomfortable physical sensations.

• Improve daily functioning at home, at work, in relationships and in social situations.

• Address depression and other mental health disorders.

Family therapy may also be helpful by examining family relationships and improving family support and functioning.

Medication

Antidepressant medication can help reduce symptoms associated with depression and pain that often occur with somatic symptom disorder.