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Measurement-based care is guided by the somatic symptom scale-8<ref name="pmid24276929">{{cite journal| author=Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Zenger M, Brähler E | display-authors=etal| title=The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden. | journal=JAMA Intern Med | year= 2014 | volume= 174 | issue= 3 | pages= 399-407 | pmid=24276929 | doi=10.1001/jamainternmed.2013.12179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24276929 }} </ref>. | Measurement-based care is guided by the somatic symptom scale-8<ref name="pmid24276929">{{cite journal| author=Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Zenger M, Brähler E | display-authors=etal| title=The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden. | journal=JAMA Intern Med | year= 2014 | volume= 174 | issue= 3 | pages= 399-407 | pmid=24276929 | doi=10.1001/jamainternmed.2013.12179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24276929 }} </ref>. | ||
A small [[randomized controlled trial]] <ref name="pmid19408058">{{cite journal| author=Smith RC, Gardiner JC, Luo Z, Schooley S, Lamerato L, Rost K| title=Primary care physicians treat somatization. | journal=J Gen Intern Med | year= 2009 | volume= 24 | issue= 7 | pages= 829-32 | pmid=19408058 | doi=10.1007/s11606-009-0992-y | pmc=2695533 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19408058 }} </ref> and a non-randomized study<ref name="pmid3084975">{{cite journal| author=Smith GR, Monson RA, Ray DC| title=Psychiatric consultation in somatization disorder. A randomized controlled study. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 22 | pages= 1407-13 | pmid=3084975 | doi=10.1056/NEJM198605293142203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084975 }} </ref> has addressed treatment. | A small [[randomized controlled trial]] <ref name="pmid19408058">{{cite journal| author=Smith RC, Gardiner JC, Luo Z, Schooley S, Lamerato L, Rost K| title=Primary care physicians treat somatization. | journal=J Gen Intern Med | year= 2009 | volume= 24 | issue= 7 | pages= 829-32 | pmid=19408058 | doi=10.1007/s11606-009-0992-y | pmc=2695533 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19408058 }} </ref> and a non-randomized study<ref name="pmid3084975">{{cite journal| author=Smith GR, Monson RA, Ray DC| title=Psychiatric consultation in somatization disorder. A randomized controlled study. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 22 | pages= 1407-13 | pmid=3084975 | doi=10.1056/NEJM198605293142203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084975 }} </ref> has addressed treatment. | ||
A [[randomized controlled trial]] of “REAL” (Recognition, Explanation, Action, Learning) found benefit as measured by the PHQ15.<ref name="pmid38879261">{{cite journal| author=Burton C, Mooney C, Sutton L, White D, Dawson J, Neilson AR | display-authors=etal| title=Effectiveness of a symptom-clinic intervention delivered by general practitioners with an extended role for people with multiple and persistent physical symptoms in England: the Multiple Symptoms Study 3 pragmatic, multicentre, parallel-group, individually randomised controlled trial. | journal=Lancet | year= 2024 | volume= 403 | issue= 10444 | pages= 2619-2629 | pmid=38879261 | doi=10.1016/S0140-6736(24)00700-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=38879261 }} </ref> REAL is described in a separate report.<ref name="pmid37441925">{{cite journal| author=Fryer K, Sanders T, Greco M, Mooney C, Deary V, Burton C| title=Recognition, explanation, action, learning: Teaching and delivery of a consultation model for persistent physical symptoms. | journal=Patient Educ Couns | year= 2023 | volume= 115 | issue= | pages= 107870 | pmid=37441925 | doi=10.1016/j.pec.2023.107870 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37441925 }} </ref> | |||
Trials<ref name="pmid18570681">{{cite journal| author=Magallón R, Gili M, Moreno S, Bauzá N, García-Campayo J, Roca M | display-authors=etal| title=Cognitive-behaviour therapy for patients with Abridged Somatization Disorder (SSI 4,6) in primary care: a randomized, controlled study. | journal=BMC Psychiatry | year= 2008 | volume= 8 | issue= | pages= 47 | pmid=18570681 | doi=10.1186/1471-244X-8-47 | pmc=2443798 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18570681 }} </ref> and reviews<ref name="pmid18040099">{{cite journal| author=Kroenke K| title=Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. | journal=Psychosom Med | year= 2007 | volume= 69 | issue= 9 | pages= 881-8 | pmid=18040099 | doi=10.1097/PSY.0b013e31815b00c4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18040099 }} </ref> of [[cognitive behavioral therapy]] show benefit. | Trials<ref name="pmid18570681">{{cite journal| author=Magallón R, Gili M, Moreno S, Bauzá N, García-Campayo J, Roca M | display-authors=etal| title=Cognitive-behaviour therapy for patients with Abridged Somatization Disorder (SSI 4,6) in primary care: a randomized, controlled study. | journal=BMC Psychiatry | year= 2008 | volume= 8 | issue= | pages= 47 | pmid=18570681 | doi=10.1186/1471-244X-8-47 | pmc=2443798 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18570681 }} </ref> and reviews<ref name="pmid18040099">{{cite journal| author=Kroenke K| title=Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. | journal=Psychosom Med | year= 2007 | volume= 69 | issue= 9 | pages= 881-8 | pmid=18040099 | doi=10.1097/PSY.0b013e31815b00c4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18040099 }} </ref> of [[cognitive behavioral therapy]] show benefit. | ||
Physician empathy can help<ref name="pmid38602675">{{cite journal| author=Licciardone JC, Tran Y, Ngo K, Toledo D, Peddireddy N, Aryal S| title=Physician Empathy and Chronic Pain Outcomes. | journal=JAMA Netw Open | year= 2024 | volume= 7 | issue= 4 | pages= e246026 | pmid=38602675 | doi=10.1001/jamanetworkopen.2024.6026 | pmc=11009829 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=38602675 }} </ref>. | |||
Short-term [[psychodynamic psychotherapy]] may help<ref name="pmid19602915">{{cite journal| author=Abbass A, Kisely S, Kroenke K| title=Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. | journal=Psychother Psychosom | year= 2009 | volume= 78 | issue= 5 | pages= 265-74 | pmid=19602915 | doi=10.1159/000228247 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19602915 }} </ref>. | Short-term [[psychodynamic psychotherapy]] may help<ref name="pmid19602915">{{cite journal| author=Abbass A, Kisely S, Kroenke K| title=Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. | journal=Psychother Psychosom | year= 2009 | volume= 78 | issue= 5 | pages= 265-74 | pmid=19602915 | doi=10.1159/000228247 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19602915 }} </ref>. | ||
Latest revision as of 03:15, 3 July 2024
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]
Overview
Somatic symptom disorder is characterized by the presence of one or more somatic symptoms with excessive thoughts and behaviors associated with health concerns. [1]
Physiology
Somatic symptoms may be affected by stress[2][3].
Differential Diagnosis
- Anxiety disorder
- Body dysmorphic disorder
- Diabetes
- Heart disease
- Irritable bowel syndrome
- Fibromyalgia
- Panic disorder
- Obsessive-compulsive disorder[1]
Epidemiology and Demographics
Prevalence
The prevalence of somatic symptom disorder is 5,000 to 7,000 per 100,000 (5-7%) of the overall population.[1]
Risk Factors
- Negative affectivity (neuroticism)
- Comorbid anxiety
- Depression
- Few years of education
- Lower socioeconomic status
- History of sexual abuse[1]
Natural History, Complications and Prognosis
Poor prognostic factors include:
- Depression
- Anxiety
- Persistent depressive disorder (dysthymia)
- Panic disorder
- Social stress
- Illness benefits[1]
Diagnostic Criteria
DSM-V Diagnostic Criteria for Somatic Symptom Disorder[1]
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
AND
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.
AND
C. Although anyone somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Specify if:
- With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.
Specify if:
- Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
Specify current severity:
- Mild: Only one of the symptoms specified in Criterion B is fulfilled.
- Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
- Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).
Diagnostic scales
Most accurate diagnosis is be combining a somatic scale with a B symptoms scale, "Optimal combined cutpoints were ⩾9 for the PHQ-15 or SSS-8, and ⩾23 for the SSD-12 (sensitivity and specificity = 69% and 70%)"[4].
Somatic scales
Compared to the PHQ-15, the SSS-8 only has 8 questions, but the SSS-8 has 5 anchors for responses whereas the PHQ-15 is easier with only 3 anchors.
- PHQ-15[5].
Area under the curve (AUC) 70[4]
- Somatic Symptom Scale-8 (SSS-8)[6].
Area under the curve (AUC) 70[4] For the SS-8, a score of[4]:
- <= 6 makes somatic symptom disorder unlikely
- >= 19 makes somatic symptom disorder likely
B symptoms
The has been validated Somatic Symptom Disorder-B Criteria Scale (SSD-12)[7].
Treatment
Measurement-based care is guided by the somatic symptom scale-8[6].
A small randomized controlled trial [8] and a non-randomized study[9] has addressed treatment.
A randomized controlled trial of “REAL” (Recognition, Explanation, Action, Learning) found benefit as measured by the PHQ15.[10] REAL is described in a separate report.[11]
Trials[12] and reviews[13] of cognitive behavioral therapy show benefit.
Physician empathy can help[14].
Short-term psychodynamic psychotherapy may help[15].
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Gonlachanvit S, Rhee J, Sun WM, Chey WD (2005). "Effect of acute acoustic stress on anorectal function sensation in healthy human". Neurogastroenterol Motil. 17 (2): 222–8. doi:10.1111/j.1365-2982.2004.00592.x. PMID 15810174.
- ↑ Lee HS, Noh CK, Lee KJ (2017). "The Effect of Acute Stress on Esophageal Motility and Gastroesophageal Reflux in Healthy Humans". J Neurogastroenterol Motil. 23 (1): 72–79. doi:10.5056/jnm16119. PMC 5216637. PMID 28049863.
- ↑ 4.0 4.1 4.2 4.3 Toussaint A, Hüsing P, Kohlmann S, Löwe B (2020). "Detecting DSM-5 somatic symptom disorder: criterion validity of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8) in combination with the Somatic Symptom Disorder - B Criteria Scale (SSD-12)". Psychol Med. 50 (2): 324–333. doi:10.1017/S003329171900014X. PMID 30729902.
- ↑ Kroenke K, Spitzer RL, Williams JB (2002). "The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms". Psychosom Med. 64 (2): 258–66. doi:10.1097/00006842-200203000-00008. PMID 11914441.
- ↑ 6.0 6.1 Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Zenger M, Brähler E; et al. (2014). "The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden". JAMA Intern Med. 174 (3): 399–407. doi:10.1001/jamainternmed.2013.12179. PMID 24276929.
- ↑ Toussaint A, Murray AM, Voigt K, Herzog A, Gierk B, Kroenke K; et al. (2016). "Development and Validation of the Somatic Symptom Disorder-B Criteria Scale (SSD-12)". Psychosom Med. 78 (1): 5–12. doi:10.1097/PSY.0000000000000240. PMID 26461855.
- ↑ Smith RC, Gardiner JC, Luo Z, Schooley S, Lamerato L, Rost K (2009). "Primary care physicians treat somatization". J Gen Intern Med. 24 (7): 829–32. doi:10.1007/s11606-009-0992-y. PMC 2695533. PMID 19408058.
- ↑ Smith GR, Monson RA, Ray DC (1986). "Psychiatric consultation in somatization disorder. A randomized controlled study". N Engl J Med. 314 (22): 1407–13. doi:10.1056/NEJM198605293142203. PMID 3084975.
- ↑ Burton C, Mooney C, Sutton L, White D, Dawson J, Neilson AR; et al. (2024). "Effectiveness of a symptom-clinic intervention delivered by general practitioners with an extended role for people with multiple and persistent physical symptoms in England: the Multiple Symptoms Study 3 pragmatic, multicentre, parallel-group, individually randomised controlled trial". Lancet. 403 (10444): 2619–2629. doi:10.1016/S0140-6736(24)00700-1. PMID 38879261 Check
|pmid=value (help). - ↑ Fryer K, Sanders T, Greco M, Mooney C, Deary V, Burton C (2023). "Recognition, explanation, action, learning: Teaching and delivery of a consultation model for persistent physical symptoms". Patient Educ Couns. 115: 107870. doi:10.1016/j.pec.2023.107870. PMID 37441925 Check
|pmid=value (help). - ↑ Magallón R, Gili M, Moreno S, Bauzá N, García-Campayo J, Roca M; et al. (2008). "Cognitive-behaviour therapy for patients with Abridged Somatization Disorder (SSI 4,6) in primary care: a randomized, controlled study". BMC Psychiatry. 8: 47. doi:10.1186/1471-244X-8-47. PMC 2443798. PMID 18570681.
- ↑ Kroenke K (2007). "Efficacy of treatment for somatoform disorders: a review of randomized controlled trials". Psychosom Med. 69 (9): 881–8. doi:10.1097/PSY.0b013e31815b00c4. PMID 18040099.
- ↑ Licciardone JC, Tran Y, Ngo K, Toledo D, Peddireddy N, Aryal S (2024). "Physician Empathy and Chronic Pain Outcomes". JAMA Netw Open. 7 (4): e246026. doi:10.1001/jamanetworkopen.2024.6026. PMC 11009829 Check
|pmc=value (help). PMID 38602675 Check|pmid=value (help). - ↑ Abbass A, Kisely S, Kroenke K (2009). "Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials". Psychother Psychosom. 78 (5): 265–74. doi:10.1159/000228247. PMID 19602915.