In this video I describe some symptoms and prevalence of several disorders in the Somatic Symptoms and Related Disorders category of the DSM-5, a category formerly referred to as somatoform disorders. The prior disorder of hypochondriasis has been divided into somatic symptom disorder and illness anxiety disorder, both of which are described in this video. In addition, I briefly describe Conversion Disorder and the problem of labeling symptoms or disorders are psychogenic when there may be physiological causes not yet discovered or detectable.

Video Transcript

Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of somatic symptoms and related disorders in the DSM-5. So we should start by noting that this is a new category label in the DSM-5. So if you have an older textbook or if you’re looking at resources that predate the DSM-5 then you might see reference to a category of “somatoform disorders” but this term is no longer used. So now we call these somatic symptoms and related disorders. Similarly we have the abandonment of a previous diagnosis which is hypochondriasis. So hypochondriasis is no longer in the DSM-5; it’s been split into two different diagnoses.

So previously hypochondriasis referred to a false belief in illness, but now it’s been differentiated into a somatic symptom disorder and illness anxiety disorder. And so we’ll start by looking at these two disorders and seeing how they’re differentiated. So we’ll start with somatic symptom disorder; this refers to excessive thoughts feelings or behaviors that are related to somatic symptoms the person’s experiencing in their body, or other health concerns. So what this means is that the person does have some physical symptoms of some illness but their thoughts, feelings, and behaviors associated with that symptom have become excessive and they’ve become preoccupied by this symptom or these symptoms. And it may even reach the point it sort of becomes part of their personal identity, this symptom that they’re experiencing now. It’s important to note that their suffering is authentic; they actually do have this symptom. This is part of the reason this is differentiated from hypochondriasis before which as I said referred to a false belief in illness. Here the person does actually have a physical symptom or perhaps multiple symptoms and one of the most common symptoms of somatic symptom disorder is persistent pain. So these patients really are suffering, they really are experiencing pain but they become preoccupied with it and they experience excessive worry, anxiety, or thoughts about this symptom. Now they may also have a tendency to associate other sensations that they’re experiencing and misattribute those to the illness that they might be suffering from.

Now the prevalence of somatic symptom disorder is estimated to be about 5-7% in the DSM-5 and it’s slightly higher in females than in males, although it’s worth noting that females are more likely to report somatic symptoms and so this may play a role in the diagnosis of somatic symptom disorder.

Now as I said before this is differentiated from illness anxiety disorder and so what illness anxiety disorder refers to is where the person has excessive worry or anxiety about an illness but in this case they don’t actually have somatic symptoms of that illness or the symptoms are very very slight. And so the person is not actually suffering the symptoms of the illness yet they might be convinced that they have it or that they’re developing it.

So you could imagine somebody might believe that they have a tumor or that they’re developing cancer of some kind, even if there’s actually no evidence. There’s no physical symptoms that they actually have that illness so they have this excessive anxiety associated with that. That would be considered illness anxiety disorder and the estimated prevalence for this in the DSM-5 gives a fairly broad range from about 1.3% up to about 10% and it’s estimated to be similar between males and females.

Now the patients who receive this diagnosis of illness anxiety disorder are often found in medical settings and that’s because they don’t believe that they have a mental health problem; they think they have a physical health problem. So they go to a hospital, they go to an emergency room, when they go to see their doctor and they have this anxiety associated with the illness and yet it seems to be that they don’t actually have the illness and their belief and the anxiety that they’re experiencing can persist even after getting diagnostic tests that are negative. So they might believe they have a tumor or cancer or some other illness and yet after repeated tests it seems pretty clear that they don’t have this and they don’t have any of the symptoms of it and yet their anxiety continues. Now of course it is also possible that they do have some illness or they do have something that we’re not able to detect or that isn’t being detected accurately.

Now the last disorder that we’ll look at in this category of somatic symptoms and related disorders is called conversion disorder and this is also known as functional neurological symptom disorder. And so what we see in conversion disorder is altered voluntary motor or sensory functions and this is an alteration that can’t be explained by other diseases other disorders or some injury. In other words we don’t have a physiological explanation for this change in function and so examples of what you might see in changes in function include weakness or paralysis or we see abnormal movements or tremors.

A person may have difficulty speaking or swallowing or in rare cases we see even loss of sensory function like deafness or blindness that doesn’t seem to have a physiological explanation. So in this case we see that physiological causes can’t be found for this loss of function and the patients aren’t believed to be faking; it seems this is genuine, that they actually have paralysis or weakness or loss of function somewhere. And that’s why these are referred to as functional symptoms and the reason for that is all that seems to be damaged is the functioning of this, you know, either motor or sensory function that’s the only thing that seem to be changed.

There doesn’t seem to be another explanation for it and another term you might see to refer to this is to say that it’s psychogenic and this is something I talked about briefly in the unit on stress and health. We saw that this is actually a term we have to be very careful with this term psychogenic because it suggests, it literally means originating from the mind, but of course it could be the case that there are physiological mechanisms but we just haven’t identified them yet. We haven’t discovered what exactly is going wrong here that’s causing this loss of function. And so there are previous conditions that you used to be referred to or considered to be psychogenic and yet over time we then, you know, discover some physiological mechanisms.

So for things like stomach ulcers, which I talked about in the stress and health unit, those were considered to be resulting solely from stress and then it turns out we find the more physiological explanation, this bacteria Helicobacter pylori and now we have a physiological explanation. We can see this in other things like migraine headaches and epilepsy and even schizophrenia were at one time believed to be psychogenic until over time we understand the physiology better and now we no longer think of it as psychogenic. And so one of the criticisms here of these types of disorders or these labels for disorders is that they’re really just a cover for our ignorance. They’re saying we haven’t figured out what it is that’s causing your symptoms so we’re going to say it’s your mind and that’s not necessarily a fair thing to do, to place that on the patient, when there might be some other physiological explanation.

And perhaps, you know in years to follow, or decades later, we’ll have a much better understanding of that we’ll see that it wasn’t originating from the patient’s mind. So the estimated prevalence for conversion disorder is very, very low, there’s only about two to five cases per hundred thousand people. So it’s very, very rare and it’s estimated to be about two to three times more common in women. Ok, so those are some of the disorders in these somatic symptoms and related disorders category of the DSM-5. I hope you found this helpful if so please like the video and subscribe to the channel for more thanks for watching!