Introduction to Somatic Symptom and Related Disorders

Welcome to the Somatic Symptom and Related Disorders topic center. Formerly the "Conversion Disorders" topic center, this section reflects updates to the DSM-5 by including new diagnoses like Somatic Symptom Disorder and Illness Anxiety Disorder, which now fall under the "Somatic Symptom and Related Disorders" category rather than "Somatoform Disorders" category.*

Somatic Symptom and Related Disorders include the following: Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder (Functional Neurological Symptom Disorder), Factitious Disorder, Psychological Factors Affecting Other Medical Conditions, Other Specified Somatic Symptom and Related Disorder, and Unspecified Somatic Symptom and Related Disorder. We will focus on the first four.

Somatic Symptom and Related Disorders are defined by a common characteristic: the presence of somatic (bodily) symptoms that cause significant distress and impairment; however, these symptoms often manifest in the absence of a diagnosable medical condition. Thus, the individual experiences adverse health conditions with unknown origin or explanation. These health complaints are accompanied by abnormal thoughts, feelings, and behaviors related to these symptoms. Therefore, these disorders are not solely defined by the presence of an “unknown” medical condition, but also refer to personality and behavioral characteristics surrounding them.

Somatic symptoms sometimes result from mental disorders, like anxiety and depression. These diagnoses may also occur alongside a somatic disorder. Indeed, psychological stress is a crucial player in the development of somatic related disorders. Other factors may include genetic vulnerabilities (e.g., increased sensitivity to somatic discomfort), early traumatic experiences, learning (e.g., reinforcement from attention during previous illness, lack of reinforcement from nonsomatic expressions of distress), and cultural norms (e.g, stigmatizing mental health problems more than physical health problems).

Because symptoms often show up as physical (rather than psychological), these individuals often present in medical settings. This family of symptoms was historically (dating back to Freud) referred to as “hysteria,” a condition whereby patients would “convert” unconscious painful emotions or memories into physical symptoms (e.g., losing function in one arm). Although we approach this from a different angle today (i.e., the medical model), most professionals would agree that psychological and emotional distress certainly contribute to the manifestation of somatic symptom disorders.

The following sections will provide you with information on the four main Somatic Symptom and Related Disorders: Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder (Functional Neurological Symptom Disorder), and Factitious Disorder.

*In the DSM-4, this family of disorders fell under “Somatoform Disorders,” and included diagnoses like Hypochondriasis and Pain Disorder. Today, about 75% of those diagnosed with Hypochondriasis would meet criteria for Somatic Symptom Disorder. The other portion of these individuals would likely fall under the new Illness Anxiety Disorder diagnosis.

Material summarized from:

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.

*Note: This article has replaced a previous version from 2002 by author Mark Dombeck, Ph.D., in order to reflect updated material in the new DSM-5.