The current psychiatric diagnostic manual has abandoned hypochondria as a disorder, replacing it in 2013 with two new concepts: somatic symptom disorder and illness anxiety disorder.
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A somatic symptom disorder, formerly known as a somatoform disorder,(2013) "Somatic Symptom Disorder Fact Sheet " dsm5.org. Retrieved April 8, 2014."DSM-5 redefines hypochondriasis " mayoclinic.org. Retrieved April 8, 2014.
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The Somatic Symptom Disorder - B Criteria Scale (SSD-12) Toussaint A, Murray A, Voigt K, Herzog A, Gierk B, Kroenke K, Rief W, Henningsen P, Löwe B. Development and Validation of the Somatic Symptom Disorder–B Criteria Scale (SSD-12). Psychosomatic Medicine. 2016;78:5-12. is a brief self-report questionnaire used to assess the B criteria of DSM-5 somatic symptom disorder American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
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The content validity is supposed to be high because the items are based on the DSM-5 criteria of somatic symptom disorder.
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The SSD-12 consists of a three-factorial structure which reflects the three psychological criteria interpreted as cognitive, affective and behavioural aspects of the DSM-5 B criteria of somatic symptom disorder.
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In the DSM-5 the disorder has been renamed somatic symptom disorder (SSD), and includes SSD with predominantly somatic complaints (previously referred to as somatization disorder), and SSD with pain features (previously known as pain disorder).
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Psychometric properties of the SSD-12 were examined in three different samples from Germany (psychosomatic outpatient clinic, n = 698 ; general population, n =2362 Toussaint A, Löwe B, Brähler E, Jordan P. The Somatic Symptom Disorder - B Criteria Scale (SSD-12): Factorial structure, validity and population-based norms. Journal of Psychosomatic Research. 2017;97:9-17.; primary care, n = 501 Toussaint A, Riedl B, Kehrer S, Schneider A, Löwe B, Linde K. Validity of the Somatic Symptom Disorder - B Criteria Scale (SSD-12) in Primary Care. BMC Family Practice. 2018;35:342-347).
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The provided norms enable researchers and clinicians to compare SSD-12 scores with reference values of a general population sample. In a clinical sample a cut- point of ⩾23 for the SSD-12 proved to be suitable to identify patients at risk for SSD Toussaint A, Hüsing P, Kohlmann S, Löwe B. 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). Psychological Medicine. 2019 [Epub ahead of print];1-10.
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Some psychological conditions (anxiety disorder, somatic symptom disorder, conversion disorder) may cause symptoms resembling syncope. A number of psychological interventions are available. Low blood sugar can be a rare cause of syncope. Narcolepsy may present with sudden loss of consciousness similar to syncope.
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In a German inpatient sample from a psychosomatic rehabilitation setting, Hüsing et al. 2018 Hüsing P, Bassler M, Löwe B, Koch S, Toussaint A. Validity and sensitivity to change of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in a clinical population. General Hospital Psychiatry. 2018;55:20-26. showed that the SSD-12 is sensitive to change.
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Somatic symptom disorders, as a group, are included in a number of diagnostic schemes of mental illness, including the Diagnostic and Statistical Manual of Mental Disorders. (Before DSM-5 this disorder was split into somatization disorder and undifferentiated somatoform disorder.) In people who have been diagnosed with a somatic symptom 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 known medical condition that could cause them, though the DSM-5 cautions that this alone is not sufficient for diagnosis. The patient must also be excessively worried about their symptoms, and this worry must be judged to be out of proportion to the severity of the physical complaints themselves. A diagnosis of somatic symptom disorder requires that the subject have recurring somatic complaints for at least six months.
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Factitious disorder should be distinguished from somatic symptom disorder (formerly called somatization disorder), in which the patient is truly experiencing the symptoms and has no intention to deceive. In conversion disorder (previously called hysteria), a neurological deficit appears with no organic cause. The patient, again, is truly experiencing the symptoms and signs and has no intention to deceive. The differential also includes body dysmorphic disorder and pain disorder.
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Somatic symptom disorder has been a controversial diagnosis, since it was historically based primarily on negative criteria – that is, the absence of a medical explanation for the presenting physical complaints. Consequently, any person suffering from a poorly understood illness can potentially fulfill the criteria for this psychiatric diagnosis, even if they exhibit no psychiatric symptoms in the conventional sense.Morrison, J. (2014). DSM-5® made easy: The clinician's guide to diagnosis.
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Somatization disorder is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.
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The SSD-12 is composed of 12 items. Each of the three psychological sub-criteria of DSM-5 somatic symptom disorder (cognitive, affective, behavioral) is measured by four items with all item scores ranging between 0 and 4 (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = very often). The order of the 12 items alternates between the three subcriteria (Subcriteria 1, 2, 3, 1, 2, 3…etc). Ratings are summed up to make a simple sum score (which can vary between 0 and 48 points).
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The original SSD-12 was published in German and English. To date (July 2019), two official psychometrically validated and culturally adapted translations are available: DutchKop W, Toussaint A, Mols F, Löwe B. Somatic symptom disorder in the general population: Associations with medical status and health care utilization using the SSD-12. General Hospital Psychiatry. 2019;56:36-41. Chinese Wei, J., Fritzsche, K., Toussaint, A Jiang, Y., Cao, J., Zhang, L. Zhang, Y., Chen, H., Wu, H., Ma, X., Li, W., Ren, J., Lu, W., Müller, A.-M.
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However, since anxiety and depression are also very common in persons with confirmed medical illnesses, it remains possible that such symptoms are a consequence of the physical impairment, rather than a cause. Somatic symptom disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms). Somatic symptom disorder is difficult to diagnose and treat. Some advocates of the diagnosis believe this is because proper diagnosis and treatment requires psychiatrists to work with neurologists on patients with this disorder.
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Several mechanisms for a psychological etiology of the condition have been proposed, including theories based on misdiagnoses of an underlying mental illness, stress, or classical conditioning. Many people with MCS also meet the criteria for major depressive disorder or anxiety disorder. Other proposed explanations include somatic symptom disorder, panic disorder, migraine, chronic fatigue syndrome, or fibromyalgia and brain fog. Through behavioral conditioning, it has been proposed that people with MCS may develop real, but unintentionally psychologically produced, symptoms, such as anticipatory nausea, when they encounter certain odors or other perceived triggers.
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In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), false pregnancy is a somatic symptom disorder; it is listed as "not elsewhere classified", meaning it is in a category by itself, different from other somatic symptom disorders such as functional neurological symptom disorder (formerly known as conversion disorders). The word pseudocyesis comes from the Greek words which means "false" and which means "pregnancy". False pregnancy is sometimes referred to as "delusional pregnancy", but the distinction between the two conditions is inexact. Delusional pregnancy is typically used when there are no physical signs of pregnancy, but false pregnancy can also be delusional.
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Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is a mental disorder characterized by the maintenance of at least two distinct and relatively enduring personality states. The disorder is accompanied by memory gaps beyond what would be explained by ordinary forgetfulness. The personality states alternately show in a person's behavior, however presentations of the disorder vary. Other conditions that often occur in people with DID include post-traumatic stress disorder, personality disorders (especially borderline and avoidant), depression, substance use disorders, conversion disorder, somatic symptom disorder, eating disorders, obsessive–compulsive disorder, and sleep disorders.
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The differential diagnosis of PNES firstly involves ruling out epilepsy as the cause of the seizure episodes, along with other organic causes of non-epileptic seizures, including syncope, migraine, vertigo, anoxia, hypoglycemia, and stroke. However, between 5-20% of people with PNES also have epilepsy. Frontal lobe seizures can be mistaken for PNES, though these tend to have shorter duration, stereotyped patterns of movements and occurrence during sleep. Next, an exclusion of factitious disorder (a subconscious somatic symptom disorder, where seizures are caused by psychological reasons) and malingering (simulating seizures intentionally for conscious personal gain – such as monetary compensation or avoidance of criminal punishment) is conducted.
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The 2013 DSM-5 replaced the diagnosis of hypochondriasis with the diagnoses of somatic symptom disorder (75%) and illness anxiety disorder (25%). Hypochondria is often characterized by fears that minor bodily or mental symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or short-lasting. Additionally, many hypochondriacs experience elevated blood pressure, stress, and anxiety in the presence of doctors or while occupying a medical facility, a condition known as "white coat syndrome".
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The classification of hypochondriasis in relation to other psychiatric disorders has long been a topic of scholarly debate, and has differed widely between different diagnostic systems and influential publications. In the case of the DSM, the first and second versions listed hypochondriasis as a neurosis, whereas the third and fourth versions listed hypochondriasis as a somatoform disorder. The current version of the DSM (DSM-5) lists somatic symptom disorder (SSD) under the heading of "somatic symptom and related disorders", and illness anxiety disorder (IAD) under both this heading and as an anxiety disorder. The ICD-10, like the third and fourth versions of the DSM, lists hypochondriasis as a somatoform disorder.
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This is important for maintaining homeostatic conditions in the body and, potentially, facilitating self-awareness. Interoceptive signals are projected to the brain via a diversity of neural pathways that allow for the sensory processing and prediction of internal bodily states. Misrepresentations of internal states, or a disconnect between the body's signals and the brain's interpretation and prediction of those signals, have been suggested to underlie some mental disorders such as anxiety, depression, panic disorder, anorexia nervosa, bulimia nervosa, posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), autism spectrum disorders, somatic symptom disorder, and illness anxiety disorder. The contemporary definition of interoception is not synonymous with the term “visceroception”.
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" In order to re-oxygenate blood, Dr. John Kheir and Dr. Tahir Saleem N. Jutt (Cardiac) develop particles that can be injected into a bloodstream in 2012. Boston Children's Hospital became part of a dispute between medical doctors, the Massachusetts Department of Children and Families, and the parents of a teenager, Justina Pelletier in 2013–2014. Doctors and psychologists at Boston Children's Hospital diagnosed Justina with somatic symptom disorder, a different diagnosis than that of mitochondrial disease, which she had previously received from Tufts Medical Center physicians. Boston Children's Hospital requested that the Commonwealth of Massachusetts Department of Children and Families protect and remove the patient from her parent's custody, due to concern for a situation of "medical child abuse.
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