Somatic symptom disorder

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Somatic symptom disorder
Other namesSomatoform disorder, somatization disorder
Specialty Psychiatry, psychology
Symptoms Maladaptive thoughts, feelings, and behaviors in response to chronic physical symptoms. [1]
Complications Reduced functioning, unemployment, financial stress, and interpersonal difficulties.
Usual onsetOften, not always, begins in childhood. [2]
DurationAt least six months. [3]
CausesHeightened awareness of bodily sensations and the tendency to misinterpret bodily sensations. [4]
Risk factors Childhood neglect and abuse, chaotic lifestyle, history of substance and alcohol abuse, and psychosocial stressors. [5]
Diagnostic method Psychiatric assessment. [2]
Differential diagnosis Adjustment disorder, body dysmorphic disorder, obsessive-compulsive disorder, conversion disorder, and illness anxiety disorder. [2]
Treatment Cognitive-behavioral therapy, [6] psychiatric medication, and brief psychodynamic interpersonal psychotherapy. [7]
Medication Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors. [6]
Prognosis Often chronic but can be managed with the proper treatment. [2]
FrequencyAbout 13–23% of the general population. [8]

Somatic symptom disorder, also known as somatoform disorder or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment. [1]

Contents

Manifestations of somatic symptom disorder are variable; symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing chronic illness or medical condition. [9]

Several studies have found a high rate of comorbidity with major depressive disorder, generalized anxiety disorder, and phobias. [10] Somatic symptom disorder is frequently associated with functional pain syndromes like fibromyalgia and IBS. [11] Somatic symptom disorder typically leads to poor functioning, interpersonal issues, unemployment or problems at work, and financial strain as a result of excessive health-care visits. [9]

The cause of somatic symptom disorder is unknown. Symptoms may result from a heightened awareness of specific physical sensations paired with a tendency to interpret these experiences as signs of a medical ailment. [2] The diagnosis is controversial, as people with a medical illness can be mislabeled as mentally ill. This is especially true for women, who are more often dismissed when they present with physical symptoms. [12]

Signs and symptoms

Somatic symptom disorder can be detected by an ambiguous and often inconsistent history of symptoms that are rarely relieved by medical treatments. Additional signs of somatic symptom disorder include interpreting normal sensations for medical ailments, avoiding physical activity, being disproportionately sensitive to medication side effects, and seeking medical care from several physicians for the same concerns. [2]

Manifestations of somatic symptom disorder are highly variable. Recurrent ailments usually begin before the age of 30; most patients have many somatic symptoms, while others only experience one. The severity may fluctuate, but symptoms rarely go away completely for long periods of time. [1] Symptoms might be specific, such as regional pain and localized sensations, or general, such as fatigue, muscle aches, and malaise. [9]

Those suffering from somatic symptom disorder experience recurring and obsessive feelings and thoughts concerning their well-being. Common examples include severe anxiety regarding potential ailments, misinterpreting normal sensations as indications of severe illness, believing that symptoms are dangerous and serious despite lacking medical basis, claiming that medical evaluations and treatment have been inadequate, fearing that engaging in physical activity will harm the body, and spending a disproportionate amount of time thinking about symptoms. [9]

Somatic symptom disorder pertains to how an individual interprets and responds to symptoms as opposed to the symptoms themselves. Somatic symptom disorder can occur even in those who have an underlying chronic illness or medical condition. [9] When a somatic symptom disorder coexists with another medical ailment, people overreact to the ailment's adverse effects. They may be unresponsive toward treatment or unusually sensitive to drug side effects. Those with somatic symptom disorder who also have another physical ailment may experience significant impairment that is not expected from the condition. [1]

Comorbidities

Most research that looked at additional mental illnesses or self-reported psychopathological symptoms among those with somatic symptom disorder identified significant rates of comorbidity with depression and anxiety, but other psychiatric comorbidities were not usually looked at. [2] Major depression, generalized anxiety disorder, and phobias were the most common concurrent conditions. [10]

In studies evaluating different physical ailments, 41.5% of people with semantic dementia, 11.2% of subjects with Alzheimer's disease, [13] 25% of female patients suffering from non-HIV lipodystrophy, [14] and 18.5% of patients with congestive heart failure [15] fulfilled somatic symptom disorder criteria. 25.6% of fibromyalgia patients met the somatic symptom disorder criteria exhibited higher depression rates than those who did not. [11] In one study, 28.8% of those with somatic symptom disorder had asthma, 23.1% had a heart condition, and 13.5% had gout, rheumatoid arthritis, or osteoarthritis. [16] [17]

Complications

Alcohol and drug abuse are frequently observed, and sometimes used to alleviate symptoms, increasing the risk of dependence on controlled substances. [18] Other complications include poor functioning, problems with relationships, unemployment or difficulties at work, and financial stress due to excessive hospital visits. [9]

Causes

Somatic symptoms can stem from a heightened awareness of sensations in the body, alongside the tendency to interpret those sensations as ailments. Studies suggest that risk factors of somatic symptoms include childhood neglect, sexual abuse, a chaotic lifestyle, and a history of substance and alcohol abuse. [4] [5] Psychosocial stressors, such as unemployment and reduced job performance, may also be risk factors. [2] [19] There could also be a genetic element. A study of monozygotic and dizygotic twins found that genetic components contributed 7% to 21% of somatic symptoms, with the remainder related to environmental factors. [20] In another study, various single nucleotide polymorphisms were linked to somatic symptoms. [2]

Psychological

Evidence suggests that along with more broad factors such as early childhood trauma or insecure attachment, negative psychological factors including catastrophizing, negative affectivity, rumination, avoidance, health anxiety, or a poor physical self-concept have a significant impact on the shift from unproblematic somatic symptoms to a severely debilitating somatic symptom disorder. [17] Those who experience more negative psychological characteristics may regard medically unexplained symptoms to be more threatening and, therefore, exhibit stronger cognitive, emotional, and behavioral awareness of such symptoms. [21] In addition, evidence suggests that negative psychological factors have a significant impact on the impairments and behaviors of people suffering from somatic symptom disorder, as well as the long-term stability of such symptoms. [22] [23] [24]

Psychosocial

Psychosocial stresses and cultural norms influence how patients present to their physicians. American and Koreans engaged in a study to measure somatization within the cultural context. It was discovered that Korean participants used more body-related phrases while discussing their connections with stressful events and experienced more sympathy when asked to read texts using somatic expressions when discussing their emotions. [25]

Those raised in environments where expressing emotions during stages of development is discouraged face the highest risk of somatization. [25] In primary care settings, studies indicated that somaticizing patients had much greater rates of unemployment and decreased occupational functioning than non-somaticizing patients. [4]

Traumatic life events may cause the development of somatic symptom disorder. Most people with somatic symptom disorder originate from dysfunctional homes. A meta-analysis study revealed a connection between sexual abuse and functional gastrointestinal syndromes, chronic pain, non-epileptic seizures, and chronic pelvic pain. [25]

Physiological

The hypothalamo pituitary adrenal axis (HPA) has a crucial role in stress response. While the HPA axis may become more active with depression, there is evidence of hypocortisolism in somatization. [26] In somatic disorder, there is a negative connection between elevated pain scores and 5-hydroxy indol acetic acid (5-HIAA) and tryptophan levels. [25]

It has been suggested that proinflammatory processes may have a role in somatic symptom disorder, such as an increase of non-specific somatic symptoms and sensitivity to painful stimuli. [27] Proinflammatory activation and anterior cingulate cortex activity have been shown to be linked in those who experienced stressful life events for an extended period of time. It is further claimed that increased activity of the anterior cingulate cortex, which acts as a bridge between attention and emotion, leads to increased sensitivity of unwanted stimuli and bodily sensations. [28]

Pain is a multifaceted experience, not just a sensation. While nociception refers to afferent neural activity that transmits sensory information in response to stimuli that may cause tissue damage, pain is a conscious experience requiring cortical activity and can occur in the absence of nociception. [25] Those with somatic symptom disorder are thought to exaggerate their symptoms through choice perception and perceive them in accordance with an ailment. This idea has been identified as a cognitive style known as "somatosensorial amplification". [29] The term "central sensitization" has been created to describe the neurobiological notion that those predisposed to somatization have an overly sensitive neural network. Harmless and mild stimuli stimulate the nociceptive specific dorsal horn cells after central sensitization. As a result, pain is felt in response to stimuli that would not typically cause pain. [25]

Neuroimaging evidence

Some literature reviews of cognitive–affective neuroscience on somatic symptom disorder suggested that catastrophization in patients with somatic symptom disorders tends to present a greater vulnerability to pain. The relevant brain regions include the dorsolateral prefrontal, insular, rostral anterior cingulate, premotor, and parietal cortices. [30] [31]

Genetic

Genetic investigations have suggested modifications connected to the monoaminergic system, in particular, may be relevant while a shared genetic source remains unknown. Researchers take into account the various processes involved in the development of somatic symptom disorder as well as the interactions between various biological and psychosocial factors. [25] Given the high occurrence of trauma, particularly throughout childhood, it has been suggested that the epigenetic changes could be explanatory. [32] Another study found that the glucocorticoid receptor gene (NR3C1) is hypomethylated in those with somatic symptom disorder and in those with depression. [25]

Diagnosis

Because those with somatic syndrome disorder typically have comprehensive previous workups, minimal laboratory testing is encouraged. Excessive testing increases the possibility of false-positive results, which may result in further interventions, associated risks, and greater expenses. While some practitioners order tests to reassure patients, research shows that diagnostic testing fails to alleviate somatic symptoms. [2]

Specific tests, such as thyroid function assessments, urine drug screens, restricted blood studies, and minimal radiological imaging, may be conducted to rule out somatization because of medical issues. [2]

Somatic Symptom Scale – 8

The Somatic Symptom Scale – 8 (SSS-8) is a short self-report questionnaire that is used to evaluate somatic symptoms. It examines the perceived severity of common somatic symptoms. [33] The SSS-8 is a condensed version of the well-known Patient Health Questionnaire-15 (PHQ-15). [34]

On a five-point scale, respondents rate how much stomach or digestive issues, back discomfort, pain in the legs, arms, or joints, headaches, chest pain or shortness of breath, dizziness, feeling tired or having low energy, and trouble sleeping impacted them in the preceding seven days. Ratings are added together to provide a sum score that ranges from 0 to 32 points. [33]

DSM-5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) modified the entry titled "somatoform disorders" to "somatic symptom and related disorders", and modified other diagnostic labels and criteria. [35]

The DSM-5 criteria for somatic symptom disorder includes "one or more somatic symptoms which are distressing or result in substantial impairment of daily life". Additional criteria, often known as B criteria, include "excessive thoughts, feelings, or behaviors regarding somatic symptoms or corresponding health concerns manifested by disproportionate and persistent thoughts about the severity of one's symptoms". It continues: "Although any one somatic symptom might not be consistently present, one's state of being symptomatic is continuous (typically lasting more than 6 months)." [3]

The DSM includes five distinct descriptions for somatic symptom disorder. These include somatic symptom disorder with predominant pain, formally referred to as pain disorder, as well as classifications for mild, moderate, and severe symptoms. [3]

International Classification of Diseases

The ICD-11 classifies somatic symptom disorder as "Bodily distress disorder". Bodily distress disorder is characterized by the presence of distressing bodily symptoms and excessive attention devoted to those symptoms. The ICD-11 further specifies that if another health condition is causing or contributing to the symptoms, the level of attention must be clearly excessive in relation to the nature and course of the condition. [36]

Differential diagnosis

Somatic symptom disorder's widespread, non-specific symptoms may obscure and mimic the manifestations of other medical disorders, making diagnosis and therapy challenging. For example, conditions such as adjustment disorder, body dysmorphic disorder, obsessive-compulsive disorder, and illness anxiety disorder can also exhibit excessive and exaggerated emotional and behavioral responses. Other functional diseases with unknown etiology, such as fibromyalgia and irritable bowel syndrome, tend not to present with excessive thoughts, feelings, or maladaptive behavior. [2]

Somatic symptom disorder overlaps with illness anxiety disorder and conversion disorder [37] . Illness anxiety disorder is characterized by an obsession with having or developing a dangerous, undetected medical ailment, despite the absence of bodily symptoms. Conversion disorder may present with one or more symptoms of various sorts. Motor symptoms involve weakness or paralysis; aberrant movements including tremor or dystonic movements; abnormal gait patterns; and abnormal limb posture. The presenting symptom in conversion disorder is loss of function, but in somatic symptom disorder, the emphasis is on the discomfort that specific symptoms produce. Conversion disorder often lacks the overwhelming thoughts, feelings, and behaviors that characterize somatic symptom disorder. [3]

Treatment

Rather than focusing on treating the symptoms, the key objective is to support the patient in coping with symptoms, including both physical symptoms and psychological/behavioral (such as health anxiety and harmful behaviors). [2]

Early psychiatric treatment is advised. Evidence suggests that SSRIs and SNRIs can lower pain perception. [6] Because the somatic symptomatic may have a low threshold for adverse reactions, medication should be started at the lowest possible dose and gradually increased to produce a therapeutic effect. [2]

Cognitive-behavioral therapy has been linked to significant improvements in patient-reported function and somatic symptoms, a reduction in health-care expenses, and a reduction in symptoms of depression. [38] [39] [6] CBT aims to help patients realize their ailments are not catastrophic and to enable them to gradually return to activities they previously engaged in, without fear of "worsening their symptoms". Consultation and collaboration with the primary care physician also demonstrated some effectiveness. [40] [41] Furthermore, brief psychodynamic interpersonal psychotherapy (PIT) for patients with somatic symptom disorder has been proven to improve the physical quality of life in patients with many, difficult-to-treat, medically unexplained symptoms over time [7]

CBT can help in some of the following ways: [42]

Electroconvulsive therapy (ECT) has been used in treating somatic symptom disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT. [43] Overall, psychologists recommend addressing a common difficulty in patients with somatic symptom disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner. [44]

Outlook

Somatic symptom disorder is typically persistent, with symptoms that wax and wane. Chronic limitations in general function, substantial psychological impairment, and a reduction in quality of life are all common. [2] Some investigations suggest people can recover; the natural history of the illnesses implies that around 50% to 75% of patients with medically unexplained symptoms improve, whereas 10% to 30% deteriorate. Fewer physical symptoms and better baseline functioning are stronger prognostic indicators. A strong, positive relationship between the physician and the patient is crucial, and it should be accompanied by frequent, supportive visits to avoid the temptation to medicate or test when these interventions are not obviously necessary. [4]

Epidemiology

Somatic symptom disorder affects 5% to 7% of the general population, with a higher female representation, and can arise throughout childhood, adolescence, or adulthood. Evidence suggests that the emergence of prodromal symptoms often begins in childhood and that symptoms fitting the criteria for somatic symptom disorder are common during adolescence. A community study of adolescents found that 5% had persistent distressing physical symptoms paired with psychological concerns. [45] In the primary care patient population, the rate rises to around 17%. [2] Patients with functional illnesses such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome have a greater prevalence of somatic symptom disorder. The reported frequency of somatic symptom disorder, as defined by DSM-5 criteria, ranges from 25 to 60% among these patients. [45]

There are cultural differences in the prevalence of somatic symptom disorder. For example, somatic symptom disorder and symptoms were found to be significantly more common in Puerto Rico. [46] In addition the diagnosis is also more prevalent among African Americans and those with less than a high school education or lower socioeconomic status. [47]

There is usually co-morbidity with other psychological disorders, particularly mood disorders or anxiety disorders. [3] [48] Research also showed comorbidity between somatic symptom disorder and personality disorders, especially antisocial, borderline, narcissistic, histrionic, avoidant, and dependent personality disorder. [49]

About 10-20 percent of female first degree relatives also have somatic symptom disorder and male relatives have increased rates of alcoholism and sociopathy. [50]

History

Somatization is an idea that physicians have been attempting to comprehend since the dawn of time. The Egyptians and Sumerians were reported to have utilized the notions of melancholia and hysteria as early as 2600 BC. For many years, somatization was used in conjunction with the terms hysteria , melancholia , and hypochondriasis . [51] [25]

During the 17th century, knowledge of the central nervous system grew, giving rise to the notion that numerous inexplicable illnesses could be linked to the brain. Thomas Willis, widely regarded as the father of neurology, recognized hysteria in women and hypochondria in males as brain disorders. Thomas Sydenham contributed significantly to the belief that hysteria and hypochondria are mental rather than physical illnesses. The term "English Malady" was used by George Cheyne to denote that hysteria and hypochondriasis are brain and/or mind-related disorders. [25]

Wilhelm Stekel, a German psychoanalyst, was the first to introduce the term somatization, and Paul Briquet was the first to characterize what is now known as Somatic symptom disorder. [25] Briquet reported respondents who had been unwell for most of their lives and complained of a variety of symptoms from various organ systems. Despite many appointments, hospitalizations, and tests, symptoms continue. [52] Somatic symptom disorder was later dubbed "Briquet Syndrome" in his honor. Over time, the concept of hysteria was used in place of a personality or character type, conversion responses, phobia, and anxiety to accompany psychoneuroses, and its incorporation in everyday English as a negative word led to a distancing from this concept. [25]

Controversy

Somatic symptom disorder has long been a contentious diagnosis because it was based solely on negative criteria, namely the absence of a medical explanation for the presenting physical problems. As a result, any person suffering from a poorly understood illness may meet the criteria for this psychological diagnosis, regardless of whether they exhibit psychiatric symptoms in the traditional sense. [53] [12]

Misdiagnosis

In the opinion of Allen Frances, chair of the DSM-IV task force, the DSM-5's somatic symptom disorder brings with it a risk of mislabeling a sizable proportion of the population as mentally ill.

Millions of people could be mislabeled, with the burden falling disproportionately on women, because they are more likely to be casually dismissed as 'catastrophizers' when presenting with physical symptoms. [12]

See also

Related Research Articles

Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder in which those affected feign or induce disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to themselves. Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but patients also have a history of recurrent hospitalization, travelling, and dramatic, extremely improbable tales of their past experiences. The term Munchausen syndrome derives its name from the fictional character Baron Munchausen.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Conversion disorder (CD), or functional neurologic symptom disorder (FNsD), is a functional disorder that causes abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals with CD present with highly distressing neurological symptoms such as numbness, blindness, paralysis, or convulsions, which are not consistent with a well-established organic cause and can be traced back to a psychological trigger.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

A factitious disorder is a mental disorder in which a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain a patient's role. People with a factitious disorder may produce symptoms by contaminating urine samples, taking hallucinogens, injecting fecal material to produce abscesses, and similar behaviour. The word factitious derives from the Latin word factītius, meaning "human-made".

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no known objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders which also includes a list of the most common culture-bound conditions. Its counterpart in the framework of ICD-10 is the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

Pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.

Somatosensory amplification (SSA) is a tendency to perceive normal somatic and visceral sensations as being relatively intense, disturbing and noxious. It is a common feature of hypochondriasis and is commonly found with fibromyalgia, major depressive disorder, some anxiety disorders, Asperger syndrome, and alexithymia. One common clinical measure of SSA is the Somatosensory Amplification Scale (SSAS).

<span class="mw-page-title-main">Atypical trigeminal neuralgia</span> Medical condition

Atypical trigeminal neuralgia (ATN), or type 2 trigeminal neuralgia, is a form of trigeminal neuralgia, a disorder of the fifth cranial nerve. This form of nerve pain is difficult to diagnose, as it is rare and the symptoms overlap with several other disorders. The symptoms can occur in addition to having migraine headache, or can be mistaken for migraine alone, or dental problems such as temporomandibular joint disorder or musculoskeletal issues. ATN can have a wide range of symptoms and the pain can fluctuate in intensity from mild aching to a crushing or burning sensation, and also to the extreme pain experienced with the more common trigeminal neuralgia.

Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors, without evidence of physical injury or illness.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.

Masked depression (MD) was a proposed form of atypical depression in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder. The concept is not currently supported by the mental health profession.

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

Functional neurologic disorder or functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement problems, sensory symptoms, and convulsions. As a functional disorder, there is, by definition, no known disease process affecting the structure of the body, yet the person experiences symptoms relating to their body function. Symptoms of functional neurological disorders are clinically recognisable, but are not categorically associated with a definable organic disease.

Functional somatic syndrome (FSS) is any of a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform. The status of ME/CFS as a functional somatic syndrome is contested. Although the aetiology remains unclear, there are consistent findings of biological abnormalities, and major health bodies such as the NAM, WHO, and NIH, classify it as an organic disease.

The Somatic Symptom Disorder - B Criteria Scale (SSD-12) is a brief self-report questionnaire used to assess the B criteria of DSM-5 somatic symptom disorder, i.e. the patients’ perceptions of their symptom-related thoughts, feelings, and behaviors.

<span class="mw-page-title-main">Winfried Rief</span> German psychologist

Winfried Rief (born 12 May 1959) is a German psychologist. Since 2000 he has been a professor of clinical psychology and psychotherapy at the University of Marburg. Rief's research examines the psychological factors involved in the development, maintenance and management of physical complaints, including investigations of somatic symptom disorders and placebo effects. Rief is the founding editor of the academic journal Clinical Psychology in Europe.

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