RT Book, Section
A1 Reus, Victor I.
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1177607801
T1 Somatic Symptom Disorder
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accesspharmacy.mhmedical.com/content.aspx?aid=1177607801
RD 2024/04/20
AB Many  patients  presenting  in  general  medical  practice,  perhaps  as  many  as  5–7%,  will  experience  a  somatic  symptom(s)  as  particularly  distressing  and  preoccupying,  to  the  point  that  it  comes  to  dominate  their  thoughts,  feelings,  and  beliefs  and  interferes  to  a  varying  degree  with  everyday  functioning.  Although  the  absence  of  a  medical  explanation  for  these  complaints  was  historically  emphasized  as  a  diagnostic  element,  it  has  been  recognized  that  the  patient’s  interpretation  and  elaboration  of  the  experience  is  the  critical  defining  factor  and  that  patients  with  well-established  medical  causation  may  qualify  for  the  diagnosis.  Multiple  complaints  are  typical,  but  severe  single  symptoms  can  occur  as  well.  Comorbidity  with  depressive  and  anxiety  disorders  is  common  and  may  affect  the  severity  of  the  experience  and  its  functional  consequences.  Personality  factors  may  be  a  significant  risk  factor,  as  may  a  low  level  of  educational  or  socioeconomic  status  or  a  history  of  recent  stressful  life  events.  Cultural  factors  are  relevant  as  well  and  should  be  incorporated  into  the  evaluation.  Individuals  who  have  persistent  preoccupations  about  having  or  acquiring  a  serious  illness,  but  who  do  not  have  a  specific  somatic  complaint,  may  qualify  for  a  related  diagnosis—illness  anxiety  disorder.  The  diagnosis  of  conversion  disorder  (functional  neurologic  symptom  disorder)  is  used  to  specifically  identify  those  individuals  whose  somatic  complaints  involve  one  or  more  symptoms  of  altered  voluntary  motor  or  sensory  function  that  cannot  be  medically  explained  and  that  causes  significant  distress  or  impairment  or  requires  medical  evaluation.