Somatoform Disorder
is a neurological disorder characterized by a persistent fear or belief in the predominance of various somatic symptoms. Patients repeatedly seek medical attention for these symptoms, and various negative medical tests and physician explanations fail to dispel their doubts. Even if some kind of somatic disorder is sometimes present, it does not explain the nature or extent of the symptoms complained of, or their distress and predominant perceptions. It is often accompanied by anxiety or depression. Patients often deny the presence of psychological factors, despite the fact that the onset and persistence of symptoms are closely related to unpleasant life events, difficulties or conflicts. The disorder is present in both men and women and has a chronic fluctuating course.
[Symptom Criteria].
(1) Meet the diagnostic criteria for neurosis.
(2) The somatic symptoms are predominant, with at least 1 of the following.
(1) excessive concern about somatic symptoms (severity is clearly disproportionate to the actual situation), but not delusional.
(ii) Excessive concern for physical health, such as excessive concern for commonly occurring physical phenomena and abnormal sensations, but not delusional.
(3) Repeatedly seeking medical treatment or requesting medical examination, but neither negative test results nor reasonable explanations from the physician can dispel their doubts.
[Severity Criteria] Impaired social function.
Criteria for disease duration】Meets the criteria for symptoms for at least 3 months.
Exclusion criteria】Exclude other neurotic disorders (such as anxiety, panic disorder, or obsessive-compulsive disorder), depression, schizophrenia, and paranoid psychosis.
[Note] This disorder is sometimes combined with the presence of some kind of somatic disorder, and care must be taken to avoid missing the diagnosis.
Somatization disorder
It is a neurological disorder that is dominated by a wide variety of frequently changing somatic symptoms. Symptoms can involve any system or organ of the body, most commonly gastrointestinal discomfort (e.g., pain, hiccups, acid reflux, vomiting, nausea, etc.), abnormal skin sensations (e.g., itching, burning, tingling, numbness, soreness, etc.), skin spots, sexual and menstrual complaints are also common, and significant depression and anxiety are often present. The course is often chronic and fluctuating, and is often accompanied by severe and long-standing impairments in social, interpersonal and family behavior. It is much more common in women than in men, and most often develops in early adulthood.
Symptom criteria]
(1) Meet the diagnostic criteria for somatoform disorders.
(2) Multiple, recurrent, and frequently changing somatic symptoms are predominant, with at least two of the following four groups of symptoms, totaling six.
(1) gastrointestinal symptoms, such as: abdominal pain; nausea; abdominal distention or flatulence; tastelessness in the mouth or excessive tongue coating; vomiting or regurgitation; frequent, dilute stools, or watery stools.
(ii) respiratory and circulatory symptoms, such as: shortness of breath; chest pain.
(iii) Genitourinary symptoms, such as: difficult or frequent urination; discomfort in or around the genitals; abnormal or copious vaginal discharge.
(iv) Skin symptoms or painful symptoms, such as: scarring; pain, numbness, or tingling sensation in the limbs or joints.
(3) Physical examination and laboratory tests fail to reveal evidence of a somatic disorder that can provide a reasonable explanation for the severity, variability, persistence, or secondary impairment of social functioning of the symptoms.
(4) The predominant perception of the above symptoms causes the patient distress, constant consultation, or requests for various tests, but neither negative test results nor reasonable explanations by the physician can dispel his or her doubts.
(5) If symptoms of autonomic hyperactivity are present, but not dominant.
[Severity Criteria] Often accompanied by long-standing severe impairment in social, interpersonal and family behavior.
Criteria for disease duration】Meeting symptom criteria and severity criteria for at least 2 years.
Exclusion criteria】Exclude schizophrenia and its related disorders, psychotic disorders of the mind, adjustment disorders, or panic disorders.
Undifferentiated somatoform disorder
Diagnostic criteria
(1) The complaints of somatic symptoms are characterized by diversity and variability, but constitute insufficient typicality of somatization disorder to be considered for this diagnosis.
(2) The remaining criteria for somatization disorder are met, except for the duration of the disease, which is shorter than 2 years.
Hypochondriasis
is a neurological disorder dominated by a persistent dominant notion of fear or belief of suffering from a serious somatic disorder, for which the patient has repeatedly sought medical attention, and for which various negative medical tests and physicians’ explanations have failed to dispel his or her doubts. Even if the patient sometimes has some kind of somatic disorder, it does not explain the nature or extent of the symptoms complained of, or the patient’s distress and dominant perception, often accompanied by anxiety or depression. Doubts or predominant perceptions about physical deformities (although insufficiently based) are also part of the disorder. The disorder is present in both men and women, has no obvious family characteristics (unlike somatization disorder), and often has a chronic fluctuating course.
【Criteria for symptoms
(1) Meet the diagnostic criteria of neurosis.
(2) Predominantly hypochondriac symptoms, with at least 1 of the following.
(1) excessive worry about somatic diseases, the severity of which is clearly disproportionate to the actual situation.
(ii) A hypochondriacal interpretation of health conditions, such as commonly occurring physiological phenomena and abnormal sensations, but not delusions.
(3) solid suspicion of illness, lacking in basis, but not delusional.
(3) Repeated visits to the doctor or requests for medical examination, but neither negative test results nor reasonable explanations from the doctor can dispel his or her doubts.
[Severity Criteria] Impaired social function.
Criteria for disease duration】Meets the criteria for symptoms for at least 3 months.
Exclusion criteria】Exclude somatization disorder, other neurotic disorders (such as anxiety, panic disorder, or obsessive-compulsive disorder), depression, schizophrenia, and paranoid psychosis.
Somatic form autonomic disorder
It is a neurotic-like syndrome caused by somatic disorders in organ systems that are primarily innervated by autonomic nerves (e.g., cardiovascular, gastrointestinal, respiratory systems). The patient develops non-specific, but more individual and subjective symptoms such as pain, burning, heaviness, tightness, and swelling at indeterminate sites on top of autonomic excitatory symptoms (e.g., palpitations, sweating, flushing, tremor), none of which on examination proves that a somatic disorder has occurred in the organ or system in question. Thus this disorder is characterized by obvious autonomic involvement, nonspecific symptoms attached to subjective complaints, and insistence on attribution of symptoms to a specific organ or system.
[Diagnostic criteria
(1) Meeting the diagnostic criteria for somatoform disorders.
(2) Autonomic arousal signs in at least 2 of the following organ systems (cardiovascular, respiratory, esophageal and gastric, lower gastrointestinal tract, genitourinary system): ① palpitations; ② sweating; ③ dry mouth; ④ feverish or flushed face.
(3) at least 1 of the following symptoms complained by the patient: ① chest pain or discomfort in the precordial region; ② dyspnea or hyperventilation; ③ overexertion by slight exertion; ④ swallowing, eructation, burning sensation in the chest or epigastrium; ⑤ epigastric discomfort or fluttering or stirring sensation in the stomach; ⑥ increased frequency of stool; ⑦ frequent urination or difficulty in urination; ⑧ sensation of swelling, distension or heaviness.
(4) There is no evidence of structural or functional disturbance of the organ system that the patient is worried about.
(5) It is not seen only during episodes of fear disorder or panic disorder.
It is a persistent, severe pain that cannot be rationally explained by a physical process or somatic disorder. Emotional conflict or psychosocial problems directly contribute to the onset of pain, and no somatic lesion with corresponding complaints is found after examination. The course of the disease is prolonged, often lasting more than 6 months, and impairs social functioning. Diagnosis needs to exclude pain that is presumed to be psychogenic pain in the course of depression or schizophrenia, somatization disorders, and examination-confirmed associated somatic disorders with pain.
[Symptom criteria].
(1) Meeting the diagnostic criteria for somatoform disorders.
(2) Persistent, severe pain that cannot be reasonably explained by physiological processes or somatic disorders.
(3) Emotional conflict or psychosocial problems directly contributing to the onset of pain.
(4) No somatic lesion corresponding to the chief complaint is found by examination.
Severity Criteria】 Impaired social function or active treatment due to mental pain that is difficult to get rid of.
Criteria for disease duration】Meeting the symptom criteria has been at least 6 months.
Exclusion criteria
(1) Exclusion of detected relevant somatic diseases and pain.
(2) Exclude schizophrenia or related disorders, mood disorders, somatization disorders, undifferentiated somatoform disorders, and hypochondria.