The symptoms may or may not be associated with another medical condition. The di- agnoses of somatic symptom disorder and a concurrent medical illness are not mutually exclusive, and these frequently occur together. For example, an individual may become se- riously disabled by symptoms of somatic symptom disorder after an uncomplicated myo- cardial infarction even if the myocardial infarction itself did not result in any disability. If another medical condition or high risk for developing one is present (e.g., strong family history), the thoughts, feelings, and behaviors associated with this condition are excessive (Criterion B).
Individuals with somatic symptom disorder tend to have very high levels of worry about illness (Criterion B). They appraise their bodily symptoms as unduly threatening, harmful, or troublesome and often think the worst about their health. Even when there is evidence to the contrary, some patients still fear the medical seriousness of their symp- toms. In severe somatic symptom disorder, health concerns may assume a central role in the individual’s life, becoming a feature of his or her identity and dominating interper- sonal relationships.
Individuals typically experience distress that is principally focused on somatic symp- toms and their significance. When asked directly about their distress, some individuals de- scribe it in relation to other aspects of their lives, while others deny any source of distress other than the somatic symptoms. Health—related quality of life is often impaired, both physically and mentally. In severe somatic symptom disorder, the impairment is marked, and when persistent, the disorder can lead to invalidism.
There is often a high level of medical care utilization, which rarely alleviates the individ- ual’s concerns. Consequently, the patient may seek care from multiple doctors for the same symptoms. These individuals often seem unresponsive to medical interventions, and new interventions may only exacerbate the presenting symptoms. Some individuals with the dis- order seem unusually sensitive to medication side effects. Some feel that their medical as- sessment and treatment have been inadequate.
Cognitive features include attention focused on somatic symptoms, attribution of normal bodily sensations to physical illness (possibly with catastrophic interpretations), worry about illness, and fear that any physical activity may damage the body. The relevant as- sociated behavioral features may include repeated bodily checking for abnormalities, re— peated seeking of medical help and reassurance, and avoidance of physical activity. These behavioral features are most pronounced in severe, persistent somatic symptom disorder.
These features are usually associated with frequent requests for medical help for different somatic symptoms. This may lead to medical consultations in which individuals are so fo- cused on their concerns about somatic symptom(s) that they cannot be redirected to other matters. Any reassurance by the doctor that the symptoms are not indicative of serious physical illness tends to be short-lived and/ or is experienced by the individuals as the doctor not taking their symptoms with due seriousness. As the focus on somatic symp- toms is a primary feature of the disorder, individuals with somatic symptom disorder typ- ically present to general medical health services rather than mental health services. The suggestion of referral to a mental health specialist may be met with surprise or even frank refusal by individuals with somatic symptom disorder.
Since somatic symptom disorder is associated with depressive disorders, there is an in- creased suicide risk. It is not known whether somatic symptom disorder is associated with suicide risk independent of its association with depressive disorders.
The prevalence of somatic symptom disorder is not known. However, the prevalence of somatic symptom disorder is expected to be higher than that of the more restrictive DSM-
IV somatization disorder (<1%) but lower than that of undifferentiated somatoform dis- order (approximately 19%). The prevalence of somatic symptom disorder in the general adult population may be around 5%—7%. Females tend to report more somatic symptoms than do males, and the prevalence of somatic symptom disorder is consequently likely to be higher in females.