In older individuals, somatic symptoms and concurrent medical illnesses are common, and a focus on Criterion B is crucial for making the diagnosis. Somatic symptom disorder may be underdiagnosed in older adults either because certain somatic symptoms (e.g., pain, fatigue) are considered part of normal aging or because illness worry is considered tions than do younger people. Concurrent depressive disorder is common in older people who present with numerous somatic symptoms.
In children, the most common symptoms are recurrent abdominal pain, headache, fa- tigue, and nausea. A single prominent symptom is more common in children than in adults. While young children may have somatic complaints, they rarely worry about ”ill- ness” per se prior to adolescence. The parents’ response to the symptom is important, as this may determine the level of associated distress. It is the parent who may determine the interpretation of symptoms and the associated time off school and medical help seeking.
Temperamental. The personality trait of negative affectivity (neuroticism) has been identi- fied as an independent correlate/ risk factor of a high number of somatic symptoms. Comorbid anxiety or depression is common and may exacerbate symptoms and impairment.
Environmental. Somatic symptom disorder is more frequent in individuals with few years of education and low socioeconomic status, and in those who have recently experienced stressful life events.
Course modifiers. Persistent somatic symptoms are associated with demographic fea- tures (female sex, older age, fewer years of education, lower socioeconomic status, un- employment), a reported history of sexual abuse or other childhood adversity, concurrent chronic physical illness or psychiatric disorder (depression, anxiety, persistent depressive disorder [dysthymia], panic), social stress, and reinforcing social factors such as illness benefits. Cognitive factors that affect clinical course include sensitization to pain, height- ened attention to bodily sensations, and attribution of bodily symptoms to a possible med- ical illness rather than recognizing them as a normal phenomenon or psychological stress.
Somatic symptoms are prominent in various ”culture—bound syndromes.” High numbers of somatic symptoms are found in population-based and primary care studies around the world, with a similar pattern of the most commonly reported somatic symptoms, impair- ment, and treatment seeking. The relationship between number of somatic symptoms and illness worry is similar in different cultures, and marked illness worry is associated with impairment and greater treatment seeking across cultures. The relationship between nu- merous somatic symptoms and depression appears to be very similar around the world and between different cultures within one country.
Despite these similarities, there are differences in somatic symptoms among cultures and ethnic groups. The description of somatic symptoms varies with linguistic and other local cultural factors. These somatic presentations have been described as ”idioms of dis- tress” because somatic symptoms may have special meanings and shape patient-clinician interactions in the particular cultural contexts. ”Burnout,” the sensation of heaviness or the complaints of ”gas”; too much heat in the body; or burning in the head are examples of symptoms that are common in some cultures or ethnic groups but rare in others. Explan- atory models also vary, and somatic symptoms may be attributed variously to particular family, work, or environmental stresses; general medical illness; the suppression of feel- ings of anger and resentment; or certain culture-specific phenomena, such as semen 1055.
There may also be differences in medical treatment seeking among cultural groups, in ad- dition to differences due to variable access to medical care services. Seeking treatment for multiple somatic symptoms in general medical clinics is a worldwide phenomenon and occurs at similar rates among ethnic groups in the same country.
Functional Consequences of Somatic Symptom Disorder
The disorder is associated with marked impairment of health status. Many individuals with severe somatic symptom disorder are likely to have impaired health status scores more than 2 standard deviations below population norms.