If the somatic symptoms are consistent with another mental disorder (e.g., panic disorder), and the diagnostic criteria for that disorder are fulfilled, then that mental disorder should be considered as an alternative or additional diagnosis. A separate diagnosis of somatic symptom disorder is not made if the somatic symptoms and related thoughts, feelings, or behaviors occur only during major depressive episodes. If, as commonly occurs, the crite- ria for both somatic symptom disorder and another mental disorder diagnosis are ful- filled, then both should be coded, as both may require treatment.
Other medical conditions. The presence of somatic symptoms of unclear etiology is not in itself sufficient to make the diagnosis of somatic symptom disorder. The symptoms of many individuals with disorders like irritable bowel syndrome or fibromyalgia would not satisfy the criterion necessary to diagnose somatic symptom disorder (Criterion B). Con- versely, the presence of somatic symptoms of an established medical disorder (e.g., diabe- tes or heart disease) does not exclude the diagnosis of somatic symptom disorder if the criteria are otherwise met.
Panic disorder. In panic disorder, somatic symptoms and anxiety about health tend to occur in acute episodes, whereas in somatic symptom disorder, anxiety and somatic symp- toms are more persistent.
Generalized anxiety disorder. Individuals with generalized anxiety disorder worry about multiple events, situations, or activities, only one of which may involve their health. The main focus is not usually somatic symptoms or fear of illness as it is in somatic symptom disorder.
Depressive disorders. Depressive disorders are commonly accompanied by somatic symptoms. However, depressive disorders are differentiated from somatic symptom dis- order by the core depressive symptoms of low (dysphoric) mood and anhedonia.
Illness anxiety disorder. If the individual has extensive worries about health but no or minimal somatic symptoms, it may be more appropriate to consider illness anxiety disorder.
Conversion disorder (functional neurological symptom disorder). In conversion disor- der, the presenting symptom is loss of function (e.g., of a limb), whereas in somatic symp— tom disorder, the focus is on the distress that particular symptoms cause. The features listed under Criterion B of somatic symptom disorder may be helpful in differentiating the two disorders.
Delusional disorder. In somatic symptom disorder, the individual’s beliefs that somatic symptoms might reﬂect serious underlying physical illness are not held with delusional intensity. Nonetheless, the individual’s beliefs concerning the somatic symptoms can be firmly held. In contrast, in delusional disorder, somatic subtype, the somatic symptom be- liefs and behavior are stronger than those found in somatic symptom disorder.
Body dysmorphic disorder. In body dysmorphic disorder, the individual is excessively concerned about, and preoccupied by, a perceived defect in his or her physical features. In contrast, in somatic symptom disorder, the concern about somatic symptoms reﬂects fear of underlying illness, not of a defect in appearance.
Obsessive—compulsive disorder. In somatic symptom disorder, the recurrent ideas about somatic symptoms or illness are less intrusive, and individuals with this disorder do not exhibit the associated repetitive behaviors aimed at reducing anxiety that occur in obses- sive—compulsive disorder.
Somatic symptom disorder is associated with high rates of comorbidity with medical dis- orders as well as anxiety and depressive disorders. When a concurrent medical illness is present, the degree of impairment is more marked than would be expected from the phys- symptom disorder, the disorder should be diagnosed; however, in view of the frequent co- morbidity, especially with anxiety and depressive disorders, evidence for these concur- rent diagnoses should be sought.
Diagnostic Criteria 300.7 (F45.21)
A. Preoccupation with having or acquiring a serious illness.