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INTRODUCTION

Diagnostic criteria for somatic symptom disorder includes one or more symptoms that are distressing or result in significant disruption of daily life, such as excessive thoughts, feelings, behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: (1) disproportionate and persistent thoughts about the seriousness of one's symptoms; (2) persistently high level of anxiety about health or symptoms; and (3) excessive time and energy devoted to these symptoms or health concerns. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). Specifiers include the following: With predominant pain (previously pain disorder); this specifier is for individuals whose somatic symptoms predominantly involve pain. Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months). Current severity is also a specifier: Mild—Only one of the symptoms specified in criterion B is fulfilled. Moderate—Two or more of the symptoms specified in Criterion B are fulfilled. Severe—Two or more of the symptoms in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom) (DSM-5).

Patients who somatize psychosocial distress commonly present in medical clinical settings. Approximately 25% of patients in primary care demonstrate some degree of somatization, and at least 10% of medical or surgical patients have no evidence of a disease process. Somatizing patients use a disproportionately large amount of medical services and frustrate their physicians, who often do not recognize the true nature of these patients' underlying problems. Somatizing patients rarely seek help from psychiatrists at their own initiative, and they may resent any implication that their physical distress is related to psychological problems. Despite the psychogenic etiology of their illnesses, these patients continue to seek medical care in nonpsychiatric settings where their somatization is often unrecognized.

Somatization is not an either–or proposition. Rather, many patients have some evidence of biological disease but overrespond to their symptoms or believe themselves to be more disabled than objective evidence would indicate. Medical or surgical patients who have concurrent anxiety or depressive disorders use medical services at a rate two to three times greater than that of persons with the same diseases who do not have a comorbid psychiatric disorder.

Despite the illusion that somatic symptom and related disorders are specific entities, as is implied by the use of specific diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the symptoms most of these patients experience fail to meet the diagnostic criteria of the formal somatic symptom disorder. Further, over time, patients' symptoms tend to be fluid, and patients may be best described as having one disorder at one time and another disorder at some other time. Somatization is caused or facilitated by numerous interrelated factors, and for an individual patient a particular symptom may ...

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