30 Apr 2013
New Diagnosis of Somatic Symptom Disorder Sparks Controversy
Somatic symptom disorder (SSD) is the name of a newly defined mental health condition that appears in the May 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, a standard guidebook used by mental health professionals throughout the United States. The new disorder fully or partially replaces several other conditions, known collectively as somatoform disorders, included in the previous version of the DSM. People with SSD have distressing or disruptive symptoms of somatic illness, a term that doctors generally use to describe physical ailments that have no explainable physical cause. However, controversially, the SSD definition lets doctors diagnose the disorder even when a plausible physical explanation for their patients’ symptoms exists.
The Diagnostic and Statistical Manual of Mental Disorders is the creation of an organization called the American Psychiatric Association. Committees of mental health professionals within this organization meet periodically to discuss new developments in mental health research, compare those developments with the current accepted norms of the psychiatric community, and decide whether they need to update the accepted norms in order to incorporate relevant information from the new findings. The decisions made by these committees are included in fully or partially revised updates of the DSM and publicly released. In addition to doctors, public health officials and insurance companies typically closely follow the criteria established by the latest DSM version.
Somatoform Disorder Basics
According to the newly outdated version of the DSM, known as DSM IV or DSM 4, somatoform disorders exist as a group of related conditions, all of which revolve around the presence of physical symptoms with mental or psychiatric origins. The full list of these conditions includes somatization disorder, which centers on chronic physical symptoms appearing in multiple parts of the body; conversion disorder, which centers on symptoms affecting the nervous system; pain disorder, which centers on the presence of severe pain; hypochondriasis (known commonly as hypochondria), which centers on a fear of having or contracting a serious physical ailment; and body dysmorphic disorder, which centers on a fixation with the “disfiguring” effects of minor or entirely self-perceived physical flaws.
The new version of the DSM, called DSM 5, eliminates somatization disorder, pain disorder and hypochondriasis as diagnosable mental disorders. It also eliminates another related condition called undifferentiated somatoform disorder. The American Psychiatric Association committee that made these changes gave several reasons for their decision. First, they wanted to do away with the considerable overlap in symptoms between different somatoform disorders. They also wanted to make it easier for non-specialist doctors to make appropriate diagnoses in their patients. In addition, they wanted to curb a tendency among doctors to treat the mind and body aspects of somatic symptoms as separate medical issues.
Somatic Symptom Disorder Basics
The newly established definition for somatic symptom disorder resembles the definition for somatization disorder in certain respects. Like somatization disorder, SSD centers on the presence of somatic symptoms that disrupt a person’s normal lifestyle. However, a person with SSD also experiences extreme or excessive degrees of emotional distress and has a preoccupation with his or her physical symptoms that manifests as a significant change in his or her behaviors, feelings, or thought processes. These combined symptoms must recur consistently for about six months.
To receive a diagnosis for one of the eliminated somatoform disorders, an individual needed to have a certain number of symptoms that came from four different categories or groups. The definition for SSD does away this requirement. Critically, the definition for SSD also gives doctors the freedom to diagnose the presence of the disorder even if a patient has a medical condition that substantially accounts for his or her symptoms.
Concerns in the Medical Community
Some mental health experts disagree with the validity of the terms used to define somatic symptom disorder. This disagreement typically focuses on the freedom that doctors have to diagnose the condition in people who have reasonable medical explanations for their somatic symptoms. Many experts believe that this freedom will lead to over-diagnosis of SSD, and also unnecessarily stigmatize certain physical ailments as the products of mental health problems. A recent field trial of the new SSD definition highlights some of these issues. During this trial, 7 percent of physically healthy individuals were misdiagnosed with SSD; in addition, 15 percent of all trial participants with heart disease or cancer—and 26 percent of all participants with fibromyalgia or irritable bowel syndrome—qualified for an SSD diagnosis.