ReviewSomatic Symptom Disorders Without Known Physical Causes: One Disease with Many Names?
Section snippets
Psychiatric Nomenclature: Somatic Symptom Disorder
Formerly named “Somatoform Disorder,” this condition continues to be included within the categories of psychiatric disorders. In the latest Diagnostic and Statistical Manual of Mental Disorders, 5th edition1 handbook, it has been renamed somatic symptom disorder. Previous labels such as somatization disorder, hypochondriasis, and widespread pain disorder have been removed in favor of this more inclusive term, “somatic symptom disorder.” This new classification recognizes that mind and body
Fibromyalgia
As noted, the diagnosis of fibromyalgia suggests a physical origin, and this often leads to the referral of such patients—rightly or wrongly—to a rheumatologist. Although the major complaint in these patients is centered on pains, multiple additional symptoms are included in this disorder, and they seem to place the origin in the brain or central nervous system, with the suggested term of “central sensitization.”6, 7 In the case of fibromyalgia, we were first provided with the “objective” means
Chronic Fatigue Syndrome
One of the commonest complaints we hear as physicians is that of fatigue, which is quite prevalent in the general population. From surveys involving patients visiting family physicians, 28% reported fatigue.16 This symptom may signify a serious underlying organic disease, but it is far more often the result of psychological factors such as anxiety, depression, overwork, lack of adequate sleep, or simply boredom, stresses that may be caused by an unhappy marriage, work frustrations, or a myriad
Conclusions
Because of the similarity and tremendous overlap of symptoms among the various somatic conditions noted above, they all might best be categorized under one label, possibly somatic symptom disorder, or, alternatively, central sensitization disorder. Until we discover objective chemical or biopsy proof, little purpose is served by applying various labels that suggest differing underlying mechanisms, which often results in the referral of patients to fragmented specialty groups.
These patients may
Acknowledgment
The author is indebted to Edward R. Gabovitch, MD, rheumatologist, for providing valuable personal observations and insight concerning this important and challenging problem.
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2022, American Journal of MedicineCitation Excerpt :One clinical example of this strategy is in the quotation of statistical expectations: for instance, assuming a given surgical procedure carries a 5% mortality rate, a more optimistic outlook may be imparted by quoting a 95% success rate. Although difficult to prove, the nocebo mechanism may be operative in the production of various chronic somatic symptom disorders lacking objective findings,19 such as somatoform disorders, fibromyalgia, and hypochondriasis. In the example of fibromyalgia, treatment options20 for this disorder are usually suboptimal, often including drugs (antidepressants such as amitriptyline or duloxetine, milnacipran) and neuromodulating agents such as pregabalin), nonpharmacological treatment such as aerobic and strength-training exercises, aquatic exercises, and cognitive-behavioral therapy.
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Conflict of Interest: None.
Authorship: The author is solely responsible for writing this manuscript.