Source of information about DSM diagnoses: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

overview

Somatic symptom and related disorders involve significant distress or impairment due to physical symptoms or health-related anxiety. These conditions include somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder (conversion disorder), psychological factors affecting other medical conditions, factitious disorder, and both other specified and unspecified somatic symptom and related disorders. Individuals often present in medical settings, though the underlying concerns may be psychological.

These disorders focus less on whether symptoms are medically explained and more on the person’s emotional, cognitive, and behavioral response. Somatic symptom disorder involves real physical symptoms with disproportionate worry or behavior. Illness anxiety disorder centers on health fears with minimal symptoms. Functional neurological symptom disorder includes neurological symptoms that do not match known medical conditions. Psychological factors affecting other medical conditions involves mental health symptoms that worsen physical illness. Factitious disorder involves intentionally faking or producing symptoms for psychological reasons.

These disorders are influenced by factors such as trauma, stress, health beliefs, and cultural norms. They often co-occur with anxiety or depression and can be complex to treat, requiring a thoughtful, integrated approach.

DSM Chapter Sections:

• Somatic symptom disorder centers on the psychological response to physical symptoms rather than the symptoms themselves.

• Illness anxiety disorder applies to those with high health anxiety without significant somatic symptoms (previously a subgroup of hypochondriasis).

• Functional neurological symptom disorder (conversion disorder) includes neurological symptoms that are incompatible with medical findings and is now a diagnosis based on positive clinical signs.

• Factitious disorder involves the intentional falsification of symptoms for psychological reasons (e.g., to assume the sick role), not for external gain.

• Psychological factors affecting other medical conditions is diagnosed when mental or behavioral factors negatively impact a medical illness (e.g., poor medication adherence due to denial).

• Other specified and unspecified somatic symptom disorders allow for clinically significant presentations that do not fully meet criteria for a specific diagnosis (e.g., pseudocyesis).

somatic symptom disorder

Somatic symptom disorder is characterized by distressing physical symptoms that are accompanied by excessive thoughts, feelings, or behaviors related to those symptoms. The physical complaints may involve pain, fatigue, or other bodily sensations and may or may not be associated with a medical condition. What distinguishes this disorder is not whether the symptoms can be medically explained, but rather the individual’s disproportionate psychological response to them.

People with somatic symptom disorder often experience persistent worry about their health and view minor or routine physical sensations as serious or threatening. They may become fixated on these symptoms, frequently seeking medical care, undergoing unnecessary tests, and visiting multiple providers. Despite repeated medical evaluations and negative findings, their concerns typically remain, and reassurance offers only temporary relief.

The disorder can significantly impair daily functioning and quality of life. In severe cases, the somatic concerns may dominate a person’s self-identity and interpersonal relationships. Individuals may resist mental health referrals, believing their issues are purely physical. Common behavioral features include body checking, frequent doctor visits, and avoidance of physical activity due to fear of worsening symptoms.

Criteria:

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or health concerns, evidenced by at least one of the following:

1. Disproportionate and persistent thoughts about the seriousness of symptoms.

2. Persistently high level of health-related anxiety.

3. Excessive time and energy devoted to symptoms or health concerns.

C. The state of being symptomatic is persistent, typically lasting more than 6 months, even if individual symptoms vary.

Specifiers:

• With predominant pain: Somatic symptoms primarily involve pain (formerly pain disorder).

• Persistent: Symptoms are severe, cause marked impairment, and are long-lasting (over 6 months).

illness anxiety disorder

Illness anxiety disorder is characterized by a persistent preoccupation with having or developing a serious medical illness, despite minimal or no somatic symptoms. This disorder replaces a portion of what was previously diagnosed as hypochondriasis under DSM-IV. Unlike somatic symptom disorder, where distress arises from the physical symptoms themselves, individuals with illness anxiety disorder are primarily anxious about the idea of being ill.

This condition causes significant anxiety and distress, often impacting daily functioning and relationships. It can lead to frequent medical consultations, yet patients often feel dissatisfied with the care they receive, sometimes even avoiding health care due to overwhelming anxiety. Despite repeated negative tests, the fear of illness dominates the person’s life, reinforcing a cycle of health anxiety and compulsive behaviors. Illness anxiety disorder is more often seen in medical settings than mental health care, and managing it requires sensitivity to both psychological and physical concerns.

Criteria:

A. Persistent preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are absent or mild. If a medical condition or risk is present, the health-related concern is clearly excessive or disproportionate.
C. The individual has a high level of health-related anxiety and is easily alarmed about their health.
D. The person engages in excessive health-related behaviors (e.g., frequent body checks, doctor visits) or shows maladaptive avoidance (e.g., avoiding hospitals or medical care).
E. The preoccupation has lasted at least 6 months, though the specific illness feared may change during that time.
F. The disturbance is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, OCD, GAD, or body dysmorphic disorder.

Specifier: Care-seeking type of care-avoidant type.

functional neurological symptom disorder (Conversion disorder)

Functional neurological symptom disorder involves one or more neurological symptoms such as weakness, tremors, abnormal movements, speech disturbances, or episodes resembling seizures that cannot be explained by a recognized neurological condition. These symptoms cause significant distress or impairment and are not intentionally produced.

Diagnosis is based on clinical evidence that the symptoms are inconsistent with known neurological or medical disorders. This may include findings like tremors that stop during distraction or weakness that improves with certain tests. The diagnosis should not rely solely on the absence of medical findings but should be supported by these inconsistencies observed during the exam.

Although symptoms may begin after psychological stress or trauma, such a trigger is not required. Many individuals do not report a clear stressor. Associated symptoms can include depersonalization, derealization, or dissociative amnesia, especially around the time of symptom onset.

People with this disorder often present in medical rather than mental health settings and may resist psychological explanations for their symptoms. Compassionate, informed care is essential to avoid invalidating their experiences and to support engagement in treatment.

Criteria:

A. One or more symptoms involving changes in voluntary motor or sensory function.
B. Clinical evidence shows the symptom is not consistent with recognized neurological or medical conditions.
C. The symptom is not better explained by another medical or mental health disorder.
D. The symptom causes significant distress, impairment in daily functioning, or requires medical attention.

Specify Symptom Type:

• With weakness or paralysis, abnormal movement (such as tremor or dystonia), swallowing symptoms, speech symptoms (such as slurred speech), attacks or seizures, anesthesia or sensory loss, special sensory symptoms (such as vision or hearing issues), or mixed symptoms

Specify Duration:

• Acute episode: Symptoms last less than six months

• Persistent: Symptoms last six months or more

Specify Presence of Stressor:

• With psychological stressor (specify the stressor if known)

• Without psychological stressor

psychological factors affecting other medical conditions

This diagnosis is used when psychological or behavioral factors negatively impact a medical condition. These factors might worsen the illness, interfere with treatment, increase health risks, or contribute to symptom severity. Examples include anxiety triggering asthma, depression leading to poor diabetes management, or someone ignoring chest pain due to denial.

To qualify, the psychological factor must have a clear and clinically significant effect on the medical condition, such as increasing the risk of complications, hospitalizations, or disability. These effects can be short-term or long-term and can apply to medical illnesses with known causes (like heart disease or cancer), functional disorders (like IBS or migraines), or unexplained symptoms (like fatigue or pain).

This diagnosis is not used when psychological symptoms develop in reaction to the medical condition—in those cases, an adjustment disorder might be more appropriate. While the exact cause-and-effect link may not be proven, there must be reasonable evidence that the psychological factor is influencing the medical condition.

Criteria:

A. A medical condition or symptom (not a mental disorder) is present.
B. One or more psychological or behavioral factors are negatively affecting the medical condition in at least one of the following ways:

1. They influence the course of the medical condition (e.g., stress delays recovery or worsens symptoms).

2. They interfere with treatment (e.g., poor medication adherence).

3. They present additional health risks (e.g., ongoing smoking or substance use).

4. They influence underlying physiology, leading to symptoms or medical attention.

C. The psychological or behavioral factors are not better explained by another mental disorder, such as panic disorder or depression.

Specify Severity:

• Mild: Increases medical risk (e.g., occasionally skips medication)

• Moderate: Aggravates condition (e.g., anxiety worsening asthma)

• Severe: Leads to medical hospitalization or emergency visit

• Extreme: Poses life-threatening risk (e.g., ignoring signs of a heart attack)

Factitious disorder

Factitious disorder is characterized by the intentional falsification or induction of physical or psychological symptoms, either in oneself or in another individual. When directed at oneself, it is referred to as factitious disorder imposed on self. When directed at another person, often a dependent such as a child, it is known as factitious disorder imposed on another. The defining element of this disorder is deception. The individual deliberately misrepresents, simulates, or causes symptoms with the goal of being perceived as ill, injured, or impaired. Unlike malingering, factitious disorder occurs in the absence of obvious external rewards such as financial compensation or avoidance of responsibilities. Instead, the motivation is often internal, such as the desire to receive attention or sympathy associated with being sick.

Criteria (Imposed on Self):

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Specify if: Single episode or recurrent episodes (two or more events of falsification of illness and/or induction of injury).

Criteria (Imposed on Another):

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another person, associated with identified deception.​
B. The individual presents another person (the victim) to others as ill, impaired, or injured.​
C. The deceptive behavior is evident even in the absence of obvious external rewards.​
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.​

Note: The diagnosis is assigned to the perpetrator, not the victim.​

Specify if: Single episode or recurrent episodes (two or more events of falsification of illness and/or induction of injury)

Other Specified Somatic Symptom and Related Disorder

This diagnostic category is used when a person presents with distressing somatic symptoms or health anxiety that significantly impacts daily functioning, when the full criteria for a specific somatic disorder (like somatic symptom disorder or illness anxiety disorder) are not met. This diagnosis allows for more precise labeling when the presentation is recognizable but does not fit standard categories. This diagnosis also includes pseudocyesis (a psychological condition characterized by a false belief of being pregnant, accompanied by objective physical signs and reported symptoms typically associated with pregnancy).

Unspecified Somatic Symptom and Related Disorder

This diagnosis is used when a person presents with distressing physical or health-related symptoms that significantly impact their functioning, but the symptoms do not meet the full diagnostic criteria for any specific somatic symptom and related disorders (e.g., somatic symptom disorder and illness anxiety disorder).

Key Features:

• Clinically significant distress or impairment is present.
• Symptoms are characteristic of a somatic symptom and related disorder.
• The presentation does not meet full criteria for a more specific disorder in this category.

Important Note: This category should only be used in unusual situations, such as:

• Insufficient clinical information is available (e.g., in emergency or initial assessments).

• The provider is unable to specify the exact condition due to lack of data or clarity.

It is not intended for regular use and should be considered a placeholder diagnosis until more precise information becomes available.

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