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Somatic Symptom and Related Disorders - Comparison Tables

Table 1: Main Disorders Comparison

Disorder	Physical Symptoms	Health Anxiety	Behavior	Duration	Goal
Somatic Symptom Disorder	Present and distressing	Very high	Multiple provider visits	>6 months	Unconscious
Illness Anxiety Disorder	Absent or mild	Very high	Excessive body checking	>6 months	Unconscious
Conversion Disorder	Neurological symptoms	Moderate	Normal behavior	Variable	Unconscious
Factitious Disorder	Fabricated or induced	Low	Concealing truth	Variable	Gain attention
Psychological Factors	Real medical condition	Moderate	Non-adherence to treatment	Variable	Unconscious

Table 2: Simplified Diagnostic Criteria

Disorder	Primary Criterion	Additional Criteria	Important Exclusions
Somatic Symptom Disorder	One or more somatic symptoms	Excessive thoughts + anxiety + time/energy	Duration >6 months
Illness Anxiety Disorder	Preoccupation with serious illness	Excessive checking or avoidance	Physical symptoms absent
Conversion Disorder	Motor or sensory symptoms	Incompatible with neurological conditions	Not intentionally produced
Factitious Disorder	Falsification or induction of symptoms	Evidence of deception	No external rewards
Psychological Factors	Medical condition present	Psychological factors adversely affect	Real medical illness

Table 3: Etiology and Theories

Theory	Somatic Symptom Disorder	Illness Anxiety Disorder	Conversion Disorder	Factitious Disorder
Psychodynamic	Repression and displacement	Death anxiety	Unconscious conflict repression	Need for care
Behavioral	Sick role learning	Illness behavior reinforcement	Symptom modeling	Attention reinforcement
Cognitive	Faulty interpretation of sensations	Catastrophic thinking	Symptom amplification	Perceptual distortion
Biological	High sensitivity to pain	Neurotransmitter dysfunction	Dominant hemisphere deficit	Personality disorder

Table 4: Common Symptoms and Distinguishing Features

Disorder	Common Symptoms	Distinguishing Features	Patient Behavior
Somatic Symptom Disorder	Multiple pains, fatigue, GI problems	Dramatic, inconsistent stories	Urgent requests for tests
Illness Anxiety Disorder	Fear of diseases, body checking	Hospital avoidance or overuse	Compulsive checking behavior
Conversion Disorder	Paralysis, blindness, sensory loss	Neurological incompatibility	Lack of normal concern
Factitious Disorder	Atypical symptoms	Resistance to team access to information	Complex treatment history

Table 5: Differential Diagnosis

Suspected Disorder	Must Rule Out	Distinguishing Signs	Required Tests
Somatic Symptom Disorder	Real medical conditions	Repeatedly normal tests	Comprehensive workup
Illness Anxiety Disorder	Panic disorder, OCD	No physical symptoms	Psychiatric assessment
Conversion Disorder	Real neurological diseases	Neurological incompatibility	Neurological examination
Factitious Disorder	Malingering, somatic disorders	Deception motives	Careful monitoring

Table 6: Treatment and Management

Treatment Type	Somatic Symptom Disorder	Illness Anxiety Disorder	Conversion Disorder	Factitious Disorder
Psychotherapy	CBT, insight-oriented therapy	CBT, behavioral therapy	Psychodynamic therapy	Specialized psychotherapy
Pharmacotherapy	SSRIs for anxiety/depression	SSRIs, anxiolytics	As needed	Based on comorbidities
Medical Management	Reassurance, symptom management	Avoid unnecessary tests	Physical therapy	Careful medical monitoring
Multidisciplinary Approach	Multidisciplinary team	Single primary physician	Coordinated care	Complex case management

Table 7: Prognosis and Course

Disorder	Expected Course	Prognostic Factors	Potential Complications
Somatic Symptom Disorder	Chronic with fluctuations	Early treatment, social support	Functional disability, depression
Illness Anxiety Disorder	Chronic with periods of improvement	Insight, psychotherapy	Medical treatment avoidance
Conversion Disorder	May improve spontaneously	Psychological stress, support	Motor or sensory disability
Factitious Disorder	Serious, requires intervention	Early diagnosis, treatment	Serious medical complications

Table 8: Medications Used

Drug Type	Mechanism	Examples	Dosage	Main Side Effects
SSRIs	Serotonin reuptake inhibition	Fluoxetine, Sertraline	20-80 mg	GI disturbances, sexual dysfunction
TCAs	All monoamine reuptake inhibition	Imipramine, Amitriptyline	100-300 mg	Anticholinergic effects, cardiac toxicity
Anxiolytics	GABA enhancement	Lorazepam, Clonazepam	0.5-2 mg	Sedation, dependence
Antipsychotics	Dopamine blockade	Quetiapine, Olanzapine	25-200 mg	Weight gain, movement disorders

Table 9: Clinical Presentation Patterns

Disorder	Typical Presentation	Patient Attitude	Family History	Response to Treatment
Somatic Symptom Disorder	Multiple, shifting symptoms	Dramatic, demanding	Often positive	Partial improvement
Illness Anxiety Disorder	Minimal physical symptoms	Anxious, hypervigilant	Variable	Good with reassurance
Conversion Disorder	Sudden neurological symptoms	Surprisingly calm	Trauma history	Variable, may resolve
Factitious Disorder	Unusual, inconsistent symptoms	Evasive, secretive	Often disrupted	Poor, resistant

Table 10: Red Flags and Clinical Clues

Disorder	Red Flags	Clinical Clues	Investigation Strategy
Somatic Symptom Disorder	Multiple provider visits	Vague, colorful stories	Comprehensive but limited workup
Illness Anxiety Disorder	Excessive medical research	Internet health searches	Minimal testing, reassurance
Conversion Disorder	Neurological inconsistency	La belle indifférence	Neurological consultation
Factitious Disorder	Treatment resistance	Knowledge of medical terms	Covert surveillance

Quick Reference Memory Aids:

Quick Differentiation:

Physical symptoms + excessive worry = Somatic Symptom Disorder
No physical symptoms + illness fear = Illness Anxiety Disorder
Neurological symptoms + inconsistency = Conversion Disorder
Fabricated symptoms + deception = Factitious Disorder

Important Exam Points:

All disorders require ruling out medical causes first
Duration is crucial for diagnosis (usually 6 months)
Psychotherapy is fundamental in all cases
Professional reassurance is more important than medication in most cases
The term "psychosomatic" demonstrates mind-body interaction
Primary and secondary gain concepts are essential
Cultural factors influence presentation and prevalence

DSM-5 Specifiers to Remember:

Somatic Symptom Disorder: Mild/Moderate/Severe, Persistent, With predominant pain
Conversion Disorder: Acute episode vs. Persistent, With/Without psychological stressor
Factitious Disorder: Single episode vs. Recurrent episodes

Treatment Hierarchy:

Rule out medical causes
Establish therapeutic alliance
Provide reassurance and education
Implement psychotherapy (CBT preferred)
Consider medication for comorbidities
Coordinate multidisciplinary care

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Somatic Symptom and Related Disorders - Comparison Tables | Claude