Although specific somatic symptoms may change, and the nature of physical symptoms may be intermittent, symptoms must last longer than six months to be diagnosed.
Patients with somatic symptom disorders frequently have a history of extensive medical workup due to multiple unexplained symptoms. This could include several imaging tests, blood tests, or even biopsies.
Patients who have somatic symptom disorder or related disorders do not intentionally produce or feign their symptoms; in other words, the symptom production and motivation are unconscious. Contrast this with intentional symptom production in patients with factitious disorders and malingering.
Conversion disorder is characterized by a neurological impairment involving voluntary motor or sensory function with no primary neurological cause; symptoms may include paralysis, blindness, mutism, or seizures. This condition is more common in adolescents and young adults.
History taking often reveals an acute stressor preceding the onset of symptoms. The patient is often aware of but is indifferent toward symptoms; this is known as "la belle indifference". It is important to note that while this fact is often emphasized heavily in board preparation material, this characteristic is not part of the diagnostic criteria, and some patients may be very concerned about their symptoms.
To meet the diagnosis, the patient should have some type of neurologic deficit following a stressful event without a neurologic lesion that could explain the symptoms.
Illness anxiety disorder is characterized by a fear of having a serious illness despite mild symptoms or no symptoms at all. It is also characterized by maladaptive behaviors associated with the concern about the health and excessive checkups despite medical evaluation and reassurance.
Illness anxiety disorder is characterized by excessive worry about health and illness despite having minimal to no somatic symptoms.
These patients typically have a history of extensive medical workups despite negative results. Treatment consists of establishing a longitudinal relationship with a single primary care physician and having regular follow-up visits. This prevents unnecessary workups and diagnostic procedures which carry their own risks.
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