A 35-year-old woman presents with multiple physical complaints (pain, GI symptoms, sexual dysfunction) over 5 years, causing significant distress, despite extensive negative workup. She is excessively worried and rates her health as poor. In DSM-5, what key feature distinguishes Somatic Symptom Disorder (SSD) from Illness Anxiety Disorder (IAD)?
- A SSD requires medically unexplained symptoms; IAD does not
- B In SSD, somatic symptoms are prominent and distressing; in IAD, somatic symptoms are absent or minimal with fear of having/getting a disease ✓
- C SSD occurs only in women; IAD is equally distributed by sex
- D SSD requires DSM-5 Criterion A be present for 2 years; IAD requires 1 year
Explanation
In DSM-5, SSD has prominent, distressing, and disruptive somatic symptoms PLUS at least one of: disproportionate/persistent thoughts about symptom seriousness, high anxiety about health, excessive time and energy devoted to symptoms. IAD (replacing Hypochondriasis) has minimal or no somatic symptoms but intense preoccupation with fear of having or acquiring a serious illness. The key distinction is: SSD = prominent somatic symptoms; IAD = disease fear with absent/minor somatic symptoms. DSM-5 importantly removed the requirement for symptoms to be 'medically unexplained' from SSD.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.