National Drug Strategy
National Drug Strategy

Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician

10.1 Somatoform disorders

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The common feature of somatoform disorders is the presence of physical symptoms that suggest a general medical condition. However, these symptoms are not adequately explained by a general medical condition by the direct effects of a substance, or by another mental disorder (such as anxiety producing palpitations or breathlessness, depression causing lack of energy).

Symptoms cause significant distress or impairment in social, occupational or other areas of functioning. There is no diagnosable medical condition that can fully account for the physical symptoms. People with somatoform disorders are reluctant to accept that psychological factors may be contributing to their physical symptoms.

This expression of physical symptoms is not a conscious deception by the patient.

There are a number of diagnostic subtypes of somatoform disorders.

In addition, unexplainable physical symptoms can be seen in situations where the symptoms are intentionally expressed. If the motivator behind this is the adoption of the sick role, then the condition is termed a 'factitious disorder'; if the intent is some external gain, then the condition is termed 'malingering'.

It is important to note that while unexplained physical symptoms are extremely common, most people with such symptoms do not have a somatoform disorder - most of the 'somatizing' presentations to general practice settings would not meet the criteria for one of these disorders.

Similarly, most people presenting with pain do not have a ‘pain disorder’ or form a somatoform disorder, but rather, have pain of organic origin that may be expressed in a range of ways.

Disorders 10.1.7 to 10.1.9 are not within the group known as somatoform disorders, but may present with physical symptoms for which there is no adequate physical cause.

10.1.1 Somatization disorder

This disorder is a polysymptomatic disorder commencing before the age of 30 and extending over a period of years. It is characterised by multiple somatic symptoms in a combination of pain, gastrointestinal, sexual and pseudoneurological symptom areas.

10.1.2 Undifferentiated somatoform disorder

This disorder is characterised by unexplained physical complaints that last for at least six months and are below the threshold for a diagnosis of somatization disorder.

10.1.3 Conversion disorder

This disorder involves unexplained symptoms or deficits affecting voluntary motor or sensory function that suggests a neurological or other general medical condition. Psychological factors are judged as being associated with the symptoms or deficits.

10.1.4 Pain disorder

Pain is the predominant focus of clinical attention in this disorder. Additionally, psychological factors are judged to play an important role in the onset, severity, exacerbation and maintenance of the disorder.

10.1.5 Hypochondriasis

This disorder involves a preoccupation with the fear of having, or the idea that a person has, a serious disease based on the individuals misinterpretation of bodily symptoms or functions.

10.1.6 Body dysmorphic disorder

This disorder involves a preoccupation with an imagined or exaggerated defect in physical appearance.

10.1.7 Chronic fatigue syndrome

This syndrome refers to a symptom complex of marked and prolonged fatigue for which no identifiable physical cause can be found.

10.1.8 Factitious disorder

This disorder is characterised by physical or psychological symptoms that are intentionally produced in order to assume the sick role (psychological reasons assumed).

10.1.9 Malingering

Management approaches to somatoform disorders

For further information please refer to:
Understanding somatisation and somatisation disorders: A handbook for health care workers(387).

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