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. 2022 Mar;52(4):632-648.
doi: 10.1017/S0033291721004177. Epub 2021 Nov 15.

Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis

Bernd Löwe  1 , James Levenson  2 , Miriam Depping  1 , Paul Hüsing  1 , Sebastian Kohlmann  1 , Marco Lehmann  1 , Meike Shedden-Mora  1   3 , Anne Toussaint  1 , Natalie Uhlenbusch  1 , Angelika Weigel  1
Affiliations

Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis

Bernd Löwe et al. Psychol Med. 2022 Mar.

Abstract

Background: In 2013, the diagnosis of somatic symptom disorder (SSD) was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This review aims to comprehensively synthesize contemporary evidence related to SSD.

Methods: A scoping review was conducted using PubMed, PsycINFO, and Cochrane Library. The main inclusion criteria were SSD and publication in the English language between 01/2009 and 05/2020. Systematic search terms also included subheadings for the DSM-5 text sections; i.e., diagnostic features, prevalence, development and course, risk and prognostic factors, culture, gender, suicide risk, functional consequences, differential diagnosis, and comorbidity.

Results: Eight hundred and eighty-two articles were identified, of which 59 full texts were included for analysis. Empirical evidence supports the reliability, validity, and clinical utility of SSD diagnostic criteria, but the further specification of the psychological SSD B-criteria criteria seems necessary. General population studies using self-report questionnaires reported mean frequencies for SSD of 12.9% [95% confidence interval (CI) 12.5-13.3%], while prevalence studies based on criterion standard interviews are lacking. SSD was associated with increased functional impairment, decreased quality of life, and high comorbidity with anxiety and depressive disorders. Relevant research gaps remain regarding developmental aspects, risk and prognostic factors, suicide risk as well as culture- and gender-associated issues.

Conclusions: Strengths of the SSD diagnosis are its good reliability, validity, and clinical utility, which substantially improved on its predecessors. SSD characterizes a specific patient population that is significantly impaired both physically and psychologically. However, substantial research gaps exist, e.g., regarding SSD prevalence assessed with criterion standard diagnostic interviews.

Keywords: diagnosis; diagnostic and statistical manual of mental disorders; international classification of diseases; review; somatic symptom disorder; somatoform disorders.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Study flow chart for scoping review. Displayed are the number of articles per DSM-5 text section. Some articles were identified for multiple text sections, thus the total number of articles included does not equal the column total (e.g. full texts included: column total, n = 119; total number of included articles, n = 59).
Fig. 2.
Fig. 2.
Forest plot of frequency estimates on somatic symptom disorder (with 95% CI). Of note, almost all frequencies estimates are based on proxy diagnoses of SSD, using self-report questionnaires or clinical judgement. The vertical lines indicate the mean values across several studies of a comparable setting (with 95% CI). Underlined references refer to studies in children and/or adolescents. *Data reported in this paper are based on Creed et al., .
Fig. 3.
Fig. 3.
Forest plot of frequency rates of mental comorbidities in somatic symptom disorder (with 95% CI).
See this image and copyright information in PMC

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