310 Somatic Symptom and Related Disorders
to these symptoms). However, medically unexplained symptoms remain a key feature in
conversion disorder and pseu docyesis (other specified somatic symptom and related dis-
order) because it is possible to demonstrate de finitively in such disorders that the symp-
toms are not consistent with medical pathophysiology.
It is important to note that some other ment al disorders may initially manifest with pri-
marily somatic symptoms (e.g., major depressi ve disorder, panic disorder). Such diagno-
ses may account for the somatic symptoms, or they may occur alongside one of the somatic
symptom and related diso rders in this chapter. There is also considerable medical comor-
bidity among somatizing individuals. Althou gh somatic symptoms are frequently associ-
ated with psychological distress and psyc hopathology, some somatic symptom and
related disorders can arise spontaneously, and their causes can remain obscure. Anxiety
disorders and depressive disorders may acco mpany somatic symptom and related disor-
ders. The somatic component adds severity an d complexity to depressive and anxiety dis-
orders and results in higher severity, functi onal impairment, and ev en refractoriness to
traditional treatments. In rare instances, the degree of preoccupation may be so severe as
to warrant consideration of a delusional disorder diagnosis.
A number of factors may contribute to so matic symptom and related disorders. These
include genetic and biological vulnerability (e.g., increased sensitivity to pain), early trau-
matic experiences (e.g., violence, abuse, deprivation), and learning (e.g., attention ob-
tained from illness, lack of reinforcement of nonsomatic expressions of distress), as well as
cultural/social norms that devalue and stig matize psychological suffering as compared