314 Somatic Symptom and Related Disorders
Differential Diagnosis
If the somatic symptoms are consistent with an other mental disorder (e.g., panic disorder),
and the diagnostic criteria for that disorder are fulfilled, then that mental disorder should
be considered as an alternative or additional diagnosis. A separate diagnosis of somatic
symptom disorder is not made if the somatic symptoms and related thoughts, feelings, or
behaviors occur only during major depressive episodes. If, as commonly occurs, the crite-
ria for both somatic symptom disorder and another mental disorder diagnosis are ful-
filled, then both should be coded, as both may require treatment. 
Other medical conditions. The presence of somatic symptoms of unclear etiology is not
in itself sufficient to make the diagnosis of somatic symptom disorder. The symptoms of
many individuals with disorders like irritabl e bowel syndrome or fibromyalgia would not
satisfy the criterion necessary to diagnose somatic symptom disorder (Criterion B). Con-
versely, the presence of somatic symptoms of an established medical disorder (e.g., diabe-
tes or heart disease) does not exclude the di agnosis of somatic symptom disorder if the
criteria are otherwise met.
Panic disorder. In panic disorder, somatic symptoms  and anxiety about health tend to
occur in acute episodes, wher eas in somatic symptom disorder, anxiety and somatic symp-
toms are more persistent.
Generalized anxiety disorder. Individuals with generalized anxiety disorder worry about
multiple events, situations, or  activities, only one of whic h may involve their health. The
main focus is not usually somatic symptoms or fear of illness as it is in somatic symptom
disorder.
Depressive disorders. Depressive disorders are comm only accompanied by somatic
symptoms. However, depressive disorders ar e differentiated from somatic symptom dis-