Somatic symptoms and related disorders

Rationale

Prominent or vague somatic symptoms are common presentations in primary care and other medical settings. These symptoms are often accompanied by significant patient distress and disability but do not have consistent pathophysiologic findings.

Causal Conditions

(list not exhaustive)

1. Psychological factors affecting other medical conditions
2. Malingering or factitious disorder
3. Substance use disorder
4. Other psychiatric disorders (e.g., somatic symptom disorder, illness anxiety disorder, conversion disorder, posttraumatic stress disorder)
5. Adverse life events (e.g., adverse childhood events, intimate partner violence, other traumas, adult physical abuse)

Key Objectives

Given a patient with prominent or vague somatic symptoms and significant distress causing disability, without consistent pathophysiologic findings, the candidate will consider a somatic symptom–type disorder.

Enabling Objectives

Given a patient with symptoms consistent with somatic symptoms or a related disorder, the candidate will

1. list and interpret critical clinical findings, including:
   1. potential contributing conditions identified through appropriate history and physical examination;
   2. integrating current history and findings with information from available medical records; and
2. list and interpret critical investigations, including:
   1. an alcohol and recreational drug screen, where appropriate;
   2. investigation of new symptoms, where appropriate;
   3. no further investigations, where appropriate; and
3. construct an effective initial management plan, including:
   1. educating the patient about the connection between physical symptoms and psychological distress;
   2. appropriate pharmacotherapy, as indicated;
   3. referring the patient for specialized care, if necessary.