Page 28 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Somatic symptom disorders and aging

Diagnostic and Statistical Manual of Mental Disorders These so-called positive symptoms are in response to the
(DSM-5-TR). This category has undergone significant individual’s somatic symptoms and they can be identified
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change and clarification over prior editions of the DSM, with observable behaviors, emotions, and cognitions.
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which has hampered research efforts to understand these Positive symptoms can present in a multitude of ways, for
disorders more clearly in diverse populations. Before the example, spending an excessive amount of time focusing
publication of the DSM-5, SSRDs were previously called on health concerns, excessively seeking reassurance from
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somatoform disorders, which was a confusing name that medical professionals, or feeling intense and debilitating
was also not very intuitive for people to understand. Specific anxiety due to health concerns. Regardless of whether
mental disorders under the umbrella of somatoform there is a known organic etiology to some (or all) of the
disorders included somatization disorder, undifferentiated person’s somatic symptoms, it is important to recognize
somatoform disorder, conversion disorder, pain disorder, that the suffering and discomfort of the affected individuals
hypochondriasis, body dysmorphic disorder, and are genuine, rather than being consciously fabricated, for
somatoform disorder not otherwise specified. 5 example, in cases of malingering.
At present, the DSM-5-TR section on SSRDs consists Cultural factors are also known to impact the SSRDs.
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of somatic symptom disorder, illness anxiety disorder, According to the DSM-5-TR, variations in SSRD
functional neurological symptom disorder (conversion symptoms can be due to sociocultural factors such as
disorder), factitious disorder, psychological factors stigma. Language differences can also account for some
affecting other medical conditions, unspecified somatic variation, where somatic symptoms may have special
symptom disorder, and other specified SSRDs. For each meanings in particular cultural contexts. For example,
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of these disorders, there is a strong presumption that sensations of heaviness, complaints of gas, too much heat
psychological factors play a meaningful role regarding in the body, or burning in the head are common in some
the onset, severity, exacerbation, and/or maintenance of cultures or ethnic groups but rare in others. In China,
symptoms. While these disorders share similar symptoms, shenjing shuairuo, or “weakness of the nerves,” manifests
some notable differences are evident. For example, illness in fatigue and decreased energy, showing a distinct
anxiety disorder differs from somatic symptom disorder cultural manifestation. Regarding functional neurological
in that somatic symptoms are typically not present or are symptom disorder, changes in functional neurological
minor in people with illness anxiety disorder, who are symptoms are common in certain culturally sanctioned
instead preoccupied with having or acquiring a serious rituals and thus should not be pathologized.
illness. If somatic symptoms are present in people with According to Kleinstäuber, gender differences can
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illness anxiety disorder, the focus is more on the nefarious be seen in SSRDs, where women tend to report somatic
meaning of the symptoms, rather than on the somatic symptoms more commonly than men. Women, specifically,
symptoms per se. Functional neurological symptom are diagnosed with functional neurological symptom
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disorder shares common symptoms with somatic symptom disorder at higher rates than men. Still, gender differences
disorder. However, in functional neurological symptom are heavily influenced by cultural factors. For example,
disorder, the symptoms involve altered voluntary motor there are higher prevalence rates of SSRDs in women in
or sensory functions, mimicking a neurological disorder, Western societies. Moreover, race and ethnicity have been
despite evidence of the incompatibility of the symptoms considered in epidemiological studies; SSRD symptoms are
with known neurological conditions. Further, individuals more common in South American primary care practices
with functional neurological symptom disorder typically compared to other study centers in European countries,
display a striking lack of worry or concern about their Africa, Asia, and the USA. Notably, studies have shown
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symptoms, which is not typical in somatic symptom somatic symptoms and the distress commonly associated
disorder, where distress about physical symptoms is a key with these disorders represent a worldwide phenomenon.
component. However, most somatic symptom self-report scales have
The previously formulated somatoform disorders been developed in Western contexts, and thus, these scales
required a hallmark symptom of unexplained medical may not be fully sensitive to culture-specific symptoms.
symptoms, which was highly problematic. In the current Overall, cultural beliefs, previous illnesses, insurance
conceptualization, this criterion was removed entirely. status, health literacy, and health care experiences influence
Indeed, the current SSRDs are characterized by one’s one’s perception of somatic symptoms and the health care
reactions to physical symptoms (regardless of whether use among individuals across the lifespan.
these is a clear organic etiology or not) which cause Due to a multitude of reformulations and revisions to
major emotional distress and/or problems functioning. the SSRD diagnostic category over time, these disorders

Volume 3 Issue 4 (2025) 22 doi: 10.36922/JCBP025080013