Somatic Symptoms without Medical Explanation
OVERVIEW
This page is used to organize CRG work on clinical findings and observable entities related to clinical findings and disorders in which a person experiences physical symptoms for which no known medical explanation can be found.
RELEVANT SNOMED CONCEPT HIERARCHIES
Bodily distress disorder (disorder)
Dissociative neurological symptom disorder (disorder)
Disturbance of perception associated with conversion and dissociative phenomenon (finding)
Hysterical simulation of disease
Psychophysiologic disorder (finding)
Psychosomatic factor in physical condition (finding)
Somatoform disorder (disorder)
RELEVANT TERMS
QUALIFIER TERMS COMMONLY USED IN FSNs
Somatoform disorder
Somatic symptom disorder
Somatization disorder
Illness anxiety disorder
Functional neurologic disorder
Hypochondriasis
Body distress disorder
These terms can be used in searching SNOMED descriptions for concepts relevant to this project:
Psychogenic
Psychosomatic
Hysterical
Conversion
Somatoform
Functional neurologic
Dissociative neurological
MAJOR FUNCTION, PROCESS, AND OTHER OBSERVABLE ENTITY CONCEPTS
Major Concepts | Commonly Used Terms | Working Definition |
|---|---|---|
DEFINITIONS
Term | Source | Definition |
|---|---|---|
Hypochondriasis | APA Dictionary of Psychology Accessed Jan 31, 2021 | hypochondriasisn. in DSM–IV–TR, a somatoform disorder characterized by a preoccupation with the fear or belief that one has a serious physical disease based on the incorrect and unrealistic interpretation of bodily symptoms. This fear or belief persists for at least 6 months and interferes with social and occupational functioning in spite of medical reassurance that no physical disorder exists. DSM–5 eliminates this diagnosis, partly because of its perceived negative connotations (e.g., it has been perceived by patients as dismissing the validity of their concerns), and replaces it with two separate diagnoses that are each characterized by high health anxiety and health-related preoccupations but that occur either in the presence of significant somatic symptoms (see somatic symptom disorder) or in the absence or with minimal evidence of such symptoms (see illness anxiety disorder). |
Hypochondriasis | ICD11 accessed Nov 22, 2023 | Hypochondriasis is characterised by persistent preoccupation or fear about the possibility of having one or more serious, progressive or life-threatening illnesses. The preoccupation is accompanied by either: 1) repetitive and excessive health-related behaviours, such as repeatedly checking of the body for evidence of illness, spending inordinate amounts of time searching for information about the feared illness, repeatedly seeking reassurance (e.g. arranging multiple medical consultations); or 2) maladaptive avoidance behaviour related to health (e.g. avoids medical appointments). The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. |
Somatic symptom disorder | APA Dictionary of Psychology Accessed Jan 31, 2021 | somatic symptom disorderin DSM–5, a disorder characterized by one or more significant bodily symptoms (e.g., pain) that cause distress or impair daily function and by excessive, maladaptive thoughts (preoccupation) or excessive worry about the symptoms, with or without the presence of a medical condition to account for the symptoms. One of two replacement diagnoses for hypochondriasis, somatic symptom disorder is determined based only on this set of criteria and does not also apply to high health anxiety that occurs in the absence of significant somatic symptoms, as in illness anxiety disorder. Somatic symptom disorder also replaces such DSM–IV–TR diagnoses as somatization disorder, requiring only one or two symptoms for diagnosis rather than the much higher symptom count (4 pain, 2 gastrointestinal, 1 sexual, 1 psychoneurological) of the older criteria. |
Illness anxiety disorder | APA Dictionary of Psychology Accessed Jan 31, 2021 | illness anxiety disorderin DSM–5, a disorder characterized by high anxiety about one’s health, by excessive preoccupation with having an illness or acquiring it, and by behaviors associated with the presumed or feared condition (e.g., repeatedly checking oneself for possible signs of illness), yet with no significant somatic symptoms that would warrant such concern. One of two replacement diagnoses for hypochondriasis, illness anxiety disorder is determined based only on this set of criteria and does not also apply to the presence of both high health anxiety and significant somatic symptoms. See somatic symptom disorder. |
Factitious disorder | APA Dictionary of Psychology Accessed Jan 31, 2021 | factitious disorderin DSM–IV–TR, a disorder in which the patient intentionally produces or feigns physical or psychological symptoms solely so that he or she may assume the sick role. Physical symptoms may include pain, vomiting, blackouts, seizures, or infections (see Münchausen syndrome). Psychological symptoms may include depression, suicidal thoughts following the (unconfirmed) death of a spouse, hallucinations, or delusions. DSM–5 defines the disorder similarly but divides it into two subtypes characterized by (a) the falsification of symptoms or induction of injury or disease imposed on oneself, and (b) the same deceptions or harm imposed on others (e.g., a dependent). The latter is a proxy disorder that is synonymous with Münchausen syndrome by proxy. Compare malingering. |
Malingering | APA Dictionary of Psychology Accessed Jan 31, 2021 | malingeringn. the deliberate feigning of an illness or disability to achieve a particular desired outcome. For example, it may take the form of faking mental illness as a defense in a trial, faking physical illness to win compensation, or faking an injury or misinforming people of one’s state of rehabilitation to avoid practicing or playing sport. Malingering is distinguished from factitious disorder in that it involves a specific external factor as the motivating force. —malingerer n. |
STAKEHOLDER GROUPS AND SUBJECT MATTER EXPERTS
Name | Type | Description | Notes |
|---|---|---|---|
RESOURCES
Name | Type | Description | Notes |
|---|---|---|---|
DSM-I, DSM-II, DSM-III, DSM-III-R, DSM-IV, DSM-IV-R | Nosology | Previous editions of the the Diagnostic and Statistical Manual of Mental Disorders (DSM) | Useful for understanding the evolution concepts and specific terms used at different points in time |
DSM-5, DSM-5 SCID | Nosology | Current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) | Useful for understanding terms and concepts as they are currently designed to be used by clinicians |
Nosology | Preview editions of the the International Classification of Disorders (ICD) | Useful for understanding the evolution concepts and specific terms used at different points in time | |
Nosology | Current edition of the the International Classification of Disorders (ICD) | Useful for understanding terms and concepts as they are currently designed to be used by clinicians | |
UMLS | Meta-Terminology | Unified Medical Language System (UMLS) |
PROJECT MILESTONES AND STATUS
Objective | Action Item | |
|---|---|---|
| 1 | Define scope of work | Identify the major concept(s) around which to organize a manageable project (scope of work) (artifact: mabh-crg concept plan) Complete the major concept table and iteratively update as project progresses (CRG to finalize the definition for SNOMED once all research has been completed) |
| 2 | Understand uses cases | Identify any non-standard use cases or pain points in research domain (artifact: mabh-crg use case document) Identify any non-standard use cases or pain points in clinical domain (artifact: mabh-crg use case document) |
| 3 | Understand major conceptualizations of the concept | Perform environmental scan to identify major theoretical models of construct/concept domain (artifact: mabh-crg theoretical model document) Perform environmental scan to identify disorders and clinical variables relevant to the concept domain (artifact: mabh-crg clinical model document) Perform environmental scan to identify existing explicit representations of concepts in the domain in terminologies (nomenclatures, nosologies, classification systems, controlled vocabularies, and ontologies) (artifact: mabh-crg umls analysis matrix, mabh-crg terminology matrix) |
| 4 | Establish contact with key stakeholders and other potential project contributors | Perform and environmental scan to Identify key stakeholders in the basic research, clinical research, clinical practice, and patient advocacy domain (artifact: mabh-crg stakeholder document) Create and implement a plan for engaging stakeholders willing to participate in the CRG for the duration of the specific concept review, either on calls or via discussion forum, or to provide the following: Stakeholder experience related to specific pain points or use cases in the domain Copies or screenshots of note templates, clinical notes, flowsheets, order sets, research protocols, other |
| 5 | Understand how concepts in the domain are currently represented in SNOMED | Review concepts in observable entity hierarchy Create dot diagram of current state Create observable entity spreadsheet Review concepts in clinical finding hierarchy Create dot diagram of current state Create observable entity spreadsheet |
| 6 | Perform gap analysis | Analyze concepts in observable entity hierarchy Create observable entity spreadsheet Create dot diagram of current state Perform review of dot diagram to identify potential duplicate, outdated, missing or inaccurately modeled concepts Update spreadsheet with changes including all defining relationships Analyze concepts in clinical finding hierarchy Create observable entity spreadsheet Create dot diagram of current state Perform review of dot diagram to identify potential duplicate, outdated, missing or inaccurately modeled concepts Update spreadsheet with additions or changes to concepts, including all defining relationships Identify missing concepts in other hierarchies (e.g., qualifier value, body structure) required to completely and accurately model observable entity and clinical finding concepts Create explicit, narrative definitions for all concepts |
| 7 | Create new and modify existing concepts in SNOMED | Submit request for changes through CRS system or via template worksheet |
| 8 | Disseminate information about changes to SNOMED for concepts in the domain |
LINKS TO SITE MATERIALS
WORK PAGES
DISCUSSION THREADS
GRAPHICS AND GLOSSARIES
Copyright © 2025, SNOMED International