Assessing DSM-5 criteria of somatic symptom disorder in medically hospitalized inpatients: A cross-sectional analysis 2026 Schaefert et al

[Andy]

Highlights​

• Empirical data on DSM-5 SSD in medically hospitalized inpatients is lacking.
• 20.6 %–21.9 % of inpatients met SSD criteria.
• SSD Criterion B appears to be a strong SSD indicator in medically hospitalized inpatients.
• In our sample, women did not show typical predominance of SSD found elsewhere.
• A critical need exists to integrate SSD management into inpatient care.
• Younger inpatients showed slightly higher SSD-related burden and distress.

Abstract​

Introduction​

In the revised DSM-5, Somatic Symptom Disorder (SSD) no longer requires medically unexplained symptoms and instead focuses on psychobehavioral positive criteria, applicable regardless of the underlying cause. Evidence on the frequency and characteristics of SSD among medically hospitalized inpatients remains scarce. We therefore investigated SSD frequency and age- and gender-associated characteristics in this population.

Methods​

This cross-sectional analysis used baseline data from SomPsyNet, an intervention targeting SOMatic hospital inpatients to prevent PSYchosocial distress through a care NETwork. SSD was assessed using the Somatic Symptom Scale-8 (SSS-8) and the Somatic Symptom Disorder-B Criteria Scale (SSD-12), applying DSM-5-aligned and established cut-offs. Criteria were operationalized as A) somatic symptom burden (SSS-8 sum score ≥ 9 or per item≥3), B) symptom-related distress (SSD-12 ≥ 23), and C) proxies for symptom persistence. Associations with age were examined using robust regression.

Results​

Among 3109 inpatients enrolled between June 2020 and December 2022, 20.6 % (SSS-8 sum score ≥ 9) to 21.9 % (SSS-8 per item≥3) met all three SSD criteria. Among the 25.5 % of patients positive for Criterion B (SSD-12 ≥ 23), Criteria A and C were frequently also met. No female predominance in symptom-related distress was observed. Younger patients reported higher somatic symptom burden and symptom-related distress (SSS-8: B = -0.04, t = −7.51; SSD-12: B = -0.05, t = −5.11).

Conclusion​

Symptoms consistent with DSM-5 SSD criteria were common among medically hospitalized inpatients. These findings underscore the frequency of SSD-related distress in this setting, highlight age- and gender-related differences in symptom presentation, and emphasize the need for further research to clarify its clinical implications.

Open access

 

[Andy]

SSD is defined by one or more distressing somatic symptoms (Criterion A), accompanied by excessive thoughts, emotions, or behaviors related to these symptoms (Criterion B) typically lasting more than six months (Criterion C) [11].

The SSS-8 assesses three symptom domains – pain (e.g., back pain, headaches), cardiopulmonary (e.g., chest pain, shortness of breath), and fatigue-related or vegetative symptoms (e.g., low energy, sleep disturbances) – reflecting the most prevalent dimensions of somatic symptom burden [39].

 

[Sean]

accompanied by excessive​

According to...?

 

[rvallee]

According to astrology, astrology is correct

Persistent and distressing somatic symptoms represent a major clinical challenge across medical specialties

That's.... that's just medicine. And illness, i.e. symptoms.

When causing substantial distress or functional impairment, they are diagnosed as “symptom-based disorders”

Literally this is just illness. This is what medicine has always been about. Illness is now a mental illness. Always has been. Maybe won't be for a few years, then back again. Repeat the cycle, since no one cares anyway. Genius stuff.

In medically hospitalized inpatients, however, distinguishing appropriate symptom concern from disproportionate preoccupation remains conceptually challenging

"Conceptually challenging", "impossible", same difference, really. It might be hard for judges to guess if a defendant is lying, but that shouldn't stop us from doing it anyway.

The relatively small difference between patients meeting the Criterion B alone (25.5 %) and those meeting all three SSD criteria (≈21 %) indicates that most inpatients with high symptom-related distress also experience substantial somatic symptom burden and persistence.

No. Way. People experiencing symptoms might experience symptoms? In a hospital?!

When contextualized within prior research, our SSD estimates appear plausible.

They're calling this science. RIP science. Welcome back, magical thinking. It never left, but now it's been promoted.

Also, gotta love the keywords: Bodily distress disorder, Functional somatic symptoms, Hospital inpatients, Persistent physical symptoms, Somatoform disorder. Going back to symptoms simply needing to be there, explained or not, probably gives the ideology several more years of doing the same things they already did decades ago. For the... probably fourth cycle, at least? The complete lack of integrity in this discipline is truly absurd.

I don't see how we'd be any worse off if astrology were used instead of this. It likely would even be better, somehow. Hell, even the whole "demonic possession" thing might actually work out better.

 

[rvallee]

accompanied by excessive​

According to...?

Whether thoughts, feelings, and behaviors appear “excessive” is context-dependent: they may be temporarily heightened by acute disease and hospitalization, or reflect a chronic maladaptive pattern.

"Content-dependent". Just making shit up. Same difference. No one has ever bothered expanding on the numerous problems with this, and they sure don't bother here either.

Edit: Actually, it's even worse than that. They acknowledge that it requires context to do that, but that they didn't bother doing it because it's too much work:

First, reliance on self-report measures without gold-standard interviews may have affected diagnostic precision, although structured interviews were infeasible at this scale.

If it's not feasible to do it in the context of a study funded to do exactly that, then obviously it's even less feasible to do so in a real-life context. Plus, it's not as if doing in-depth interviews can actually do that, whether they slap a "GOLD!" sticker on it or not. There are almost infinite reasons why different people will answer the same questionnaire the same way but for entirely different reasons. No questionnaire can account for this, and no amount of in-depth interview can make up for that.

This is quite similar to how even Wessely admitted that the PACE model is not feasible in real life, as it's very expensive and labor-intensive, with a negative scaling problem (the more therapists you have, the bigger the bureaucracy and facilities). In addition to not even working. So it's a double fantasy: it's not feasible, and it doesn't work. But it's recommended anyway. And they call this evidence-based medicine.

 

[Clio]

Whether thoughts, feelings, and behaviors appear “excessive” is context-dependent: they may be temporarily heightened by acute disease and hospitalization, or reflect a chronic maladaptive pattern.

Excuse my ignorance but doesn't that just erase the validity of any chronic illness? Because according to this suffering long-term is always "maladaptive" whatever that means...

 

[Alinda]

doesn't that just erase the validity of any chronic illness?

They cannot comprehend that symptoms that will not immediately kill you, or are obviously visible can still be impactful or even disabling. Thus, any invisible chronic illness, even if diagnosed and explained, is somehow caused by being dramatic.
Cus why would you feel distressed if your pain isn't going to kill you?

 

[rvallee]

Excuse my ignorance but doesn't that just erase the validity of any chronic illness? Because according to this suffering long-term is always "maladaptive" whatever that means...

Hence the whole "unhelpful beliefs" garbage they've been pushing on us. It doesn't make any sense but if it's simply used as an assertion of power within a complete power imbalance, then it doesn't matter. It's the same process as a tyrannical government where secret judgments are rendered with no need to explain anything, because it has been decided that some people must be guilty, and they know this because, hey, lots of people are found guilty.

Internal validation is fun. Every model is correct according to itself. It makes perfect sense if you never think about anything.

 

[Yann04]

They cannot comprehend that symptoms that will not immediately kill you, or are obviously visible can still be impactful or even disabling. Thus, any invisible chronic illness, even if diagnosed and explained, is somehow caused by being dramatic.
Cus why would you feel distressed if your pain isn't going to kill you?

If they can’t fix it, and it’s not about to kill you. Might aswell not exist.

Suzanne O’ Sullivan argues that we shouldn’t even be diagnosing illnesses we can’t treat. It just promotes distress might aswell gaslight the person into thinking they’re fine.

The distress of no one recognising your illness and feeling like you’re going insane is preferable to a little extra workload for the medics apparently.

 

[Sean]

When contextualized within prior research, our SSD estimates appear plausible.​

The methodological circle jerk continues right on, unrestrained by reality.

 

[Medfeb]

Many people, including the chair of the DSM-IV, objected to SSD when DSM-5 was being created that this would be used as an arbitrary bolt-on psychiatric diagnosis. That was ignored

This is the chair of the DSM-IV in BMJ (and elsewhere) on SSD when DSM-5 was being reviewed and then published.
The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill
BMJ Link (Paywalled) and Medscape article

Beyond SSD, he critiqued DSM-5 in general because it psychologicalized normal experience - e.g. grief as major depressive disorder
Link

 

[Liie]

accompanied by excessive​

According to...?

One would hope that there was a rigorous definition of "excessive" somewhere in the text...

 

[bobbler]

Highlights​

• Empirical data on DSM-5 SSD in medically hospitalized inpatients is lacking.
• 20.6 %–21.9 % of inpatients met SSD criteria.
• SSD Criterion B appears to be a strong SSD indicator in medically hospitalized inpatients.
• In our sample, women did not show typical predominance of SSD found elsewhere.
• A critical need exists to integrate SSD management into inpatient care.
• Younger inpatients showed slightly higher SSD-related burden and distress.

Abstract​

Introduction​

In the revised DSM-5, Somatic Symptom Disorder (SSD) no longer requires medically unexplained symptoms and instead focuses on psychobehavioral positive criteria, applicable regardless of the underlying cause. Evidence on the frequency and characteristics of SSD among medically hospitalized inpatients remains scarce. We therefore investigated SSD frequency and age- and gender-associated characteristics in this population.

Methods​

This cross-sectional analysis used baseline data from SomPsyNet, an intervention targeting SOMatic hospital inpatients to prevent PSYchosocial distress through a care NETwork. SSD was assessed using the Somatic Symptom Scale-8 (SSS-8) and the Somatic Symptom Disorder-B Criteria Scale (SSD-12), applying DSM-5-aligned and established cut-offs. Criteria were operationalized as A) somatic symptom burden (SSS-8 sum score ≥ 9 or per item≥3), B) symptom-related distress (SSD-12 ≥ 23), and C) proxies for symptom persistence. Associations with age were examined using robust regression.

Results​

Among 3109 inpatients enrolled between June 2020 and December 2022, 20.6 % (SSS-8 sum score ≥ 9) to 21.9 % (SSS-8 per item≥3) met all three SSD criteria. Among the 25.5 % of patients positive for Criterion B (SSD-12 ≥ 23), Criteria A and C were frequently also met. No female predominance in symptom-related distress was observed. Younger patients reported higher somatic symptom burden and symptom-related distress (SSS-8: B = -0.04, t = −7.51; SSD-12: B = -0.05, t = −5.11).

Conclusion​

Symptoms consistent with DSM-5 SSD criteria were common among medically hospitalized inpatients. These findings underscore the frequency of SSD-related distress in this setting, highlight age- and gender-related differences in symptom presentation, and emphasize the need for further research to clarify its clinical implications.

Open access

Cos it’s a con of a term used in order to extract genuinely ill patients into a diagnosis that is bs and has only been crowbarred in explicitly to errant assert that those unfortunate enough to cross paths with the wrong people have a ‘psych cause’ they can’t disprove because you can disprove a negative and it’s been deliberately set up to replace ‘the cause being proven to be a biomedical illness for the broken leg’ NOW hilariously not exempting anyone from it being claimed ‘but you can’t prove that wasn’t your mind’ particularly if someone warranty claims they are anxious or makes up fibs of trauma once in their life from a scary film.

The fact only 20% of all patients in entire hospitals for everything they claim this time they want to change to a diagnosis putting them out of the normal healthcare system seems just the tip of the icerberg for the future those tony numbers lobbying and then flying to sit round the table forcing it onto the DSM are looking for.

And the conclusion for these authors is somehow not that it’s a cod and deliberately catching all that any human being is vulnerable to because it becomes a ‘can’t prove it isn’t’ way of making them untouchable and unable to access healthcare in future, but what - what nonsense ‘good’ are they claiming they do or are they as usual waffling on so deliberately in a circle they never complete they know readers won’t get to the end and will assume they must have missed it due to nodding off not because it isn’t in there? Shocking

 

[bobbler]

If they can’t fix it, and it’s not about to kill you. Might aswell not exist.

Suzanne O’ Sullivan argues that we shouldn’t even be diagnosing illnesses we can’t treat. It just promotes distress might aswell gaslight the person into thinking they’re fine.

The distress of no one recognising your illness and feeling like you’re going insane is preferable to a little extra workload for the medics apparently.

I just wish that the days of the MP at least eating the burger (or feeding it to his kid) during BSE were here and these individuals had a likelihood of being some of the first locked in the systems they push for others as the honourable kinds who at least would ever experience it themselves

But sure as heck these ones have no such intentions and their objectives and articles have the silent word ‘for others’ (not me of course) inferrred through them given they are propaganda anyway. And it’s not about the treatment being good it’s about selling who ‘doesn’t matter’ according to their not wise rhetoric based on no evidence-up but random gut-felt old-fashioned discriminations of pure random (or maybe calculated for other reasons beneficial to them) dislike of ‘groups’ or seeing them as targets markets for stuff they know harms but are vulnerable enough no one will believe the patient when it doesn’t work etc.

They sure aren’t bothered about the patient outcomes in pushing this one it’s very transparent - otherwise they’d have at least left it as the more precise conditions it replaced that had exclusions that made them at least sound more rational and logical as a ‘theoretical’ (and acted as a legal safeguard that would stop the boldest unless they were doing it to those who had little power in society to ever get to court etc) even if I bet loads still had it weaponised by the wrong people too.

I feel they utterly failed but didn’t even really care to explain to anyone other than their sponsors why this change to SSD was anything other than a problem,harmful thing for anyone other than those pushing for it. I haven’t seen an explanation in any of their papers that made sense or sounded like ‘a good thing’ and I suspect they just kept being opportunistic until they found a time when no one was on guard and watching to stop it being slid in which says it all. And how the DSM entries has become more political than medical if so?