Name three major DSM-5-TR differential diagnoses for somatic symptom disorders.

• A. Major depressive disorder, generalized anxiety disorder, PTSD.
• B. Schizophrenia, bipolar disorder, obsessive-compulsive disorder.
• C. Illness Anxiety Disorder, Conversion Disorder, Factitious Disorder, Malingering, and medical/neurological conditions with unexplained symptoms.
• D. Substance use disorders, sleep disorders.

Answer: (C)

When evaluating somatic symptom disorders, the key is to consider conditions that can either mimic somatic presentations or explain them in a way that could be mistaken for a somatic symptom disorder. The most important differential diagnoses in DSM-5-TR are illnesses or conditions that can produce real symptoms or preoccupation with illness, but come from other mechanisms than a somatic symptom disorder.

Illness Anxiety Disorder fits because a person may be preoccupied with having a serious illness even when somatic symptoms are minimal or not present, which can look like a somatic concern but rests on excessive health worry rather than distress tied to actual symptoms.

Functional Neurological Symptom Disorder (formerly Conversion Disorder) is essential to consider because it involves neurological symptoms—like weakness, numbness, or non-epileptic spells—that are inconsistent with recognized medical conditions. This helps distinguish genuine medically explainable symptoms from those driven by functional neurology rather than by the somatic symptom pattern.

Factitious Disorder and Malingering are important because they involve intentional production or feigning of symptoms. Factitious Disorder is driven by a desire to assume the sick role without obvious external incentives, while Malingering is motivated by external gains. These clearly differ from somatic symptom disorders, where symptoms are not intentionally produced for external rewards.

Finally, any medical or neurological condition with unexplained symptoms must be ruled out. Sometimes organic disease or undiscovered pathology accounts for what appears to be a somatic symptom issue, so a thorough medical workup is necessary to avoid misdiagnosis.

Other disorders like major depression, anxiety disorders, PTSD, schizophrenia, bipolar disorder, or substance use disorders can accompany somatic symptom concerns, but they are not the core differential diagnoses used to distinguish somatic symptom disorders from other primary psychiatric or medical presentations.