Somatic Symptom Disorder

Somatic symptom disorder is a mental health condition where people experience extreme distress about physical symptoms like pain or fatigue, causing significant problems in daily life. The symptoms themselves are real, but the person’s reaction to them is excessive and out of proportion.

Table of contents

• What is somatic symptom disorder?
• Signs and symptoms
• Causes and risk factors
• How common is it?
• Diagnosis
• Treatment options
• Outlook and living with the condition

What is somatic symptom disorder?

Somatic symptom disorder is a condition where a person experiences one or more physical symptoms that cause major emotional distress and problems with functioning in daily life. The physical symptoms might be related to a medical condition, or they might have no clear medical cause. However, what defines this disorder is not the symptoms themselves, but rather how the person thinks about, feels about, and responds to these symptoms^[1].

People with this condition often believe the worst about their symptoms and may think they have a serious illness, even when medical tests show nothing wrong. They frequently seek medical care and continue searching for explanations even after serious conditions have been ruled out^[1]. These health concerns can become such a central focus that they interfere with the person’s ability to function normally, sometimes leading to disability^[1].

It is important to understand that people with somatic symptom disorder are not faking their symptoms. The pain and other physical sensations they experience are real and cause genuine distress^[3]. The disorder represents a problem with how the mind and body communicate with each other^[7].

Signs and symptoms

Physical symptoms

The physical symptoms that people with somatic symptom disorder experience can vary widely. They may include specific sensations such as pain or shortness of breath, or more general symptoms like fatigue or weakness^[1]. Pain is the most commonly reported symptom^[4]. Other symptoms may include numbness, gastrointestinal distress (problems with the stomach and intestines such as nausea or abdominal pain), or problems with different body systems^[5].

These symptoms can be mild to severe, and a person may have a single symptom, multiple symptoms, or symptoms that vary over time^[1]. The symptoms may be unrelated to any medical cause that can be identified, or they may be related to a medical condition like cancer or heart disease, but the person’s reaction is more significant than what would usually be expected^[1].

Thoughts, feelings, and behaviors

The key feature of somatic symptom disorder is the excessive thoughts, feelings, and behaviors related to the physical symptoms. People with this condition may experience^[4]:

• Extreme anxiety about their physical symptoms
• Constant worry that mild symptoms are signs of serious conditions
• Persistent thoughts about the seriousness of their symptoms
• Excessive time and energy spent dealing with health concerns
• Frequent visits to healthcare providers for multiple tests and exams
• Difficulty believing test results when they are negative
• Moving from one healthcare provider to another or seeking treatment from multiple providers at once
• Feeling that healthcare providers don’t take their symptoms seriously enough
• Unusual sensitivity to medication side effects

These reactions must persist for six months or more to meet the criteria for diagnosis^[9]. The distress and behaviors can become so significant that the person has trouble functioning day to day, affecting their ability to work, maintain relationships, or participate in activities they once enjoyed^[4].

Causes and risk factors

The exact cause of somatic symptom disorder is not fully understood. Scientists believe it may arise from a heightened awareness of various bodily sensations, combined with a tendency to interpret these sensations as signs of medical illness^[2]. People with this disorder may perceive normal bodily sensations in an unusual way, or they may describe feelings in physical rather than emotional terms^[5].

Several factors may increase the risk of developing somatic symptom disorder^[2]:

• Childhood neglect or sexual abuse
• Chaotic lifestyle
• History of alcohol and substance abuse
• Having a negative outlook
• Being more physically and emotionally sensitive to pain and other sensations
• Family history of the condition
• Certain personality disorders, particularly avoidant, paranoid, self-defeating, and obsessive-compulsive disorder

Psychosocial stressors, including unemployment and problems with work functioning, have also been linked to the condition^[2]. Trauma or stress may cause a person’s physical sensations to change^[5]. In children, stressful events such as pressure at school, being bullied, illness in the family, or parents’ divorce can trigger the condition. Even positive life changes can sometimes be stressful enough to affect the body^[7].

How common is it?

Somatic symptom disorder is relatively common in the general population. Studies estimate that it affects about 5% to 7% of adults^[2][4]. This makes it one of the most common categories of patient concerns in the primary care setting^[10].

The condition can occur in children, adolescents, and adults, and it usually begins by age 30^[4]. Women are significantly more likely to be diagnosed with somatic symptom disorder than men, with some estimates suggesting women are 10 times more likely to have the condition^[4].

Diagnosis

Diagnosing somatic symptom disorder involves several steps. First, a person will typically have a complete physical exam and any tests their doctor recommends to rule out or identify any medical conditions that might be causing the symptoms^[9]. There are no laboratory tests that can definitively diagnose somatic symptom disorder^[5].

A healthcare provider may also refer the person to a mental health professional, such as a therapist or psychiatrist. The mental health professional may conduct a psychological evaluation, have the person fill out questionnaires, and ask about symptoms, fears, concerns, stressful situations, relationship problems, and family history^[9].

According to the Diagnostic and Statistical Manual of Mental Disorders (the main reference book used by mental health professionals), the diagnosis requires^[9]:

• One or more physical symptoms that are distressing or cause problems in daily life
• Excessive and persistent thoughts about the seriousness of the symptoms, persistently high anxiety about health or symptoms, or too much time and energy devoted to symptoms or health concerns
• Symptoms that persist for more than six months, even though the specific symptoms may vary

Healthcare providers must be careful not to diagnose somatic symptom disorder too quickly, as people with this condition can still develop other medical illnesses. Doctors may also need to consider other conditions that can look similar, such as multiple sclerosis, lupus (an autoimmune disease), fibromyalgia (a condition causing widespread pain), or irritable bowel syndrome^[5].

Treatment options

The main goal of treatment for somatic symptom disorder is to improve symptoms and help the person function better in daily life. Treatment typically involves a combination of approaches^[9].

Psychotherapy

Psychotherapy, also called talk therapy, is considered one of the most effective treatments for somatic symptom disorder. Cognitive behavioral therapy (CBT) is the most commonly recommended type of therapy^[9][10]. CBT helps people understand the connection between their thoughts, feelings, and behaviors.

During therapy, a person can learn to^[3]:

• Examine their feelings and beliefs about health and symptoms
• Find ways to reduce stress and anxiety about symptoms
• Stop focusing as much on physical symptoms
• Recognize what seems to make symptoms worse
• Cope with pain or other symptoms more effectively
• Stay active and social, even with ongoing symptoms
• Function better in daily life

Other helpful approaches include mindfulness-based therapy, which teaches people to stay present in each moment rather than getting lost in worry, and relaxation training, which provides specific techniques like breathing exercises to calm the nervous system^[10].

Medication

Medications may be added to the treatment plan, especially if a person is also struggling with depression or anxiety. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, have been shown to be effective in reducing symptoms^[10]. These medications can help reduce anxiety and worry about symptoms, even when depression is not present^[3].

Regular care and support

Having a supportive relationship with a primary care provider is vital for treatment. It’s recommended that people with somatic symptom disorder have one main healthcare provider to help avoid unnecessary and potentially harmful tests, procedures, and treatments^[3]. Regular, scheduled appointments can help provide reassurance and ongoing support.

A stepped care approach involving close cooperation between primary care, medical specialists, and mental health professionals is often most effective. This approach is based on a understanding that both physical and psychological factors contribute to the condition^[11].

Outlook and living with the condition

Somatic symptom disorder is often a chronic condition, meaning symptoms can persist over many years^[5]. However, with proper treatment, many people can learn to manage their symptoms and improve their quality of life. The condition can be managed, and people can learn to function better even if some symptoms continue.

Living with somatic symptom disorder requires patience and commitment to treatment. It’s important for people with this condition to^[3]:

• Maintain regular appointments with their healthcare provider
• Continue with therapy even when it feels difficult
• Practice stress-reduction and relaxation techniques regularly
• Stay as active and engaged in life as possible
• Build and maintain a support network of family and friends

Family members and friends can play an important role by offering support and understanding. It’s helpful for loved ones to remember that the person is not faking their symptoms and that the distress they experience is real^[7]. Support groups and educational resources can also help both patients and their families better understand and cope with the condition.