Somatic symptom disorder is characterized by one or more chronic physical symptoms accompanied by significant and out-of-proportion levels of distress, worries, and difficulty in daily functioning related to those symptoms.
People with somatic symptom disorder are preoccupied with their symptoms and spend excessive amounts of time and energy on these symptoms and health concerns.
Doctors diagnose the disorder when people continue to be preoccupied and concerned with their symptoms after physical disorders have been ruled out or when their response to an actual physical disorder is unusually intense.
Psychotherapy, particularly cognitive-behavioral therapy, can help, as can having a supportive, trustful relationship with a doctor.
(See also Overview of Somatic Symptom and Related Disorders.)
Somatic symptom disorder replaces several previously used diagnoses: somatization disorder, undifferentiated somatoform disorder, and pain disorder. All of these disorders involve somatization—the expression of mental factors as physical symptoms. In this disorder, a person's main concern is with the physical symptoms, such as pain, weakness, fatigue, nausea, or other bodily sensations. The person may or may not have a physical disorder that causes or contributes to the symptoms. However, when a physical disorder is present, a person with somatic symptom disorder responds to it excessively.
Doctors used to diagnose this type of mental health condition (sometimes called psychosomatic or somatoform disorders) only when people reported physical symptoms that were not explained by a physical disorder. However, the definition has been changed to focus on how people respond to their symptoms or health concerns. A person with this mental health condition has excessive thoughts, feelings, or concerns about physical symptoms. This can occur regardless of whether the person has a physical disorder. For example, after a heart attack, people with somatic symptom disorder may completely recover physically, but they may continue to feel they cannot return to normal activities or worry so much about having another heart attack that they are distressed or cannot manage daily functions.
The main psychiatric diagnostic criterion for diagnosing somatic symptom disorder is the following:
People spend a lot of time and energy and frequently have thoughts or anxiety about their physical symptoms, and this causes significant distress and interferes with daily functioning.
The intensity and persistence of symptoms may reflect a strong desire to be cared for. Symptoms may help people avoid responsibilities but may also prevent them from enjoying activities and act as punishment, suggesting that they may have underlying feelings of unworthiness and guilt.
Many people with the disorder do not realize that they have a mental health condition, and they are convinced that their symptoms have a physical cause that requires medical attention. Consequently, they typically have many doctor visits and ask doctors for additional or repeated tests and treatments even after a thorough evaluation has not found a cause of the symptoms.
Symptoms of Somatic Symptom Disorder
People with somatic symptom disorder are preoccupied with their physical symptoms, particularly with how serious they may be. For these people, health concerns are often the main and sometimes all-consuming focus in life.
The physical symptoms usually begin before age 30, sometimes during childhood. Most people have many symptoms, but some have only 1 bothersome symptom, typically pain. Symptoms may be specific (such as pain in the abdomen) or vague (such as fatigue). Any part of the body may be the focus of concern.
People with somatic symptom disorder worry excessively about the symptoms and their possible catastrophic consequences. Their worry is out of proportion to the symptoms. People may attribute normal sensations or discomfort, such as a grumbling stomach, to a serious physical disorder. They tend to think the worst about any symptoms they experience. The symptoms themselves or excessive worry about them is distressing or disrupts all aspects of daily life. Some people become depressed.
People may become dependent on others, demanding help and emotional support and becoming angry when they feel their needs are not being met. They may also threaten or attempt suicide. When their doctor tries to reassure them, they often think that the doctor is not taking their symptoms seriously. Often dissatisfied with their medical care, they typically go from one doctor to another or seek treatment from several doctors at the same time. Many people with somatic symptom disorder do not respond when medical treatment is given in an attempt to treat the symptoms, and the symptoms may even worsen. Some people seem unusually sensitive to the side effects of medications.
Symptoms may lessen or worsen, but symptoms persist and are rarely completely relieved for any length of time.
Diagnosis of Somatic Symptom Disorder
A doctor's evaluation, based on standard psychiatric diagnostic criteria
A physical examination and sometimes medical tests to evaluate for physical disorders
Doctors diagnose somatic symptom disorder when people do the following:
Have thoughts that are constant and out of proportion about how serious their symptoms are
Are extremely anxious about their health or the symptoms
Spend an excessive amount of time and energy on the symptoms or health concerns
To determine whether symptoms are due to a physical disorder, doctors take an extensive medical history (which may include interviewing other family members), do a thorough physical examination, and may do laboratory tests or imaging studies. If the evaluation does not show a physical disorder, a doctor sometimes does further tests at a later time. If symptoms persist or new symptoms occur, it may be appropriate to check if a person with somatic symptom disorder has a physical disorder that was not previously diagnosed or was not present at the time of the initial evaluation.
Did You Know...
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Somatic symptom disorder can be distinguished from similar mental health conditions because a person has persistent symptoms and accompanying excessive thoughts and worries about the symptoms.
This disorder may be missed in older adults because certain symptoms, such as fatigue or pain, are considered part of aging or because worry about symptoms is considered understandable in older adults, especially those who have several medical problems and take many medications.
Treatment of Somatic Symptom Disorder
Cognitive-behavioral therapy
Even when people with somatic symptom disorder have a good relationship with their primary care doctor, they are often referred to a psychiatrist. Psychotherapy, particularly cognitive-behavioral therapy, is an effective treatment.
People with somatic symptom disorder benefit from having a supportive, trustful relationship with a doctor. The doctor can coordinate their health care, offer treatments to relieve symptoms, see them regularly, and protect them from unnecessary tests and treatments. However, the doctor must remain alert to the possibility that people may develop a new, separate physical disorder that requires evaluation and treatment. New and different symptoms should not automatically be assumed to be caused by the person's somatic symptom disorder.
Depression, if present, is treated.
