Somatic Symptom Disorder

Somatic symptom disorder is a condition in which a person feels extreme anxiety about physical sensations, such as pain or fatigue. This preoccupation with physical symptoms causes significant distress and disrupts the individual’s daily life. The physical symptoms may or may not be related to a diagnosable medical condition, but the extreme reaction to the physical symptoms is what characterizes somatic symptom disorder.

The prevalence of somatic symptom disorder is unknown, but it is estimated that 5 to 7 percent of the general population may have this condition. Females tend to report more physical symptoms than males, and it is therefore likely that the prevalence of somatic symptom disorder is higher in females. This condition is related to hypochondriasis, or illness anxiety disorder.

Symptoms

People with somatic symptom disorder have multiple physical symptoms that cause significant distress. These symptoms can be specific (pain in a specific area) or more general (fatigue), and they may be normal bodily sensations or be the result of a medical condition. Somatic symptom disorder is characterized by the way people feel and behave in response to their physical sensations, not the sensations alone.

People with somatic symptom disorder spend a great deal of time and energy experiencing high levels of worry about illness. They assume physical sensations in their bodies are threatening or harmful, and they often think the worst about their symptoms, regardless of any evidence to the contrary. For example, a person may have a surgical procedure with no complications, but their concern over physical sensations following the surgery could leave them impaired or disabled.

Health concerns may become so extreme that they are a central feature of a person’s identity and dominate their relationships with others. Individuals with somatic symptom disorder access medical care at high rates and such a level of medical care rarely improves their distress. Whether or not the physical complaints can be medically explained, their suffering is real and interferes with daily life. 

Symptoms of somatic symptom disorder as cataloged by the DSM-5:

  1. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
  2. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associ­ated health concerns as manifested by at least one of the following: 
  • Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
  • Persistently high level of anxiety about health or symptoms.
  • Excessive time and energy devoted to these symptoms or health concerns.
  • Although any somatic symptom may not be continuously present, the state of be­ing symptomatic is persistent (typically more than 6 months).

Causes

There are multiple factors that may contribute to the development of somatic symptom disorder. Major life stress might precede the development of symptoms in some cases. People who have a negative outlook or personality are more prone to developing the condition, as well as those who have a family history of somatic symptom disorder. This condition is also more commonly seen in people who have a high sensitivity to pain or have a history of alcohol and substance abuse.

Treatment

Treatment of somatic symptom disorder is multifaceted and should be tailored to the needs of each patient, keeping aware of cultural factors that influence their physical symptoms. Establishing a strong relationship with a provider and legitimizing symptoms are important aspects of treatment. Treatment strategies include medications such as antidepressants to address any underlying anxiety or depression. Effective treatment options also include cognitive behavioral therapy and mindfulness-based therapy. Somatic symptom disorder is generally a chronic condition, but research has shown that people can recover and learn strategies to minimize their distress. 

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Kurlansik, S. L., & Maffei, M. S. (2016). Somatic symptom disorder. Am Fam Physician, 93(1), 49-54.

Last reviewed 11/11/2017