Somatic symptom disorder

  • Definition
    • Somatic symptom disorder occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life.

      A person with somatic symptom disorder (SSD) is not faking his or her symptoms. The pain and other problems are real. They may be caused by a medical problem. Often, no physical cause can be found. But it's the extreme reaction and behaviors about the symptoms that are the main problem.

  • Alternative Names
    • Somatic symptom and related disorders; Somatization disorder; Somatiform disorders; Briquet syndrome; Illness anxiety disorder

  • Causes
    • SSD usually begins before age 30. It occurs more often in women than in men. It's not clear why some people develop this condition. Certain factors may be involved:

      • Having a negative outlook or personality
      • Being more physically and emotionally sensitive to pain and other sensations
      • Family history or upbringing
      • Genetics

      People who have a history of physical or sexual abuse may be more likely to have this disorder. But not every person with SSD has a history of abuse.

      SSD is similar to illness anxiety disorder. This is when a person is overly anxious about becoming sick or developing a serious disease. The person fully expects they will at some point become very ill. But unlike SSD, there are few or no actual symptoms.

  • Symptoms
    • Physical symptoms that can occur with SSD may include:

      Symptoms may be mild to severe. A person may have one or more symptoms. They may come and go or change. Symptoms may be due to a medical condition. They also may have no clear cause.

      How a person feels and behaves in response to these physical sensations are the main symptoms of SSD. These reactions must persist for 6 months or more. A person with SSD may:

      • Feel extreme anxiety about symptoms
      • Feel concern that mild symptoms are a sign of serious disease
      • Go to the doctor for multiple tests and procedures, but not believe the results
      • Feel that the doctor does not take their symptoms seriously enough or has not done a good job treating the problem
      • Spend a lot of time and energy dealing with health concerns
      • Have trouble functioning because of thoughts, feelings, and behaviors about symptoms
  • Exams and Tests
    • You will have a complete physical exam. Your health care provider may do certain tests to find any physical causes. The types of tests that are done depend on what symptoms you have.

      Your provider may refer you to a mental health provider. The mental health provider may do further testing.

  • Treatment
    • The goal of treatment is to control your symptoms and help you function in life.

      Having a supportive relationship with your health care provider is vital for your treatment.

      • You should have only one primary care provider. This will help you avoid having unneeded tests and procedures.
      • You should see your provider regularly to review your symptoms and how you are coping.

      You may also see a mental health provider (therapist). It's important to see a therapist who has experience treating SSD. Cognitive behavioral therapy is a type of talk therapy that can help treat SSD. Working with a therapist can help relieve your pain and other symptoms. During therapy, you will learn to:

      • Look at your feelings and beliefs about health and your symptoms
      • Find ways to reduce stress and anxiety about symptoms
      • Stop focusing as much on your physical symptoms
      • Recognize what seems to make the pain or other symptoms worse
      • Learn how to cope with the pain or other symptoms
      • Stay active and social, even if you still have pain or other symptoms
      • Function better in your daily life

      Your therapist will also treat depression or other mental health illnesses you may have. You may take antidepressants to help relieve anxiety and depression.

      You should not be told that your symptoms are imaginary or all in your head. Your provider should work with you to manage both physical and emotional symptoms.

  • Possible Complications
    • If not treated, you may have:

      • Trouble functioning in life
      • Problems with family, friends, and work
      • Poor health
      • An increased risk for depression and suicide
      • Money problems due to the cost of excess office visits and tests

      SSD is a long-term (chronic) condition. Working with your health care providers and following your treatment plan is important for managing with this disorder.

  • When to Contact a Medical Professional
    • You should contact your health care provider if you:

      • Feel so concerned about physical symptoms that you can't function
      • Have symptoms of anxiety or depression
  • Prevention
    • Counseling may help people who are prone to SSD learn other ways of dealing with stress. This may help reduce the intensity of symptoms.

  • References
    • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.

      Ferri F. Somatization disorder. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier; 2016:section 1144-1144.e1.

      Gerstenblith TA, Kontos N. Somatic symptom disorders. In: Stern TA, Rosenbaum JF, Fava M, et al, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 24.