What Is Somatic Symptom Disorder?

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Somatic symptom disorder (SDD) is a mental disorder characterized by recurring, multiple, and clinically significant complaints about physical symptoms. Previously known as somatization disorder or psychosomatic illness, SSD causes such worry and preoccupation that it interferes with daily living. 

People with SSD may perceive routine medical procedures or conditions as life-threatening. The feelings and behaviors associated with the concern over illness are not relieved by receiving normal test results. Treatment for SSD includes cognitive behavior therapy (CBT) and certain antidepressants.

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Somatic Symptom Disorder Symptoms

Somatic symptom disorder is a psychiatric diagnosis characterized by physical symptoms that are either very distressing or cause a significant disruption in the ability to function normally.

Symptoms commonly include pain, fatigue, weakness, and shortness of breath. The degree of symptoms is not relevant to a diagnosis of SSD. For some people, symptoms can be traced to another medical condition, though often no physical cause is found. 

The key feature of SSD is excessive and disproportionate thoughts, feelings, and behaviors related to the symptoms or to overall health. To be diagnosed with SSD, you must have persistent symptoms lasting for at least six months.

Causes

There is no clear cause of SSD.

A variety of factors have been found to predispose a person to develop SSD:

  • Age: People who develop SSD typically begin to have signs of the condition before age 30.
  • Gender: It is more common in women than in men. 
  • Genetics: A family history of SSD or anxiety disorders has been associated with developing the condition.
  • Personality: The disorder is more common in people who are highly sensitive to physical or emotional pain or those with a negative outlook.
  • Personal history: People who have experienced physical or sexual abuse may be at an increased risk of developing SSD.

Although the symptoms are very real and occur in common patterns in specific groups, the actual mechanisms for these diseases have yet to be established. One example is chronic fatigue syndrome, which in the past was considered by many to be psychosomatic.

Diagnosis

A diagnosis of SSD typically isn't made until a person has experienced a stream of unexplained physical symptoms, medical tests, and treatments. However, physical symptoms do not need to be medically unexplained in order for SSD to be diagnosed.

If your primary care physician suspects you have SSD, they may refer you to a psychiatrist, who will determine whether you meet the criteria established in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Issue 5 (DSM-5).

Characteristics that differentiate SSD from other illnesses include:

  • Symptoms of SSD most commonly involve pain in different parts of the body (including the back, joint, head, or chest), disturbances in organ function (gastrointestinal, respiratory, etc.), fatigue, and exhaustion.
  • People with SSD usually suffer from multiple physical symptoms as well as co-existing mental and psychosocial issues that perpetuate or precipitate symptoms. For example, work-related stress may lead to the onset of respiratory symptoms with no physical or chemical cause for them.
  • People with SSD tend to have problems with emotion regulation—the ability to respond to a situation in a manner that is socially acceptable and proportionate. It is not uncommon for people with SSD to be "overreactive" or unable to disengage from an emotional upset.
  • People with SSD often "doctor hop," visiting one practitioner after another in search of a diagnosis or treatment without letting each one know they have undergone the same testing or treatment with another practitioner.

Many of the emotional features of SSD—a preoccupation with symptoms or a worsening of symptoms with emotional triggers—can affect anyone who has a persistent or chronic illness.

What's different about SSD is that the excessive thoughts, feelings, or behaviors will manifest in at least one of three characteristic ways:

  • The thoughts are persistent and disproportionate to the seriousness of the symptoms.
  • There is a persistently high level of anxiety about one's health or symptoms.
  • Excessive time and energy are devoted to these symptoms or health concerns.

If one or all of these emotional features disrupt the ability to function normally, SSD is a possible cause.

Changes to Diagnostic Criteria in the DSM-5

Somatic symptom disorder was introduced in the DSM-5 in 2013 and the following diagnoses from the DSM-IV were removed:

  • Somatization disorder
  • Hypochondriasis
  • Pain disorder
  • Undifferentiated somatoform disorder

People previously diagnosed with these conditions most likely meet the current criteria for SSD.

Other changes to the DSM-5 include:

  • The requirement that symptoms from four specific symptom groups—pain, gastrointestinal, sexual, and pseudo-neurological—must be present was eliminated.
  • Doctors no longer need to decide if the symptoms are intentionally feigned or produced.

Differential Diagnoses

Psychiatric conditions related to SSD include:

  • Illness anxiety disorder (IAS), formerly known as hypochondriasis, is the preoccupation with having or developing a serious illness. People with IAS may or may not have been diagnosed with medical conditions, but no serious disease is present in most cases. A person with IAS may believe, for instance, that a cough is a sign of lung cancer or that a bruise is a sign of AIDS.
  • Conversion disorder (CD), also known as functional neurological symptom disorder, is characterized by the appearance of neurologic symptoms (such as paralysis, seizure, blindness, or deafness) with no physical or biochemical causes. In past eras, such events were often referred to as "hysterical blindness" or "hysterical paralysis."
  • Psychological factors affecting other medical conditions (PFAOMC) is a classification in the DSM-5 in which a general medical condition is adversely affected by a psychological or behavioral problem. This may include the inability to adhere to treatment, engaging in behaviors that prolong illness, exacerbate symptoms, or knowingly placing one's health at risk.
  • Factitious disorder (FD) is diagnosed when a person acts as if they have an illness by making up, exaggerating, or producing symptoms, often for the purpose of inciting someone to their care. People with FD often have an eagerness for medical testing, describe complicated but convincing medical conditions, and are frequently hospitalized.
  • Other specific somatic symptom and related disorder (OSSSRD) is a category in which symptoms fail to meet the diagnostic criteria of SDD but cause significant distress nonetheless. With OSSSRD, symptoms occur for a period of fewer than six months. An example is pseudocyesis in which a woman falsely believes that she is pregnant due to perceived changes in breast size or the movement of a "fetus" in her abdomen.

Treatment

The treatment options for SDD vary. If a person recognizes that their preoccupation with symptoms is interfering with their quality of life, cognitive-behavioral therapy (CBT) may help identify and correct distorted thoughts, unfounded beliefs, and behaviors that trigger health anxiety.

This type of therapy is often used in tandem with mindfulness-based therapy, including meditation, with the aim of disengaging from self-criticism, rumination, and negative moods or thoughts.

A greater challenge occurs when a person with SSD clings to the belief that their symptoms have an underlying physical cause, despite a lack of evidence or extensive medical testing. Often, individuals like these are brought in by a spouse or family member who has also been adversely affected by their loved one's abnormal thoughts and behaviors.

When needed, selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants may be prescribed, both of which have proven effective in alleviating SSD symptoms.

Anticonvulsants and antipsychotics that are commonly used in the treatment of mood and anxiety disorders, as well as other antidepressants, such as monoamine oxidase inhibitors (MAOIs) and Wellbutrin (bupropion), are not effective for treating SSD.

A Word From Verywell

A diagnosis of SSD may be unnerving, but with proper therapy and counseling, you can begin the process of restoring your quality of life and the ability to function normally without fear about your health hanging over you. Don't expect things to change overnight; persistence is key. If you remain uncertain about the diagnosis, don't be afraid to seek a second opinion from a certified psychiatric professional.

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12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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