Somatic Symptom Disorder

Somatic symptom disorder (SSD) is a mental health condition in which you feel significantly distressed about physical symptoms. You may have excessive thoughts, emotions and/or behaviors in response to the symptoms, which disrupt your daily functioning. This condition was formerly known as somatoform disorder.

Common physical symptoms involved in this disorder include pain, fatigue and shortness of breath. They may or may not have a known medical cause, but they’re real. You may think about the symptom(s) constantly and see healthcare providers often.

You may not feel that your concern for your health is excessive, because it’s a very real issue. But intense stress can greatly affect anyone’s daily life. Because of that, it’s important to get help if physical symptoms are mentally overwhelming.

Symptoms of somatic symptom disorder

Somatic symptom disorder can occur in children, adolescents and adults. It usually begins by age 30. Physical symptoms that you may have include pain, fatigue or shortness of breath. These symptoms may range from mild to severe, and you may have more than one.

How you think, feel and behave in response to physical symptoms are the main signs of SSD. You may:

• Feel anxious or depressed about the physical symptoms
• Feel concerned that the symptoms are signs of serious conditions
• See your healthcare provider or several providers for multiple tests and exams
• Not be reassured by test results
• Spend a lot of time and energy dealing with health concerns
• Often be sensitive to medication side effects
• Become dependent on others for care and emotional support
• Have trouble doing everyday tasks because of these thoughts, feelings and behaviors

Somatic symptom disorder causes

Researchers don’t know the exact cause of somatic symptom disorder. But they think it stems from having an enhanced awareness of how your body feels.

A combination of genetic, biological and environmental factors may contribute to it. For example, certain personality traits or life experiences may affect how you view or interpret sensations.

Risk factors

Factors that may increase your risk of somatic symptom disorder include:

• Anxiety and depression
• Alcohol and/or substance use disorders
• Neglect during childhood
• Physical and sexual abuse
• Chaotic lifestyle and trauma
• A tendency to catastrophize
• Certain personality disorders, including avoidant, paranoid and obsessive-compulsive personality disorders

Complications

Without treatment, somatic symptom disorder can lead to:

• Difficulty functioning
• Unemployment or poor work performance
• Disability
• Decreased quality of life
• Alcohol and substance use disorders

Because of these complications, it’s important to get help as soon as you start to feel overwhelmed.

How healthcare providers diagnose this condition

A mental health provider confirms a diagnosis of somatic symptom disorder using criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Generally, they diagnose it if you have symptoms for at least six months and have one or more of the following:

• Constant and long-lasting thoughts about the seriousness of physical symptoms
• High levels of anxiety about health or physical symptoms
• An extreme amount of time and energy spent focused on health concerns

How is somatic symptom disorder treated?

The goal of somatic symptom disorder treatment is to learn to cope with physical symptoms. This typically involves talk therapy. In some cases, your healthcare provider may prescribe medications to help treat underlying anxiety and depression.

Cognitive behavioral therapy (CBT) is the main type of talk therapy for SSD. A therapist helps you better cope with stressors and respond to situations more effectively. CBT can help you:

• Evaluate your feelings and beliefs about your physical symptoms and general health
• Find ways to reduce stress and anxiety
• Stop focusing as much on physical symptoms
• Recognize what seems to make symptoms worse
• Find ways to stay active and social, even if you still have pain or other symptoms
• Function better in your daily life

Your healthcare provider may prescribe medication, such as an antidepressant, to help your mood. Antidepressants may help ease pain, fatigue and sleep problems.

What can I expect if I have this condition?

Without treatment, somatic symptom disorder tends to be a long-term condition. Episodes may come and go for several months or years.

One study found that cognitive behavioral therapy reduced somatic symptoms within a year.

It helps to have a supportive primary care provider you trust. They can help address the physical symptoms while a mental health provider helps you manage your response to them.