Somatic Symptom Disorder in Adults

What is somatic symptom disorder?

Somatic symptom disorder (SSD) is a mental health condition in which a person feels significantly distressed about physical symptoms and has abnormal thoughts, feelings and behaviors in response to them. The disorder disrupts their daily functioning and quality of life.

Although a person with somatic symptom disorder reports symptoms, the symptoms may have no medical explanation or be normal body sensations or discomfort. Even when there’s a medical cause, the person’s worry is out of proportion to the symptom.

People with somatic symptom disorder are often unaware of their underlying mental health condition and believe that they have serious physical ailments. The distress often causes them to visit multiple healthcare providers and to have many medical tests and unnecessary procedures.

What’s the difference between somatic symptom disorder and illness anxiety disorder?

Illness anxiety disorder is a mental health condition in which a person is preoccupied and excessively worried about having an illness or getting an illness. Unlike somatic symptom disorder, a person with illness anxiety disorder usually doesn’t experience physical symptoms.

What’s the difference between conversion disorder and somatic symptom disorder?

Conversion disorder (functional neurological symptom disorder) is a condition involving the function of your nervous system with no evidence of physical or neurological causes. This can cause symptoms that affect your perception, sensation or mobility.

While people with conversion disorder frequently experience depression or anxiety, excessive worrying and distress about the physical symptoms aren’t part of the diagnosis for conversion disorder. In contrast, excessive concern about physical symptoms is the main part of the diagnosis of somatic symptom disorder.

Who does somatic symptom disorder affect?

Somatic symptom disorder can occur in children, adolescents and adults, and it usually begins by age 30.

People assigned female at birth (AFAB) are 10 times more likely to be diagnosed with somatic symptom disorder than people assigned male at birth (AMAB).

How common is somatic symptom disorder?

Somatic symptom disorder is somewhat common and occurs in about 5% to 7% of the adult population.

What are the signs and symptoms of somatic symptom disorder?

Physical symptoms that people with SSD may have include:

• Pain (the most commonly reported symptom).
• Fatigue or weakness.
• Shortness of breath (dyspnea).

The physical symptoms may be mild to severe, and there may be one or multiple symptoms. They may be due to a medical condition or have no clear cause.

How people think, feel and behave in response to these physical symptoms are the main signs of somatic symptom disorder. People with SSD may:

• Feel extreme anxiety about their physical symptoms.
• Feel concerned that mild physical symptoms are signs of serious conditions.
• See their healthcare provider for multiple diagnostic tests and exams but not believe the results.
• Feel that their healthcare provider doesn’t take their physical symptoms seriously enough.
• Go from one healthcare provider to another or seek treatment from multiple providers at once.
• Spend excessive amounts of time and energy dealing with health concerns.
• Frequently seem unusually sensitive to drug side effects.
• Become dependent on others, demanding help and emotional support, and become angry when they feel their needs aren’t met.
• Have trouble functioning day to day because of thoughts, feelings and behaviors about their physical symptoms.

Approximately 30% to 60% of people with somatic symptom disorder also have anxiety and/or depression.

What causes somatic symptom disorder?

Researchers believe there are many biological, environmental and psychological factors that can contribute to the development of SSD, including:

• Childhood physical and sexual abuse.
• Poor awareness of emotions or emotional development during childhood. This can be the result of parental neglect or a lack of emotional closeness.
• Excessive anxiety and attention to bodily processes and possible signs of illness.

How is somatic symptom disorder diagnosed?

Your healthcare provider will perform a physical exam and probably order some laboratory tests to rule out conditions that may be causing your physical symptoms. They’ll also ask you about your health history.

If test results show that you don’t have a medical condition or illness or that your medical condition doesn’t match the severity of your symptoms, your healthcare provider may refer you to a mental health provider for assessment.

A mental health provider, such as a psychologist or psychiatrist, confirms a diagnosis of somatic symptom disorder using specific criteria.

To be diagnosed, a person must have one or more symptoms that cause distress or disrupt daily life for at least six months. They must also have excessive thoughts, feelings or behaviors in response to the symptoms that meet at least one of the following criteria:

• Overly excessive and long-lasting thoughts about the seriousness of the physical symptoms.
• Continuously high levels of anxiety about health or physical symptoms.
• Extreme amount of time and energy focused on physical symptoms and health concerns.

People with somatic symptom disorder may have a difficult time accepting that their concerns are excessive.

How is somatic symptom disorder treated?

The goal of treating somatic symptom disorder is to manage physical symptoms, as well as psychological symptoms using psychotherapy (talk therapy) and sometimes medications that treat underlying anxiety and depression.

Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people learn ways to change their patterns of thinking or behavior in order to change the way they feel. Under the guidance of a psychologist or psychiatrist, CBT helps people better cope with anxiety and stress and respond to situations more effectively.

If you have somatic symptom disorder, CBT can help you:

• Evaluate your feelings and beliefs about your physical symptoms and health in general.
• Find ways to reduce stress and anxiety about your symptoms.
• Stop focusing as much on your physical symptoms.
• Recognize what seems to make your physical 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. In addition to helping mood, antidepressants have been reported to help ease such symptoms as pain, fatigue, pain in joints and sleep problems.

What are the risk factors for developing somatic symptom disorder?

Studies have found certain risk factors associated with somatic symptom disorder. These risk factors include a history of:

• Heightened attention to bodily sensations.
• Substance use disorder.
• Alcohol use disorder.
• Neglect during childhood.
• Physical and sexual abuse.
• Chaotic lifestyle/trauma.
• Chronic illness during childhood.
• Presence of other psychiatric conditions, especially anxiety or depression.
• Presence of certain personality disorders, including avoidant personality disorder, paranoid personality disorder and obsessive-compulsive personality disorder.

Therapy may help people who are prone to SSD learn other ways of dealing with stress and triggers. This may help reduce the intensity of their symptoms.

What is the prognosis (outlook) for somatic symptom disorder?

The course of somatic symptom disorder is likely chronic (long-term), with episodes that come and go from several months to years.

Left untreated, somatic syndrome disorder can lead to:

• Limited daily function.
• Unemployment or poor work performance.
• Psychological disability.
• Decreased quality of life.
• Alcohol and substance use disorders.

The good news is that with treatment, most people can experience an improvement or remission in their symptoms.

How do I take care of myself if I have somatic symptom disorder?

If you’ve been diagnosed with somatic symptom disorder, taking the following steps will likely aid in your treatment:

• Develop a supportive relationship with your primary healthcare provider.
• Only have one primary care provider. This will help you avoid getting unneeded tests and procedures.
• See your healthcare provider regularly to review your physical symptoms and how you’re coping.
• See your mental health provider regularly to help manage and monitor your psychological symptoms, such as excessive worry and fear.

When should I see my healthcare provider about somatic syndrome disorder?

It’s important to see your primary healthcare provider and/or mental health provider if you:

• Feel so worried about your physical symptoms that you can't function.
• Have symptoms of anxiety or depression.

A note from Cleveland Clinic

It’s important to remember that somatic symptom disorder (SSD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors.