Due to diagnostic changes, about 75% of people who previously carried a diagnosis of hypochondriasis now have somatic symptom disorder.1 In somatic symptom disorder (SSD), people experience anxiety-provoking physical symptoms that disrupt their life, often without a medical explanation for the symptoms. SSD commonly presents in medical settings, but people should be aware of its psychological origins and treatments.
Signs of Somatic Symptom Disorder: What It Looks Like
A person with somatic symptom disorder will present as someone very focused on and influenced by their bodily sensations and discomfort. These health concerns will trigger a powerful anxious reaction leading to extreme worry and negatively impact their thoughts, feelings, and behaviors while negatively affecting many facets of their life.2,3
Somatic symptom disorder involves a person feeling various specific or vague physical complaints, even though there are no concrete medical explanations for these symptoms. In order to identify and treat these physical symptoms, a person will schedule and attend numerous appointments with healthcare providers to receive testing, scans, and bloodwork.
SSD causes many people to experience a high level of anxiety and worry about the state of their health followed by frustration when their medical providers cannot identify and resolve their symptoms. Someone with somatic symptom disorder may find it challenging to think of much else other than their physical health, which will impact their focus and performance at home, work, school, and other important situations.
Somatic symptom disorder affects as many as 7% of the population in the U.S., but the condition may be underdiagnosed as people may not see the connection between physical symptoms and mental health. Women with somatic symptom disorder outnumber men by a rate of 10 to 1, and the condition usually begins before age 30.2,3
Common signs of somatic symptom disorder include:1,2,3
- Complaints about medical concerns like pain, fatigue, and
- Frequent doctors’ appointments
- Being distracted and disorganized
- Being fearful that physical activity could damage the body
- Repeatedly checking and inspecting the body
Children may also experience periods of SSD. Common signs of somatic symptom disorder in children include:1
- Recurrent physical symptoms, especially stomach pain, headaches, low energy, and nausea
- Missed days of school due to illness
- Complaining of individual symptoms more than concerns of being ill or having an overarching disease
Symptoms of Somatic Symptom Disorder
Somatic symptom disorder only has a few criteria required to receive the diagnosis, but because of the focus on physical symptoms, the person may be reluctant to report to a mental health professional. Medical professionals may make many differential diagnoses.
The primary symptom of somatic symptom disorder is the person having one or more distressing and uncomfortable medical symptoms. These symptoms must substantially disturb the individual’s life, routine, and daily functioning.1
Physical symptoms of somatic symptom disorder may include:3
- Pain, especially in the chest, arms, legs, joints, back, or stomach
- Neurological symptoms like headaches, trouble moving, feeling weak, being dizzy, or fainting
- Digestive issues including pain, diarrhea, constipation, or incontinence
- Sexual symptoms like pain during sex or painful menstruation
These physical complaints lead to thoughts, feelings, and behaviors which are excessive and distorted.
A person with somatic symptom disorder may experience:1
- Persistent thoughts about medical health that are not proportional to the symptoms
- Very high ratings of worry, stress, and tension about these health symptoms
- Extreme levels of time and energy spent being concerned about their physical health status
To have the diagnosis, a person with somatic symptom disorder must have consistent physical health worries for typically more than six months.1 The worries may change, though. One person could remain concerned with the same sensation, while another could have many shifting symptoms over time. The overriding symptom of SSD is the intense anxiety a person is likely to experience. Regardless of encouraging test results and medical professionals’ reassurance, the anxiety will not dissipate.2
Another important consideration with somatic symptom disorder is that the individual is not somehow “faking” or “making up” their symptoms. Whether their experience is pain, fatigue, or another issue, it is real, but their symptoms are not caused by a medical issue.2
Somatic Symptom Disorder Vs. Hypochondriasis Vs. Illness Anxiety Disorder
The signs and symptoms of somatic disorder may be frequently confused with hypochondriasis and illness anxiety disorder. As mentioned, the American Psychiatric Association (APA) eliminated hypochondriasis as a diagnosis in 2013, and the condition was essentially split into two categories – somatic symptom disorder and illness anxiety disorder.1
With 75% of people who previously had hypochondriasis now having somatic symptom disorder, the remaining 25% now have illness anxiety disorder. In illness anxiety disorder, people will feel a great amount of stress and worry about their physical health, but they are missing the specific physical complaint that is common in somatic symptom disorder. Rather than pinpointing an area of pain or discomfort, people with illness anxiety disorder have a generalized sense of being ill at some point.1
Causes of Somatic Symptom Disorder
Like other mental health conditions, somatic symptom disorder does not have a singular cause. Instead, there are multiple environmental and biological factors related to the person’s history, genetics, perception of sensations, and physiology that cause the condition.
Some of the most common causes of somatic symptom disorder include:1,2,3
- Childhood physical, sexual, and emotional abuse
- Childhood neglect
- Substance abuse
- Instability during childhood
- High anxiety levels
- Poor awareness and understanding of feelings
- Low pain threshold
- Hypersensitivity to bodily sensations
- An overly pessimistic outlook on self, others, and the world
- Poor education and low socioeconomic status
Having a past or ongoing physical health problem could trigger SSD. Many people with established and documented medical issues may still experience SSD.
Treatment of Somatic Symptom Disorder
To best treat somatic symptom disorder, a team of professionals will provide some combination of psychotherapy, medication management, and physical health care. Important treatment team members include a therapist, a medication prescriber like a psychiatrist, and a primary care physician (PCP). Like with other mental health concerns, the treatment goal will be to control symptoms and improve life functioning.2
Therapy
Therapy will play the central role in the treatment of somatic symptom disorder. Moresoe than with other mental health disorders, a person with SSD may have even less insight into their condition, so the therapist must provide education about the condition and illuminate the connection between physical health and mental health issues.
Therapy will help to relieve symptoms of somatic symptom disorder by:2
- Processing the client’s beliefs about the health and symptoms
- Planning ways to reduce stress and anxiety
- Shifting focus away from physical health
- Identifying triggers and stressors that worsen symptoms
- Teaching new coping skills
- Focusing on staying active, social, and engaged with others
People with SSD may show early resistance to treatment due to poor awareness of their symptoms. In time, the therapist can encourage the person to explore alternative points of view.
Cognitive Behavioral Therapy for Somatic Symptom Disorder
Though other styles may be helpful for SSD, researchers have identified cognitive behavioral therapy (CBT) as the preferred therapy approach for somatic symptom disorder. CBT works by demonstrating the link between one’s thoughts, feelings, and behaviors, which is especially necessary for somatic symptom disorder.1,4,5
The CBT therapist can act as a teacher and a collaborator to help the client with SSD better understand their condition and resolve their symptoms. Since many people with somatic symptom disorder also have anxiety and depressive disorders, the CBT therapist can concurrently address these conditions to mitigate symptom load.1
Intended Treatment Outcome & Timeline
Effective therapy for somatic symptom disorder will limit symptoms of the condition, address underlying triggers, reduce the influence of other mental health disorders, and improve the individual’s overall well-being. The timeline for effective treatment is harder to establish.
CBT can regularly improve clinical outcomes in as little as 12 sessions for disorders related to depression and anxiety, but with SSD, the course of treatment may be longer. People with somatic symptom disorder may refuse treatment initially and require substantial time to recognize the mental health connection to their physical health symptoms. 1
If the person invests into the treatment plan, quick progress is possible, though.
Medication: Common Prescription Drugs for Somatic Symptom Disorder
No medication is specifically approved for the treatment of somatic symptoms disorder. In fact, using medication alone for the treatment of SSD tends to have poor outcomes, according to controlled studies.5 Even though therapy strategies are likely to be more effective for somatic symptom disorder, medications could show benefit by addressing underlying or co-occurring depressive and anxious disorders.
Some possible medications used in the treatment of somatic symptom disorder include:5
- Imipramine (Tofranil)*
- Fluoxetine (Prozac)*
- Sertraline (Zoloft)*
- Citalopram (Celexa)*
- Escitalopram (Lexapro)*
- Fluvoxamine (Luvox CR)*
- Paroxetine (Pexeva, Paxil, Paxil CR)*
- Mirtazapine (Remeron, Remeron SolTab)*
- Duloxetine (Cymbalta)*
- Venlafaxine (Effexor, Effexor XR)*
One recent study showed some promise by combining several types of antidepressants to target somatic symptom disorder. The researchers combined a selective serotonin reuptake inhibitor (SSRI) called citalopram (Celexa) with paliperidone (Invega), which is from another class of medications called atypical antidepressants. By combining SSRIs and atypical antidepressants, people with somatic symptom disorder could improve.5
Based on the unique needs of the individual, the psychiatrist, nurse practitioner, or PCP will prescribe a medication or combination of medications to reduce the influence of somatic symptom disorder. The above medications are all antidepressants, but they may interact with chemicals in the brain differently to create the desired effects.
These medications may lead to negative side effects. Some of these medicines may take more than a month to decrease depression. Antidepressants are typically safe and effective when used as prescribed, but distressing or dangerous side effects can occur in some situations.5
*Thes medications have a black box warning, the most serious kind of warning from the FDA for the risk of suicidal thoughts and behaviors in certain people. Before starting any of the medications above, you should talk with your doctor about these risks.
Physical Health Treatment
The primary care physician represents an immensely important part of the somatic symptom disorder treatment plan. With open and honest communication, the PCP can work in a collaborative way with mental health professionals to address and resolve symptoms of SSD.
First, the PCP should offer clear education to the patient about somatic symptom disorder and how it is affecting their perception of physical health complaints. The PCP will stress the idea that the symptoms stem from emotional, not physical, issues while validating the person’s experience.5
Second, the PCP will provide regular assessments and preventive appointments to reinforce the notion that symptoms are not severe or disabling. By emphasizing the idea that symptoms may improve without intervention, the PCP can help the patient reduce their anxiety.
Third, the PCP can focus on accepting the person’s symptoms connected to the SSD without the need to resolve them. This approach may be frustrating for the individual, which is why a strong partnership is imperative.5
Lifestyle Changes
When someone has somatic symptom disorder, their entire life may seem to revolve around physical health and wellness. Adding healthy lifestyle choices that target both physical health and mental health issues while subtracting the negative coping skills can boost the efficacy of professional treatment options.
Lifestyle changes are incredibly valuable but extremely trying because people with somatic symptom disorder center their lives around illness. Helpful lifestyle changes include:6
Shifting Focus to Health Rather Than Illness
With SSD, so many body sensations seem to indicate how unwell the person is. Regular exercise, a healthier diet, and regular sleep can give everyone a sense of control over their health and well-being. Exercise, in particular, is linked to fewer somatic symptoms.
Reducing The Stress
Too much time spent thinking about illness will add stress, but it can also reduce effective stress-management skills. To combat stress, identify sources of stress, change what you can, and practice relaxation techniques to accept what you cannot modify.
Creating Positive Interactions
Somatic symptom disorder will consume all thoughts and relationships when symptoms are severe, and it is your task to move communication away from physical health. Avoid the trap of talking only to others about medical concerns and form positive relationships with friends and family around shared interests and support.
Discovering a New Purpose
It may seem like seeking medical treatment has been the motivating purpose for some time, but that result was only the effect of SSD controlling life. Change your lifestyle by finding a new purpose. With a new purpose aimed at health and recovery of self or others, you can achieve fulfillment like never before. A purpose can be as simple as a new hobby or spending time in volunteer activities.
Of course, all people would love a quick fix for their anxiety and somatic complaints, but making lifestyle changes takes time, consistency, and patience. Lifestyle changes take time to create results, so stick to the plan to improve your condition.
How to Get Help for Someone with Somatic Symptom Disorder
People with somatic symptom disorder are notoriously resistant to the idea that their symptoms originate from mental, not medical, sources. Even professionals can struggle to direct people with SSD towards the proper help, so the task of getting help for a loved one will pose a challenge. Patience, love, and support will be key.
To help someone, you should always adopt an approach of collaboration and teamwork, rather than opposition. If you only mention the need for mental health treatment during periods of conflict and anger, they will become defensive and reject your help and your message.
In children with SSD, the parent’s view of the diagnosis is crucial. When parents accept the presence of the condition, the child is 20 times more likely to recover from somatic symptom disorder, so the best thing a parent can do is trust the diagnosis.5
You can do much to help a loved one with SSD, but be cautious. People with somatic symptom disorder need professional treatment to resolve their symptoms. You may offer to attend medical and mental health appointments with your loved one to provide helpful information to their treatment team, but you cannot resolve their symptoms alone.
Practical Ways to Help Cope with Somatic Symptom Disorder
Coping with somatic symptom disorder may seem daunting, but when using practical skills, a person can improve their condition. By looking at the symptoms in a new way and making subtle behavioral changes like improving exercise, communication, and sleep habits, hope and health will replace worry and anxiety.
Practical ways to help cope with somatic symptom disorder include:6
- Boost your exercise routine: Exercise has a tremendously positive impact on SSD. Exercise can reduce physical symptoms while improving self-esteem, empowerment, and social connections
- Avoid the negatives: When stress and anxiety are high, people too often turn towards negative coping skills to quickly reduce symptoms. Unfortunately, alcohol, drugs, overspending, overeating, and causal sex only increase long-term stress.
- Renew relationships: Reflect, review, and renew your relationships to cope with SSD. Over time, your relationships may have centered around you and your somatic symptoms, so spend some time giving back to and strengthening the bond with the people who have given love and support.
- Retrain your thinking: Since the onset of your condition, your brain has convinced you that your symptoms had a physical source. Now, you must confront that faulty belief by consistently telling yourself that your physical health is stable
- Care for your body: Increasing your exercise will help you, but it is only one piece of your physical well-being. Improving your quality of sleep and diet will protect your physical health and reduce your anxiety.
- Stick to treatment: If your treatment consists of therapy, medication, and PCP visits, maintaining these appointments may become frustrating as the weeks turn to months. Staying invested in treatment will be the only way to see results, so stick to the plan.
Coping skills are a lot like lifestyle changes because they take time to produce the wanted results. People may grow tired and frustrated from carrying on with healthy coping skills as the allure of negative coping skills becomes stronger, but stay the course. Unhealthy coping skills promise quick fixes but end with bigger problems in the future. Healthy coping skills will be uncomfortable initially while creating lasting, positive changes.
Somatic Symptom Disorder Statistics
Somatic symptom disorder has only been an official APA diagnosis since 2103, so many of the data and statistics available refer to hypochondriasis.
Still, the somatic symptom disorder statistics offer compelling information regarding the condition:5
- 75% people who previously had a hypochondriasis diagnosis now have somatic symptom disorder
- Between 5 and 7% of people in the U.S. have somatic symptoms disorder
- Between 20 and 25% of people with acute somatic symptoms will go on to develop a somatic symptom disorder
- Ten times as many women have somatic symptom disorder than do men
- A child is 20 times more likely to recover from somatic symptom disorder when their caregivers accept and support the diagnosis
Based on these statistics, the condition may be more widespread than people would like to believe. The good news is that children with SSD may recover with proper care.
For Further Reading
Like illness anxiety disorder, somatic symptom disorder is not a very well-known mental health condition, which means experts do not devote as much research and funding to the diagnosis. Even still, world-class organizations are working to learn more about somatic symptom disorder, its causes, and its most effective treatments.
Some of these organizations include:
