Somatic Symptom Disorder: Signs, Symptoms, & Treatments

What Is Somatic Symptom Disorder?

Somatic symptom disorder is when a person is excessively focused on a physical symptom of complaint. This could include something like shortness of breath, or an ache or pain. The person may ruminate excessively about these physical sensations and repeatedly seek medical treatment. The symptoms may not be related to any actual medical condition, but the person genuinely believes they are sick.²

An 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.³

How Common Is Somatic Symptom Disorder?

Somatic symptom disorder is usually diagnosed by age 30, and is more prevalent in females than in males. It is fairly common, affecting 5-7% of adults. 30% to 60% of people with somatic symptom disorder also have co-occurring anxiety and/or depression. This can create a challenge for both mental health and primary care providers.²

Related Disorders

The signs and symptoms of somatic symptom disorder may be frequently confused with hypochondriasis and illness anxiety disorder. 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.

Somatic Symptom Disorder Vs. Illness Anxiety Disorder

With 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

Somatic Symptom Disorder Vs. Conversion Disorder

Somatic symptom disorder can cause a person to experience physical symptoms that are very real to them, even though there is no medical evidence. In conversion disorder, an individual may experience blindness, paralysis, or other nervous system impairments that can not be explained by a medical cause. These symptoms often appear after a time of extreme stress.

Somatic Symptom Disorder Vs. Factitious Disorder

In somatic symptom disorder, the person affected genuinely feels symptoms and believes that they are sick. The symptoms cause them very real distress. In factitious disorder, on the other hand, a person fakes being sick, or sometimes even makes themselves sick in order to deceive others. Both are serious mental disorders.¹

Somatic Symptom Disorder Symptoms

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 person’s life, routine, and daily functioning.¹

Physical Symptoms of Somatic Symptom Disorder

Physical symptoms of somatic symptom disorder may include:²

• 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

Mental Symptoms of SSD

Someone’s 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 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.³

Causes of Somatic Symptom Disorder

Like other mental health conditions, somatic symptom disorder does not have one 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, or emotional abuse
• Childhood neglect
• Substance misuse
• 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.

Long-Term Effects of Living With Somatic Symptom Disorder

While people suffering with somatic symptom disorder often don’t have an identifiable medical diagnosis, the distress they endure is very real. The physical and mental anguish caused by their symptoms can cause a great deal of suffering, and frequent medical tests and procedures can be time-consuming, costly, and lead to other health problems.

Some of the long-term impacts of living with somatic symptom disorder can include:

• Impaired quality of life due to focusing so much on symptoms
• Health problems caused by unnecessary tests and procedures
• Anxiety
• Depression
• Negative impact on relationships
• Financial strain due to the amount of medical appointments
• Reluctance to seek mental health treatment
• Misdiagnosis

Is Somatic Symptom Disorder Preventable?

Somatic symptom disorder may not be completely preventable, as many of the factors that contribute to it are unknown. However, there are things you can do to cope with your anxiety:

• Seek treatment early for any symptoms of anxiety or depression: Therapy with a licensed mental health provider can help you build coping skills and reduce the impact of anxiety and depression.
• Learn to recognize when you’re stressed: Learn your own stress signals and triggers, and take steps now to reduce your stress level. Many mental health symptoms worsen in times of extreme stress, so keeping baseline stress level low is important.
• If you think you have SSD, seek help as early as possible: Many with somatic symptom disorder resist mental health treatment because they are convinced that the problem is not mental. Seeking help early can help reduce your distress and likely be more effective when started sooner. 
• Stick with your treatment plan: Stick with whatever treatment plan you and your provider agree on, and give it time to work.

Practical Ways to 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

• Shift your focus to health instead of 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.
• Reduce your stress levels: 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.
• 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 risky sex only increase long-term stress.
• Renew relationships and avoid talking too much about your physical symptoms: 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.
• Discover other life purposes: It may seem like seeking medical treatment has been your motivating purpose for some time, but that result was only the effect of SSD controlling your 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.
• 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.
• Be patient: 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.

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.³

Therapy

Therapy will play the central role in the treatment of somatic symptom disorder. A person with SSD may have very limited 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:³

• 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

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 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.

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. Antidepressants are typically safe and effective when used as prescribed, but distressing or dangerous side effects can occur in some situations.⁵

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

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.

Somatic Symptom Disorder Statistics

Somatic symptom disorder has only been an official APA diagnosis since 2013, 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.