Somatic Symptom and Related Disorders
Learn
One or more distressing somatic symptoms, accompanied by excessive thoughts, feelings, or behaviors related to those symptoms, causing significant disruption to daily life.
Somatic Symptom Disorder centers on real, distressing physical symptoms -- pain, fatigue, GI complaints, or others -- combined with a disproportionate amount of thought, worry, time, or energy devoted to those symptoms. Unlike a diagnosis that hinges on whether a symptom is medically explained, SSD can be diagnosed whether or not a medical cause is found, because what defines it is the excessive response to the symptom, not the symptom's medical explicability.
Can begin at any age; presentations in youth are more often centered on specific complaints like abdominal pain or headache, and can be difficult to distinguish from ordinary somatic complaints of childhood without careful assessment of the excessive-response criterion.
Impairment often centers on the practical consequences of the excessive symptom focus -- repeated medical visits and testing, work or school absence tied to symptom preoccupation, and strain on relationships from the level of health-related concern and care-seeking.
A specifier for predominant pain exists when pain is the primary symptom; a persistent specifier applies when severe symptoms, marked impairment, and long duration (more than 6 months) characterize the presentation, marking a more chronic course.
The idiom of distress through which physical symptoms are experienced and communicated varies substantially across cultural contexts, and some cultures more readily express psychological distress through somatic language -- clinicians should be cautious not to pathologize culturally normative styles of describing distress while still recognizing when the excessive-thought/behavior criteria are genuinely met.
A common misconception is that Somatic Symptom Disorder means 'the symptoms are not real' or 'it's all in the person's head.' The physical symptoms are genuinely experienced and distressing; the diagnosis is about the excessive thoughts, feelings, and behaviors in response to real symptoms, not about whether the symptoms themselves are medically explained or 'fake.'
If the worry about illness persists with minimal or no actual physical symptom anchoring it, reconsider Illness Anxiety Disorder instead.
A 38-year-old has chronic back pain confirmed on imaging, but spends several hours daily researching possible causes, has seen six specialists in a year each time convinced something serious is being missed, and has stopped working due to the combination of pain and preoccupation.
Know
Somatic Symptom Disorder is a real, distressing physical symptom plus a disproportionate amount of thought, worry, or behavior devoted to it -- diagnosable regardless of whether a medical cause is found.
Notice
In a case, notice a genuine physical symptom anchoring excessive health-related thought, anxiety, or care-seeking behavior, not simply a worried patient.
Distinguish
Distinguish from Illness Anxiety Disorder by whether an actual distressing somatic symptom is present and driving the concern.
Recognize
One or more somatic symptoms that are distressing or disrupt daily life, plus excessive thoughts (about the seriousness of symptoms), persistently high anxiety about health or symptoms, or excessive time/energy devoted to symptoms/health concerns, persisting typically 6+ months (though any one symptom may not be continuously present).
Distinguish
Distinguish from Illness Anxiety Disorder by whether an actual distressing somatic symptom is present and driving the concern.
Illness Anxiety Disorder involves high illness-related anxiety with minimal or no actual somatic symptoms present -- the worry exists largely independent of a real physical complaint. Somatic Symptom Disorder specifically requires a real, distressing somatic symptom anchoring the excessive thoughts/feelings/behaviors; the presence of an actual symptom driving the concern is the deciding feature.
Students often treat these as the same disorder with different names. They aren't: SSD is fundamentally a symptom-focused disorder with an anxious/behavioral overlay; IAD is fundamentally an anxiety disorder about illness with little or no symptom anchor.
Other Specified/Unspecified Somatic Symptom and Related Disorder is sometimes assumed to be a lesser or vaguer diagnosis than Somatic Symptom Disorder, when in fact it requires the same careful assessment, with the added step of documenting the specific reason full criteria were not met.
Both are sometimes casually described as 'stress affecting health,' but only one requires a diagnosed medical condition whose course is demonstrably worsened by the psychological factor.
Reason
Apply
Distinguish Somatic Symptom Disorder's real-symptom-plus-excessive-response pattern from Illness Anxiety Disorder's symptom-independent worry.
Distinguish Psychological Factors Affecting Other Medical Conditions, where a psychological factor measurably worsens a diagnosed disease, from Somatic Symptom Disorder's excessive preoccupation with symptoms.
Apply the 6-month duration criterion distinguishing Brief Somatic Symptom Disorder from full Somatic Symptom Disorder.
Retrieve
2 question(s) reference this disorder. Practice Somatic Symptom Disorder →
Master