Somatic symptom disorder, also known as somatoform disorder or somatization disorder, is chronic

somatization Somatization is the generation of somatic symptoms due to psychological distress, often coinciding with a tendency to seek medical help for them. The term ''somatization'' was introduced by Wilhelm Stekel in 1924. Somatization is a worldwide ph ...

. One or more chronic physical symptoms coincide with excessive and

maladaptive In evolution, a maladaptation ( /ˌmælædæpˈteɪʃən/) is a trait that is (or has become) more harmful than helpful, in contrast with an adaptation, which is more helpful than harmful. All organisms, from bacteria to humans, display maladapt ...

thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment. Manifestations of somatic symptom disorder are variable; symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing

chronic illness A chronic condition (also known as chronic disease or chronic illness) is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the ...

or medical condition. Several studies have found a high rate of comorbidity with

major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive depression (mood), low mood, low self-esteem, and anhedonia, loss of interest or pleasure in normally ...

generalized anxiety disorder Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning. Individuals with GAD are often overly con ...

, and

phobia A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected ...

s. Somatic symptom disorder is frequently associated with functional pain syndromes like

fibromyalgia Fibromyalgia (FM) is a functional somatic syndrome with symptoms of widespread chronic pain, accompanied by fatigue, sleep disturbance including awakening unrefreshed, and Cognitive deficit, cognitive symptoms. Other symptoms can include he ...

and

irritable bowel syndrome Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating, and changes in the consistency of bowel movements. These symptoms may ...

(IBS). Somatic symptom disorder typically leads to poor functioning,

interpersonal In social psychology, an interpersonal relation (or interpersonal relationship) describes a social association, connection, or affiliation between two or more people. It overlaps significantly with the concept of social relations, which are ...

issues,

unemployment Unemployment, according to the OECD (Organisation for Economic Co-operation and Development), is the proportion of people above a specified age (usually 15) not being in paid employment or self-employment but currently available for work du ...

or problems at work, and financial strain as a result of excessive healthcare visits. The cause of somatic symptom disorder is unknown. Symptoms may result from a heightened awareness of specific physical sensations paired with a tendency to interpret these experiences as signs of a medical ailment. The diagnosis is controversial, as people with a physical illness can be misdiagnosed with it. This is especially true for girls and women, who are more often dismissed when they present with physical symptoms.

Signs and symptoms

Somatic symptom disorder can be detected by an ambiguous and often inconsistent history of symptoms that are rarely relieved by medical treatments. Additional signs of somatic symptom disorder include interpreting normal sensations for medical ailments, avoiding

physical activity Physical activity is defined as any voluntary movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/07/2018 ...

, being disproportionately sensitive to medication side effects, and seeking medical care from several physicians for the same concerns. Manifestations of somatic symptom disorder are highly variable. Recurrent ailments usually begin before the age of 30; most patients have many somatic symptoms, while others only experience one. The severity may fluctuate, but symptoms rarely go away completely for long periods of time. Symptoms might be specific, such as regional pain and localized sensations, or general, such as

fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...

, muscle aches, and

malaise In medicine, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. It is considered a vague termdescribing the state of simply not feeling well. The word has exist ...

. Those suffering from somatic symptom disorder experience recurring and obsessive feelings and thoughts concerning their well-being. Common examples include severe anxiety regarding potential ailments, misinterpreting normal sensations as indications of severe illness, believing that symptoms are dangerous and serious despite lacking medical basis, claiming that medical evaluations and treatment have been inadequate, fearing that engaging in physical activity will harm the body, and spending a disproportionate amount of time thinking about symptoms. Somatic symptom disorder pertains to how an individual interprets and responds to symptoms as opposed to the symptoms themselves. Somatic symptom disorder can occur even in those who have an underlying

or medical condition. When a somatic symptom disorder coexists with another medical ailment, people overreact to the ailment's adverse effects. They may be unresponsive toward treatment or unusually sensitive to drug side effects. Those with somatic symptom disorder who also have another physical ailment may experience significant impairment that is not expected from the condition.

Comorbidities

Most research that looked at additional

mental disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

or self-reported psychopathological symptoms among those with somatic symptom disorder identified significant rates of

comorbidity In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sicknes ...

with depression and

anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

, but other psychiatric comorbidities were not usually looked at.

Major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive depression (mood), low mood, low self-esteem, and anhedonia, loss of interest or pleasure in normally ...

, and

s were the most common concurrent conditions. In studies evaluating different physical ailments, 41.5% of people with

semantic dementia In neurology, semantic dementia (SD), also known as semantic variant primary progressive aphasia (svPPA), is a progressive neurodegenerative disorder characterized by loss of semantic memory in both the verbal and non-verbal domains. However, t ...

, 11.2% of subjects with

Alzheimer's disease Alzheimer's disease (AD) is a neurodegenerative disease and the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems wit ...

, 25% of female patients suffering from non-HIV lipodystrophy, and 18.5% of patients with

congestive heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF typically pr ...

fulfilled somatic symptom disorder criteria. 25.6% of

patients met the somatic symptom disorder criteria exhibited higher depression rates than those who did not. In one study, 28.8% of those with somatic symptom disorder had

asthma Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wh ...

, 23.1% had a heart condition, and 13.5% had

gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and Joint effusion, swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crysta ...

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

, or

osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...

Complications

Alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

and

drug abuse Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder, differing definitions ...

are frequently observed, and sometimes used to alleviate symptoms, increasing the risk of dependence on

controlled substance A controlled substance is generally a drug or chemical whose manufacture, possession and use is regulated by a government, such as illicitly used drugs or prescription medications that are designated by law. Some treaties, notably the Sing ...

s. Other complications include poor functioning, problems with relationships,

or difficulties at work, and financial stress due to excessive hospital visits.

Causes

Somatic symptoms can stem from a heightened awareness of sensations in the body, alongside the tendency to interpret those sensations as ailments. Studies suggest that risk factors of somatic symptoms include childhood neglect,

sexual abuse Sexual abuse or sex abuse is abusive sexual behavior by one person upon another. It is often perpetrated using physical force, or by taking advantage of another. It often consists of a persistent pattern of sexual assaults. The offender is re ...

, a chaotic lifestyle, and a history of substance and alcohol abuse.

Psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...

stressors, such as unemployment and reduced job performance, may also be risk factors. There could also be a genetic element. A study of

monozygotic Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of Twin Last Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two e ...

and

dizygotic Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of Twin Last Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two e ...

twins found that genetic components contributed 7% to 21% of somatic symptoms, with the remainder related to

environmental factors An environmental factor, ecological factor or eco factor is any factor, abiotic or biotic, that influences living organisms. Abiotic factors include ambient temperature, amount of sunlight, air, soil, water and pH of the water soil in which an ...

. In another study, various

single nucleotide polymorphisms In genetics and bioinformatics, a single-nucleotide polymorphism (SNP ; plural SNPs ) is a germline substitution of a single nucleotide at a specific position in the genome. Although certain definitions require the substitution to be present in ...

were linked to somatic symptoms.

Psychological

Evidence suggests that along with more broad factors such as early

childhood trauma Childhood trauma is often described as serious adverse childhood experiences. Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and phys ...

insecure attachment Attachment theory is a psychological and evolutionary framework, concerning the relationships between humans, particularly the importance of early bonds between infants and their primary caregivers. Developed by psychiatrist and psychoanalys ...

, negative psychological factors including catastrophizing,

negative affectivity In psychology, negative affectivity (NA), or negative affect, is a personality variable that involves the experience of negative emotions and poor self-concept. Negative affectivity subsumes a variety of negative emotions, including anger, contem ...

, rumination, avoidance, health anxiety, or a poor physical self-concept have a significant impact on the shift from unproblematic somatic symptoms to a severely debilitating somatic symptom disorder. Those who experience more negative psychological characteristics may regard medically unexplained symptoms to be more threatening and, therefore, exhibit stronger cognitive, emotional, and behavioral awareness of such symptoms. In addition, evidence suggests that negative psychological factors have a significant impact on the impairments and behaviors of people suffering from somatic symptom disorder, as well as the long-term stability of such symptoms.

Psychosocial

stresses and

cultural norms A social norm is a shared standard of acceptable behavior by a group. Social norms can both be informal understandings that govern the behavior of members of a society, as well as be codified into rules and laws. Social normative influences or so ...

influence how patients present to their

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

s. American and Koreans engaged in a study to measure

within the

cultural Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...

context. It was discovered that Korean participants used more body-related phrases while discussing their connections with stressful events and experienced more

sympathy Sympathy is the perception of, understanding of, and reaction to the Mental distress, distress or need of another life form. According to philosopher David Hume, this sympathetic concern is driven by a switch in viewpoint from a personal perspe ...

when asked to read texts using somatic expressions when discussing their emotions. Those raised in environments where expressing emotions during stages of development is discouraged face the highest risk of somatization. In

primary care Primary care is a model of health care that supports first-contact, accessible, continuous, comprehensive, and coordinated person-focused care. It aims to optimise population health and reduce disparities across the groups by ensuring equitable ...

settings, studies indicated that somaticizing patients had much greater rates of unemployment and decreased occupational functioning than non-somaticizing patients. Traumatic life events may cause the development of somatic symptom disorder. Most people with somatic symptom disorder originate from

dysfunctional In psychology, abnormality (also dysfunctional behavior, maladaptive behavior, or deviant behavior) is a behavioral characteristic assigned to those with conditions that are regarded as dysfunctional. Behavior is considered to be abnormal when i ...

homes. A meta-analysis study revealed a connection between sexual abuse and functional gastrointestinal syndromes,

chronic pain Chronic pain is pain that persists or recurs for longer than 3 months.https://icd.who.int/browse/2025-01/mms/en#1581976053 It is also known as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is in cont ...

non-epileptic seizure Non-epileptic seizures (NES) are paroxysmal events that resemble epileptic seizures but are not caused by abnormal electrical discharges in the brain. They are not a single condition, but a descriptive category encompassing multiple disorders th ...

s, and

chronic pelvic pain Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis. Common causes in include ...

Physiological

The hypothalamo pituitary adrenal axis (HPA) has a crucial role in

stress response The fight-or-flight or the fight-flight-freeze-or-fawn (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first describ ...

. While the

HPA axis The pascal (symbol: Pa) is the unit of pressure in the International System of Units (SI). It is also used to quantify internal pressure, stress, Young's modulus, and ultimate tensile strength. The unit, named after Blaise Pascal, is an SI ...

may become more active with depression, there is evidence of hypocortisolism in somatization. In somatic disorder, there is a negative connection between elevated pain scores and 5-hydroxy indol acetic acid (5-HIAA) and

tryptophan Tryptophan (symbol Trp or W) is an α-amino acid that is used in the biosynthesis of proteins. Tryptophan contains an α-amino group, an α-carboxylic acid group, and a side chain indole, making it a polar molecule with a non-polar aromat ...

levels. It has been suggested that

proinflammatory Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', ''d ...

processes may have a role in somatic symptom disorder, such as an increase of non-specific somatic symptoms and sensitivity to painful

stimuli A stimulus is something that causes a physiological response. It may refer to: *Stimulation **Stimulus (physiology), something external that influences an activity **Stimulus (psychology), a concept in behaviorism and perception *Stimulus (economi ...

Proinflammatory Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', ''d ...

activation and

anterior cingulate cortex In human brains, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33. It is involved ...

activity have been shown to be linked in those who experienced stressful life events for an extended period of time. It is further claimed that increased activity of the anterior cingulate cortex, which acts as a bridge between attention and emotion, leads to increased sensitivity of unwanted stimuli and bodily sensations.

Pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

is a multifaceted experience, not just a sensation. While

nociception In physiology, nociception , also nocioception; ) is the Somatosensory system, sensory nervous system's process of encoding Noxious stimulus, noxious stimuli. It deals with a series of events and processes required for an organism to receive a pai ...

refers to afferent neural activity that transmits sensory information in response to stimuli that may cause tissue damage, pain is a conscious experience requiring cortical activity and can occur in the absence of nociception. Those with somatic symptom disorder are thought to exaggerate their symptoms through choice perception and perceive them in accordance with an ailment. This idea has been identified as a

cognitive Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...

style known as "somatosensorial amplification". The term " central sensitization" has been created to describe the

neurobiological Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions, and its disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, ...

notion that those predisposed to somatization have an overly sensitive

neural network A neural network is a group of interconnected units called neurons that send signals to one another. Neurons can be either biological cells or signal pathways. While individual neurons are simple, many of them together in a network can perfor ...

. Harmless and mild

stimulate the

nociceptive In physiology, nociception , also nocioception; ) is the sensory nervous system's process of encoding noxious stimuli. It deals with a series of events and processes required for an organism to receive a painful stimulus, convert it to a molecular ...

specific dorsal horn cells after central sensitization. As a result, pain is felt in response to stimuli that would not typically cause pain.

Neuroimaging evidence

Some literature reviews of cognitive–affective neuroscience on somatic symptom disorder suggested that catastrophization in patients with somatic symptom disorders tends to present a greater vulnerability to pain. The relevant brain regions include the dorsolateral prefrontal, insular, rostral anterior cingulate, premotor, and parietal cortices.

Genetic

Genetic investigations have suggested modifications connected to the

monoaminergic Monoaminergic means "working on monoamine neurotransmitters", which include serotonin, dopamine, norepinephrine, epinephrine, and histamine. A monoaminergic, or monoaminergic drug, is a chemical, which functions to directly modulate the seroton ...

system, in particular, may be relevant while a shared genetic source remains unknown. Researchers take into account the various processes involved in the development of somatic symptom disorder as well as the interactions between various

biological Biology is the scientific study of life and living organisms. It is a broad natural science that encompasses a wide range of fields and unifying principles that explain the structure, function, growth, origin, evolution, and distribution of ...

and psychosocial factors. Given the high occurrence of trauma, particularly throughout childhood, it has been suggested that the

epigenetic In biology, epigenetics is the study of changes in gene expression that happen without changes to the DNA sequence. The Greek prefix ''epi-'' (ἐπι- "over, outside of, around") in ''epigenetics'' implies features that are "on top of" or "in ...

changes could be explanatory. Another study found that the

glucocorticoid receptor The glucocorticoid receptor (GR or GCR) also known by its gene name ''NR3C1'' ( nuclear receptor subfamily 3, group C, member 1) is the steroid receptor for glucocorticoids such as cortisol. The GR is expressed in almost every cell in the bod ...

gene ( NR3C1) is hypomethylated in those with somatic symptom disorder and in those with depression.

Diagnosis

Because those with somatic syndrome disorder typically have comprehensive previous workups, minimal laboratory testing is encouraged. Excessive testing increases the possibility of

false positive A false positive is an error in binary classification in which a test result incorrectly indicates the presence of a condition (such as a disease when the disease is not present), while a false negative is the opposite error, where the test resu ...

results, which may result in further interventions, associated risks, and greater expenses. While some practitioners order tests to reassure patients, research shows that

diagnostic testing A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic ...

fails to alleviate somatic symptoms. Specific tests, such as thyroid function assessments, urine drug screens, restricted blood studies, and minimal radiological imaging, may be conducted to rule out somatization because of medical issues.

Somatic Symptom Scale – 8

The Somatic Symptom Scale – 8 (SSS-8) is a short self-report questionnaire that is used to evaluate somatic symptoms. It examines the perceived severity of common somatic symptoms. The SSS-8 is a condensed version of the well-known Patient Health Questionnaire-15 (PHQ-15). On a five-point scale, respondents rate how much stomach or digestive issues, back discomfort, pain in the legs, arms, or joints,

headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...

chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

shortness of breath Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that con ...

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to Balance disorder, disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a ...

, feeling tired or having low energy, and

trouble sleeping Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

impacted them in the preceding seven days. Ratings are added together to provide a sum score that ranges from 0 to 32 points.

DSM-5

The fifth edition of the ''Diagnostic and Statistical Manual of Mental Disorders'' (

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...

) modified the entry titled "somatoform disorders" to "somatic symptom and related disorders", and modified other diagnostic labels and criteria. The DSM-5 criteria for somatic symptom disorder includes "one or more somatic symptoms which are

distressing Distressing (or weathered look) in the decorative arts is the activity of making a piece of furniture or object appear aged and older, giving it a "weathered look". There are many methods to produce an appearance of age and wear. Distressing is ...

or result in substantial impairment of daily life." Additional criteria, often known as B criteria, include "excessive thoughts, feelings, or behaviors regarding somatic symptoms or corresponding health concerns manifested by disproportionate and persistent thoughts about the severity of one's symptoms." It continues: "Although any one somatic symptom might not be consistently present, one's state of being symptomatic is continuous (typically lasting more than 6 months)." The DSM-5 includes five distinct descriptions for somatic symptom disorder. These include somatic symptom disorder with predominant pain, formally referred to as pain disorder, as well as classifications for mild, moderate, and severe symptoms.

International Classification of Diseases

The

ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...

includes bodily distress disorder, which bears similarities to somatic symptom disorder. While both conditions involve somatic symptoms, bodily distress disorder appears to be more strongly associated with the experience of physical symptoms, whereas somatic symptom disorder is more closely linked to psychological distress. Patients meeting the criteria for both diagnoses tend to exhibit greater symptom severity across various psychosocial domains. Bodily distress disorder is characterized by the presence of distressing bodily symptoms and excessive attention devoted to those symptoms. The ICD-11 further specifies that if another health condition is causing or contributing to the symptoms, the level of attention must be clearly excessive in relation to the nature and course of the condition.

Differential diagnosis

Somatic symptom disorder's widespread, non-specific symptoms may obscure and mimic the manifestations of other medical disorders, making diagnosis and therapy challenging. For example, conditions such as

adjustment disorder Adjustment disorder is a Mental disorder, mental and Abnormality (behavior), behavioral Mental disorder, disorder defined by a maladaptive response to a psychosocial stressor. The maladaptive response usually involves otherwise normal emotional a ...

body dysmorphic disorder Body dysmorphic disorder (BDD), also known in some contexts as dysmorphophobia, is a mental disorder defined by an overwhelming preoccupation with a perceived flaw in one's physical appearance. In BDD's delusional variant, the flaw is imagined ...

obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...

(OCD),

hypochondriasis Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that th ...

can also exhibit excessive and exaggerated emotional and behavioral responses. Other functional diseases with unknown

etiology Etiology (; alternatively spelled aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek word ''()'', meaning "giving a reason for" (). More completely, etiology is the study of the causes, origins ...

, such as

and

(IBS), tend not to present with excessive thoughts, feelings, or

behavior. Somatic symptom disorder overlaps with hypochondriasis and functional neurologic symptom disorder (FNsD), previously known as

conversion disorder Conversion disorder (CD) was a formerly diagnosed psychiatric disorder characterized by abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals diagnosed with CD presented with highly distressin ...

. Hypochondriasis is characterized by an obsession with having or developing a dangerous, undetected medical ailment, despite the absence of bodily symptoms. FNsD may present with one or more symptoms of various sorts: motor symptoms, which may involve

weakness Weakness is a symptom of many different medical conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, ...

paralysis Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...

; aberrant movements, including

tremor A tremor is an involuntary, somewhat rhythmic muscle contraction and relaxation involving neural oscillations, oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the h ...

or dystonic movements; abnormal gait patterns; and abnormal limb posture. The presenting symptoms in FNsD is loss of function, but in somatic symptom disorder, the emphasis is on the discomfort that specific symptoms produce. FNsD often lacks the overwhelming thoughts, feelings, and behaviors that characterize somatic symptom disorder.

Treatment

Rather than focusing on treating the symptoms, the key objective is to support the patient in

coping Coping refers to conscious or unconscious strategies used to reduce and manage unpleasant emotions. Coping strategies can be cognitions or behaviors and can be individual or social. To cope is to deal with struggles and difficulties in life. It ...

with symptoms, including both physical symptoms and psychological/behavioral (such as health anxiety and harmful behaviors). Early

psychiatric treatment Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental conditions. These include matters related to cognition, perceptions, mood, emotion, and behavior. Initial psychiatric assessment of ...

is advised. Evidence suggests that SSRIs and SNRIs can lower pain perception. Because people with somatic symptom disorder may have a low threshold for adverse reactions, medication should be started at the lowest possible dose and gradually increased to produce a

therapeutic effect Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. This is true whether the result was expected, unexpected, or even an unintended consequence. An adverse effect (i ...

Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

(CBT) has been linked to significant improvements in patient-reported function and somatic symptoms, a reduction in healthcare expenses, and a reduction in symptoms of depression. CBT aims to help patients realize their ailments are not catastrophic and to enable them to gradually return to activities they previously engaged in, without fear of "worsening their symptoms". Consultation and collaboration with a

primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...

also demonstrated some effectiveness. Furthermore, brief psychodynamic interpersonal psychotherapy (PIT) for patients with somatic symptom disorder has been proven to improve the physical quality of life in patients with many difficult-to-treat and medically unexplained symptoms over time CBT can help in some of the following ways: * Learn to reduce stress * Learn to cope with physical symptoms * Learn to deal with depression and other psychological issues * Improve quality of life * Reduce preoccupation with symptom

Electroconvulsive therapy Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment that causes a generalized seizure by passing electrical current through the brain. ECT is often used as an intervention for mental disorders when other treatments are inadequ ...

(ECT) has been used in treating somatic symptom disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT. Overall, psychologists recommend addressing a common difficulty in patients with somatic symptom disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner.

Prognosis

Somatic symptom disorder is typically persistent, with symptoms that wax and wane. Chronic limitations in general function, substantial psychological impairment, and a reduction in quality of life are all common. Some investigations suggest people can recover; the natural history of the illnesses implies that around 50% to 75% of patients with medically unexplained symptoms improve, whereas 10% to 30% deteriorate. Fewer physical symptoms and better baseline functioning are stronger prognostic indicators. A strong, positive relationship between the physician and the patient is crucial, and it should be accompanied by frequent, supportive visits to avoid the temptation to medicate or test when these interventions are not obviously necessary.

Epidemiology

Somatic symptom disorder affects 5% to 7% of the general population, with a higher female representation, and can arise throughout childhood, adolescence, or adulthood. A 2015 study found prevalence of 11% (n = 5738). Evidence suggests that the emergence of prodromal symptoms often begins in childhood and that symptoms fitting the criteria for somatic symptom disorder are common during adolescence. A community study of adolescents found that 5% had persistent distressing physical symptoms paired with psychological concerns. In the primary care patient population, the rate rises to around 17%. Patients with functional illnesses such as fibromyalgia, irritable bowel syndrome, and

chronic fatigue syndrome Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling Chronic condition, chronic illness. People with ME/CFS experience profound fatigue that does not go away with rest, as well as sleep issues and problems with memory ...

have a greater prevalence of somatic symptom disorder. The reported frequency of somatic symptom disorder, as defined by the DSM-5 criteria, ranges from 25 to 60% among these patients. There are cultural differences in the prevalence of somatic symptom disorder. For example, somatic symptom disorder and symptoms were found to be significantly more common in

Puerto Rico ; abbreviated PR), officially the Commonwealth of Puerto Rico, is a Government of Puerto Rico, self-governing Caribbean Geography of Puerto Rico, archipelago and island organized as an Territories of the United States, unincorporated territo ...

. In addition, the diagnosis is also more prevalent among African Americans and those with less than a high school education or lower socioeconomic status. There is usually co-morbidity with other psychological disorders, particularly

mood disorders A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the ''Diagnostic ...

anxiety disorders Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...

. Research also showed comorbidity between somatic symptom disorder and

personality disorder Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture. ...

s, especially antisocial, borderline,

narcissistic Narcissism is a self-centered personality style characterized as having an excessive preoccupation with oneself and one's own needs, often at the expense of others. Narcissism, named after the Greek mythological figure ''Narcissus'', has evolv ...

, histrionic,

avoidant Avoidant personality disorder (AvPD), or anxious personality disorder, is a cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy (despite an intense desire for it), severe feelings of inadeq ...

, and dependent personality disorder. About 10–20% of female first degree relatives also have somatic symptom disorder and male relatives have increased rates of

alcoholism Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...

and sociopathy.

History

Somatization is an idea that physicians have been attempting to comprehend since the dawn of time. The

Egyptians Egyptians (, ; , ; ) are an ethnic group native to the Nile, Nile Valley in Egypt. Egyptian identity is closely tied to Geography of Egypt, geography. The population is concentrated in the Nile Valley, a small strip of cultivable land stretchi ...

and

Sumer Sumer () is the earliest known civilization, located in the historical region of southern Mesopotamia (now south-central Iraq), emerging during the Chalcolithic and Early Bronze Age, early Bronze Ages between the sixth and fifth millennium BC. ...

ians were reported to have utilized the notions of

melancholia Melancholia or melancholy (from ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complain ...

and

hysteria Hysteria is a term used to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, female hysteria was considered a diagnosable physical illness in women. It is assumed that the bas ...

as early as 2600 BC. For many years, somatization was used in conjunction with the terms ''

'', ''

'', and ''

''.

Wilhelm Stekel Wilhelm Stekel (; 18 March 1868 – 25 June 1940) was an Austrian physician and psychologist, who became one of Sigmund Freud's earliest followers, and was once described as "Freud's most distinguished pupil". According to Ernest Jones, "Stekel ...

, a German

psychoanalyst PsychoanalysisFrom Greek: and is a set of theories and techniques of research to discover unconscious processes and their influence on conscious thought, emotion and behaviour. Based on dream interpretation, psychoanalysis is also a talk th ...

, was the first to introduce the term

, while

Paul Briquet Paul Briquet or Pierre Briquet (12 January 1796 – 25 November 1881) was a French physician and psychologist who advanced the reasoned treatment of disturbed people said to be hysterics. Briquet became a medical doctor in 1824, a professor in 18 ...

was the first to characterize what is now known as somatic symptom disorder. Briquet reported respondents who had been unwell for most of their lives and complained of a variety of symptoms from various organ systems. Despite many appointments, hospitalizations, and tests, symptoms continue. Somatic symptom disorder was later dubbed "Briquet Syndrome" in his honor.

Controversy

Somatic symptom disorder has long been a contentious diagnosis because it was based solely on negative criteria, namely the absence of a medical explanation for the presenting physical problems. As a result, any person suffering from a poorly understood illness may meet the criteria for this psychological diagnosis, regardless of whether they exhibit psychiatric symptoms in the traditional sense.

Misdiagnosis

Allen Frances Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as ch ...

, chair of the DSM-IV task force, claimed that the DSM-5's somatic symptom disorder brings with it a risk of mislabeling a sizable proportion of the population as mentally ill.