Epidemiology and Etiology
- Estimated prevalence in the general population: 0.1%
- More commonly affects women
- Risk factors:
- Low socioeconomic status
- Low educational level
- Minority population
- Often associated with physical and sexual abuse in childhood
- Poor awareness of emotions and emotional development during childhood due to parental neglect or lack of emotional closeness
- Excessive anxiety and attention to bodily processes or illnesses
- Mood disorders
- Substance use disorder
Age of onset
- Manifests in adolescence and early adulthood
- Older adults presenting for the first time with somatic symptoms are much more likely to have an occult organic condition than somatic symptom disorder.
- Presents with multiple somatic complaints, often across various organ systems
- Symptoms may include (but are not limited to) nonspecific pain, fatigue, GI distress, palpitations, weakness, and numbness.
- Note: Descriptions of somatic symptoms may vary depending on cultural factors.
- Patients are significantly distressed about their symptoms and have a high level of worry about their health.
- Patients’ concerns are time consuming and limit activities of daily living.
A diagnosis of somatic symptom disorder (SSD) may not be made until the symptoms have no other clinical explanation.
The following diagnostic tests may be used to explain or rule out physical causes of the symptoms.
- Basic metabolic panel
- Thyroid panel
- Liver function tests
- Toxicology screen
DSM-V diagnostic criteria
- At least 1 somatic symptom that causes distress or functional impairment
- Overwhelming thoughts, emotions, or actions associated with somatic symptoms, as demonstrated by 1 or more of the following:
- Persistent thoughts about the seriousness of the symptoms
- Severe and constant anxiety about the symptoms or one’s health
- Devoting exorbitant time and energy to the symptoms
- The overall disorder is present > 6 months (specific symptoms may change).
|Symptoms||Excessive worry||Exam findings|
|Somatic symptom disorder||+||+||–|
|Illness anxiety disorder||–||+||–|
Individuals with SSD often feel misunderstood. Therefore, the primary goal of treatment is to form a therapeutic alliance with the patient.
- Regularly schedule visits with the same physician to establish a relationship and address patient concerns.
- Encourage functional behavior, such as relaxation techniques and moderate exercise.
- Avoid repetitive, risky, or costly diagnostic tests that serve to calm the patient.
- Patients should be discouraged from seeking multiple specialist opinions and ED consultations unless severe symptoms arise.
Whether to put the focus of treatment on the physical or psychiatric symptoms is often difficult to determine.
- CBT is the 1st-line treatment for most patients.
- Treatment of pain should be accomplished with nonopioid analgesics.
- Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have shown modest efficacy compared with placebo.
- Illness anxiety disorder: a condition characterized by prolonged and exaggerated concern about one’s health and possible illness. Patients fear or are convinced that they have a disease and interpret minor or normal bodily symptoms as signs of serious medical conditions. Somatic symptoms are only mild or nonexistent.
- Conversion disorder: the presence of symptoms or deficits that affect voluntary motor or sensory function in a way that suggests a neurological condition but is not explained by medical findings. Diagnosis is clinical, and management includes psychological and physical therapy. Unlike SSD, the motor or sensory symptoms of conversion disorder are specific and more well defined.
- Delusional disorder: a psychiatric condition in which patients cannot tell the difference between reality and imagination. These delusions have a fixed quality. Compared with delusional disorder, individuals with SSD are able to accept the possibility that they may not have a certain disease.
- American Psychiatric Association. (2013). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- D’Souza RS, Hooten WM. Somatic Syndrome Disorders. [Updated 2021 Mar 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK532253/
- Sadock, BJ, Sadock, VA, & Ruiz, P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Chapter 13, Psychosomatic medicine, pages 465-503. Philadelphia, PA: Lippincott Williams and Wilkins.
- Henningsen P. (2018). Management of somatic symptom disorder. Dialogues in clinical neuroscience, 20(1), 23–31. https://doi.org/10.31887/DCNS.2018.20.1/phenningsen