Somatic symptom disorder

Overview

Somatic symptom disorder is characterized by an extreme focus on physical symptoms — such as pain or fatigue — that causes major emotional distress and problems functioning. You may or may not have another diagnosed medical condition associated with these symptoms, but your reaction to the symptoms is not normal.

You often think the worst about your symptoms and frequently seek medical care, continuing to search for an explanation even when other serious conditions have been excluded. Health concerns may become such a central focus of your life that it's hard to function, sometimes leading to disability.

If you have somatic symptom disorder, you may experience significant emotional and physical distress. Treatment can help ease symptoms, help you cope and improve your quality of life.

Symptoms

Symptoms of somatic symptom disorder may be:

• Specific sensations, such as pain or shortness of breath, or more general symptoms, such as fatigue or weakness
• Unrelated to any medical cause that can be identified, or related to a medical condition such as cancer or heart disease, but more significant than what's usually expected
• A single symptom, multiple symptoms or varying symptoms
• Mild, moderate or severe

Pain is the most common symptom, but whatever your symptoms, you have excessive thoughts, feelings or behaviors related to those symptoms, which cause significant problems, make it difficult to function and sometimes can be disabling.

These thoughts, feelings and behaviors can include:

• Constant worry about potential illness
• Viewing normal physical sensations as a sign of severe physical illness
• Fearing that symptoms are serious, even when there is no evidence
• Thinking that physical sensations are threatening or harmful
• Feeling that medical evaluation and treatment have not been adequate
• Fearing that physical activity may cause damage to your body
• Repeatedly checking your body for abnormalities
• Frequent health care visits that don't relieve your concerns or that make them worse
• Being unresponsive to medical treatment or unusually sensitive to medication side effects
• Having a more severe impairment than is usually expected from a medical condition

For somatic symptom disorder, more important than the specific physical symptoms you experience is the way you interpret and react to the symptoms and how they impact your daily life.

When to see a doctor

Because physical symptoms can be related to medical problems, it's important to be evaluated by your primary care provider if you aren't sure what's causing your symptoms. If your primary care provider believes that you may have somatic symptom disorder, he or she can refer you to a mental health professional.

Caring for a loved one

When physical symptoms considered to be somatic symptom disorder occur, it can be difficult to accept that a life-threatening illness has been eliminated as the cause. Symptoms cause very real distress for the person and reassurance isn't always helpful. Encourage your loved one to consider the possibility of a mental health referral to learn ways to cope with the reaction to symptoms and any disability it causes.

Physical disability may cause the person to be dependent and need extra physical care and emotional support that can exhaust caregivers and cause stress on families and relationships. If you feel overwhelmed by your role as caregiver, you may want to talk to a mental health professional to address your own needs.

Causes

The exact cause of somatic symptom disorder isn't clear, but any of these factors may play a role:

• Genetic and biological factors, such as an increased sensitivity to pain
• Family influence, which may be genetic or environmental, or both
• Personality trait of negativity, which can impact how you identify and perceive illness and bodily symptoms
• Decreased awareness of or problems processing emotions, causing physical symptoms to become the focus rather than the emotional issues
• Learned behavior — for example, the attention or other benefits gained from having an illness; or "pain behaviors" in response to symptoms, such as excessive avoidance of activity, which can increase your level of disability

Risk factors

Risk factors for somatic symptom disorder include:

• Having anxiety or depression
• Having a medical condition or recovering from one
• Being at risk of developing a medical condition, such as having a strong family history of a disease
• Experiencing stressful life events, trauma or violence
• Having experienced past trauma, such as childhood sexual abuse
• Having a lower level of education and socio-economic status

Complications

Somatic symptom disorder can be associated with:

• Poor health
• Problems functioning in daily life, including physical disability
• Problems with relationships
• Problems at work or unemployment
• Other mental health disorders, such as anxiety, depression and personality disorders
• Increased suicide risk related to depression
• Financial problems due to excessive health care visits

Prevention

Little is known about how to prevent somatic symptom disorder. However, these recommendations may help.

• If you have problems with anxiety or depression, seek professional help as soon as possible.
• Learn to recognize when you're stressed and how this affects your body — and regularly practice stress management and relaxation techniques.
• If you think you have somatic symptom disorder, get treatment early to help stop symptoms from getting worse and impairing your quality of life.
• Stick with your treatment plan to help prevent relapses or worsening of symptoms.