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Definition

Somatic symptom disorder (SSD) occurs when a person feels extreme, exaggerated anxiety about physical symptoms. The person has such intense thoughts, feelings, and behaviors related to the symptoms, that they feel they cannot do some of the activities of daily life. They may believe routine medical problems are life threatening. This anxiety may not improve despite normal test results and reassurance from the health care provider.

A person with SSD is not faking their symptoms. The pain and other problems are real. They may be caused by a medical problem. Often, no physical cause can be found. However, it is the extreme reaction and behaviors about the symptoms that are the main problem.

Causes

SSD usually begins before age 30. It occurs more often in women than in men. It's not clear why some people develop this condition. Certain factors may be involved:

• Having a negative outlook
• Being more physically and emotionally sensitive to pain and other sensations
• Family history or upbringing
• Genetics

People who have a history of physical or sexual abuse may be more likely to have this disorder. But not everyone with SSD has a history of abuse.

SSD is similar to illness anxiety disorder (hypochondria). This is when people are overly anxious about becoming sick or developing a serious disease. They fully expect they will become very ill at some point. Unlike SSD, with illness anxiety disorder, there are few or no actual physical symptoms.

Symptoms

Physical symptoms that can occur with SSD may include:

• Pain
• Fatigue or weakness
• Shortness of breath

Symptoms may be mild to severe. There may be one or more symptoms. They may come and go or change over time. Symptoms may be due to a medical condition but they also may have no clear cause.

How people feel and behave in response to these physical sensations are the main symptoms of SSD. These reactions must persist for 6 months or more. People with SSD may:

• Feel extreme anxiety about symptoms
• Feel concern that mild symptoms are a sign of serious disease
• Go to the provider for multiple tests and procedures, but not believe the results if they are normal
• Feel that the provider does not take their symptoms seriously enough or has not done a good job treating the problem
• Spend a lot of time and energy dealing with health concerns
• Have trouble functioning because of thoughts, feelings, and behaviors about symptoms

Exams and Tests

You will have a complete physical exam. Your provider may do certain tests to find any physical causes of your symptoms. The types of tests that are done depend on what symptoms you have.

Your provider may refer you to a mental health provider. The mental health provider may do further testing.

Treatment

The goal of treatment is to control your symptoms and help you function in life.

Having a supportive relationship with your provider is vital for your treatment.

• You should have only one primary care provider. This will help you avoid having unneeded tests and procedures.
• You should see your provider regularly to review your symptoms and how you are coping.

You may also see a mental health provider (therapist). It's important to see a therapist who has experience treating SSD. Cognitive behavioral therapy is a type of talk therapy that can help treat SSD. Working with a therapist can help relieve your pain and other symptoms. During therapy, you will learn to:

• Look at your feelings and beliefs about health and your symptoms
• Find ways to reduce stress and anxiety about symptoms
• Stop focusing as much on your physical symptoms
• Recognize what seems to make the pain or other symptoms worse
• Cope with the pain or other symptoms
• Stay active and social, even if you still have pain or other symptoms
• Function better in your daily life

Your therapist will also treat depression or other mental health illnesses you may have. You may take antidepressants to help relieve anxiety and depression.

You should not be told that your symptoms are imaginary or all in your head. Your provider should work with you to manage both physical and emotional symptoms.

Possible Complications

If not treated, you may have:

• Trouble functioning in life
• Problems with family, friends, and work
• Poor health
• An increased risk for depression and suicide
• Money problems due to the cost of medical care

SSD is a long-term (chronic) condition. Working with your providers and following your treatment plan is important for managing this disorder.

When to Contact a Medical Professional

You should contact your provider if you:

• Feel so concerned about physical symptoms that you can't function
• Have symptoms of anxiety or depression

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Prevention

Counseling may help people who are prone to SSD learn other ways of dealing with stress. This may help reduce the intensity of symptoms.

References

American Psychiatric Association. Somatic symptom and related disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: American Psychiatric Association Publishing; 2022

Gerstenblith TA, Kontos N. Somatic symptom disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 24.

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