Somatic symptom disorder is diagnosed when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning. The individual has excessive thoughts, feelings and behaviors relating to the physical symptoms. The physical symptoms may or may not be associated with a diagnosed medical condition, but the person is experiencing symptoms and believes they are sick (that is, not faking the illness).

A person is not diagnosed with somatic symptom disorder solely because a medical cause can’t be identified for a physical symptom. The emphasis is on the extent to which the thoughts, feelings and behaviors related to the illness are excessive or out of proportion.

A diagnosis of somatic symptom disorder requires the person experiencing

• One or more physical symptoms that are distressing or cause disruption in daily life.
• Excessive thoughts, feelings or behaviors related to the physical symptoms or health concerns with at least one of the following:
  • Ongoing thoughts that are out of proportion with the seriousness of symptoms
  • Ongoing high level of anxiety about health or symptoms
  • Excessive time and energy spent on the symptoms or health concerns.
• At least one symptom is constantly present, although there may be different symptoms and symptoms may come and go.

People with somatic symptom disorder typically go to a primary care physician rather than a psychiatrist or other mental health professional. Individuals with somatic symptom disorder may experience difficulty accepting that their concerns about their symptoms are excessive. They may continue to be fearful and worried even when they are shown evidence that they do not have a serious condition. Some people have only pain as their dominant symptom. Somatic symptom disorder usually begins by age 30.

Treatment for somatic symptom disorder is intended to help control symptoms and to allow the person to function as normally as possible.

Treatment for somatic symptom disorder typically involves the person having regular visits with a trusted health care professional. The physician can offer support and reassurance, monitor health and symptoms and avoid unnecessary tests and treatments. Psychotherapy (talk therapy) can help the individual change their thinking and behavior and learn ways to cope with pain or other symptoms, as well as learn to deal with stress and improve functioning.

Antidepressant or anti-anxiety medications can be useful if the person is also experiencing significant depression or anxiety.

Illness anxiety disorder

llness anxiety disorder was previously referred to as "hypochondriasis." A person with this condition is preoccupied with having an illness or getting an illness – constantly worrying about their health. They may frequently check themselves for signs of illness and take extreme precautions to avoid health risks. Unlike somatic symptom disorder, a person with illness anxiety disorder generally does not experience physical symptoms.

Conversion disorder

Conversion disorder (functional neurological symptom disorder) is a condition in which the symptoms affect a person’s perception, sensation or movement with no evidence of a physical cause. A person may have numbness, blindness or trouble walking. The symptoms tend to come on suddenly. The symptoms may last for a long time or may go away quickly. People with conversion disorder also frequently experience depression or anxiety disorders. If the symptoms do not resolve spontaneously in a few days, the person may benefit from psychotherapy.

Factitious disorder

Factitious disorder involves people producing or faking physical or mental illness when they are not actually ill. Some people may intentionally make a minor illness worse. A person with factitious disorder may also create an illness or injury in another person (factitious disorder imposed on another), such as faking the symptoms of a child in their care. The benefit to the person is to occupy the “sick role” and receive the care accompanying that role. If a person creates an illness or feigns illness in order to obtain a material benefit such as getting compensation or avoiding work, legal situations, or important responsibilities, this is malingering, which is not a psychiatric diagnosis. .

Reference

1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association. (2022).

Physician Review

Philip R. Muskin, M.D., M.A.

July 2024