What is Somatic Symptom Disorder?

If you’ve heard the term somatic symptom disorder from your own doctor, these three words likely frustrate you, and possibly bring a feeling of hopelessness. This vague disorder is simultaneously responsible for an incredible amount of pain in some people, and also may not really be responsible for anything at all. 

In many ways, it’s a catchall condition to diagnose someone when there’s not another obvious diagnosis. 

Even when compared with other blanket-term mental disorders, somatic symptom disorder has a wide-reaching definition. Between the symptoms it encompasses and the way healthcare professionals employ it, there’s no wonder that many women who have been hearing it for years understand just as little as women hearing it for the first time.

Whether you’ve been diagnosed with somatic symptom disorder or are just the loving, supporting friend or family member of someone who has been diagnosed, there are some important things to understand about this condition, why it exists and what it means for treatment. But first, let’s cover some basics about somatic symptom disorder.

Somatic symptom disorder is a combination of two issues: 

• Physical symptoms of pain, unpleasant bodily sensations and discomfort that may or may not result from an underlying medical condition

• Excessive thoughts, behaviors and emotions associated with that pain and discomfort. 

Typically, this means some sort of pain (often intense or chronic) that causes distress or dysfunction or reduces the quality of life for the sufferer. 

To put it simply, somatic symptom disorder is when your anxiety about the pain becomes worse than the pain. 

In previous eras, this may have been called conversion disorder or somatization disorder, as well as many other names. It also may have common symptoms with hypochondria, in which diagnostic testing doesn’t find a source of physical symptoms. 

In a practical sense, this sounds like it could include just about any illness or source of pain, and if you think that, well, you’re mostly right. The sources of the pain and other physical symptoms of somatic symptom disorder are often unable to be found or explained — it’s thought to be associated with psychological stress and previous traumas, but there’s just not a lot of certainty about how exactly this happens.

We do know that there are potentially many causes of somatic symptom disorder — and they’re potentially diverse.

Studies have explored whether somatic symptom disorder originates from traumatic life experiences, and they’ve explored whether it’s related to sexual abuse, chaotic lifestyle, childhood neglect or alcohol and substance abuse histories. They’ve also explored links with personality disorders like avoidant and paranoid behaviors, obsessive-compulsive disorder and others, and seen an association in some extreme cases of somatic symptom disorder.

There are some reasons to believe that it might also be brought on by sudden changes. In addition to the traumatic experiences we’ve already mentioned, experiences like sudden changes in employment or function have been associated with somatic symptom disorder.

While we don’t necessarily know the underlying cause, we do know that somatic symptom disorder is far more likely to occur in women than in men, and it typically first appears when a person is under 30 years old.

Symptoms of somatic symptom disorder in adults have a truly wide-ranging breadth and depth. They may manifest as anxiety, shortness of breath, pain, fatigue, weakness and distrust of medical results, and in the extreme, worry that small pains or mild symptoms may be the result of a far more serious disease or physical illness.

Somatic symptom disorder is difficult to diagnose. The condition is characterized by distress and a lack of explanation for pain, and so diagnosis is more of a process of elimination of other physical disorders and mental health disorders (like depressive disorder and generalized anxiety disorder).

There may be overlap with other physical or psychiatric conditions as well, further complicating the road to treatment.

Because there is a lot of psychological and psychiatric weight wrapped up in somatic symptom disorder, it can be difficult to effectively treat this condition, especially for a primary care provider.

The American Psychiatric Association says that effective treatment plans should include regular visits and conversations with a trusted healthcare professional. This healthcare provider can offer support, help you avoid unnecessary testing and treatments and make the proper recommendations and referrals for additional support like therapy.

The main goal of treatment is to learn how to cope with your pain, and generally move past stress and anxiety to allow you to resume daily functions and live a fulfilling life.

In the big picture, treating and managing somatic symptom disorder is really about coping with the symptoms, instead of just treating them one by one. This will likely mean changing maladaptive behaviors that can increase your pain and learning to generally manage your anxiety. 

A healthcare provider may offer you a variety of treatment options for anxiety. In many cases, this means therapy. Cognitive behavioral therapy is a key part of best-practice somatic symptom disorder treatment and an effective tool for managing anxiety.

Therapy will give you the tools and context to learn to handle those anxiety-based responses to pain and discomfort, and learn to manage your intrusive thoughts about what could be causing the pain — many of which aren’t realistic, no matter what WebMD says.

You may also be offered medications like antidepressants, which are effective in treating mood disorders generally. With medication, the first line of defense is often selective serotonin reuptake inhibitors, which help your brain balance serotonin levels.

It’s hard to grapple with the reality that a physical illness might be in your head. And it’s hard to grapple with the idea that your anxiety about health issues may itself be a health issue that needs medical care. But it happens — excessive anxiety about health is a form of mental illness. 

If this anxiety disorder is consuming your days with health concerns and keeping you from enjoying the meaningful parts of your daily life, it’s probably time to seek support from a mental health professional.

First step: get a physical exam with your primary care physician to eliminate those “what if” potential causes of your unexplained symptoms. But be ready to talk about psychological factors.

Truth be told, somatic symptom disorder is a complicated problem to deal with. Above all, somatic symptom disorder requires us to be honest with ourselves about what’s going on and willing to trust in others to guide us. That may mean your doctor; it should also mean a therapist.

While your healthcare provider may be correct in diagnosing you with somatic symptom disorder, it’s important to trust your gut (at least at first) and make sure you explore any medical issues, pains or other potentially telling symptoms for serious illness. And then, to treat somatic symptom disorder, you’ll need to work with a therapist.