Definition and Diagnosis
Somatic symptom disorder (historically grouped with the somatoform disorders) is characterized by one or more physical symptoms that are distressing or disrupt daily life, accompanied by excessive thoughts, feelings, or behaviors related to the symptoms, such as disproportionate health-related anxiety or excessive time and energy devoted to the symptoms.
Epidemiology
Somatic symptom disorder is relatively common, particularly in primary care settings, with estimated prevalence around 5-7% in the general population and higher rates among those presenting with medically unexplained symptoms.
Risk Factors
Risk factors include a history of childhood adversity or illness, co-occurring anxiety or depressive disorders, a family or personal history of chronic illness, and personality traits involving heightened bodily awareness or health anxiety.
Symptoms and Subtypes
Symptoms can affect any organ system and may or may not be medically explained; the defining feature is not the symptom itself but the excessive, persistent thoughts about the seriousness of symptoms, high health-related anxiety, and excessive time or energy devoted to symptoms or health concerns.
Diagnosis
DSM-5-TR criteria require one or more distressing somatic symptoms, excessive thoughts, feelings, or behaviors related to the symptoms or associated health concerns, and persistence of the symptomatic state for six months or more (though a specific symptom may vary).
Treatment
Treatment centers on a strong, consistent physician relationship, regular scheduled visits rather than symptom-driven ones, cognitive behavioral therapy targeting health anxiety and symptom-focused thinking, and cautious avoidance of unnecessary investigations or procedures.
Prognosis
Course is often chronic and fluctuating, but engagement in structured psychotherapy and a stable care relationship can meaningfully reduce symptom-related distress and healthcare utilization over time.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).