Somatic Symptom Disorder

DEFINITION

Somatic symptom disorder involves having a significant focus on physical symptoms — such as pain or fatigue — to the point that it causes major emotional distress and problems functioning. You may or may not have another diagnosed medical condition associated with these symptoms.

Excessive thoughts, feelings and behaviors in response to physical symptoms may lead to frequent doctor visits. You often think the worst about your symptoms and continue 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 suffering. Treatment can help ease symptoms, help you cope and improve your quality of life.

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

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.

Excessive thoughts, feelings and behaviors can include:

• Having a high level of worry about potential illness
• Considering normal physical sensations as a sign of severe physical illness
• Fearing the medical seriousness of symptoms, even when there is no evidence to support that concern
• Appraising physical sensations as threatening, harmful or causing problems
• 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 would usually be expected related to 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 you’re concerned about physical symptoms and medical illness, you may start by seeing your primary care provider. Because symptoms can be related to health problems, it’s important to be evaluated by your health care provider if you aren’t sure what’s causing your symptoms.

If your provider believes that you may have somatic symptom disorder, he or she may also refer you to a mental health provider.

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.