Understanding Somatic Symptom Disorder: Diagnosis, Symptoms, and Treatment

Everyone, at some point in their lives, experiences worry about their health. New or strange symptoms increase this anxiety for everyone, but this worry takes over and consumes people with somatic symptom disorder.

What is Somatic Symptom Disorder?

The Diagnostic and Statistical Manual for Mental Disorders 5, Text Revision (DSM-5-TR) defines somatic symptom disorder as:

One or more physical (somatic) symptoms that are distressing or cause significant disruption in daily life
Excessive or intrusive thoughts, worries, or behaviors related to the somatic symptoms 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 issues
- Excessive time and energy spent on health concerns or symptoms
At least one symptom is consistently present for at least six months

The most current DSM-5-TR reflects a crucial change to the diagnostic criteria for somatic symptom disorder. In DSM-5-TR, the criteria for a somatic symptom disorder diagnosis no longer require that the symptoms causing distress are ‘medically unexplained,’ meaning that the patient may genuinely have real medical conditions causing the symptoms. Having a legitimate, identifiable medical condition causing the symptoms does not negate the excessive worry and anxiety the patient is experiencing. Having somatic symptom disorder does not mean ‘it’s all in their head.’

Symptoms of Somatic Symptom Disorder

Because of the nature of the condition, somatic symptom disorder symptoms can vary significantly from person to person. Pain is a frequent symptom, both local and generalized, along with headaches, digestive issues like diarrhea or constipation, and sexual issues.

No two people with somatic symptom disorder will have the same symptoms and issues. This condition causes individuals to experience distress that is highly disproportionate to the physical symptom, so a minor complaint to one person may elicit a severe response from another.

Psychological symptoms include:

Excessive worrying and preoccupation about existing or potential illness and symptoms
Constant fear
Frequent healthcare visits out of concern for symptoms (visits that are not always medically warranted)
A belief that normal or minor feelings or sensations are severe and dangerous

Judy: An Example of Somatic Symptom Disorder

Judy has a history of a brain tumor that was removed years ago with no lingering effects. For the past year, Judy has been experiencing headaches, varying in severity. No identifiable triggers are causing her headaches. Judy keeps a headache diary, and her family reports she is “obsessed” with any possible symptom that she fears will lead to a headache. Judy no longer attends her water aerobics out of fear that the chlorine smell will trigger a headache. Judy’s family physician ruled out any organic cause of her headaches and gave her a clean bill of health. As part of her recovery from brain tumor removal, she was advised to report any new symptoms or severe headaches to her physician, but her doctor notes that her frequent visits and constant worry exceed the expected response.

*Judy and her case are entirely fictional.

Somatic Symptom Disorder Treatment

An individualized, interdisciplinary approach is recommended to manage the often debilitating symptoms of somatic symptom disorder effectively. Treating this condition requires careful consideration of a variety of factors, not just the physical symptoms themselves. Healthcare professionals should evaluate the patient’s medical and psychiatric history, cultural views, and social support to determine the best care plan. Because of the highly emotional nature of somatic symptom disorder, an essential component of treatment is for professionals to acknowledge and legitimize symptoms when appropriate respectfully.

The CARE MD approach describes the multifaceted approach that is effective in treating somatic symptom disorder.

CARE MD:

Consultation/Cognitive Behavioral Therapy
Assessment
Regular Visits
Empath
Medical/Psychiatric Interface
Do No Harm

Like many other psychiatric conditions, somatic symptom disorder can significantly impact one’s quality of life by inhibiting them from doing the things they enjoy and living the life they deserve. Developing trust is a critical step in the treatment process. Healthcare providers must remember that no matter what medical diagnoses the patient may or may not have, those with somatic symptom disorder are experiencing the utmost distress because of their symptoms – and those feelings are very real.

Written by Jessica Dzubak, MSN, RN

References

American Psychiatric Association. (2018, November). What is somatic symptom disorder. https://www.psychiatry.org/patients-families/somatic-symptom-disorder/what-is-somatic-symptom-disorder

American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed, text revision). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.

Cleveland Clinic. (2018, November 7). Somatic symptom disorder in adults. Retrieved January 15, 2021 https://my.clevelandclinic.org/health/diseases/17976-somatic-symptom-disorder-in-adults

Mayo Clinic. (n.d.). Somatic symptom disorder. Retrieved January 15, 2021 https://www.aafp.org/afp/2016/0101/p49.html

Jessica Dzubak, MSN, RN, is the Director of Nursing Practice for the Ohio Nurses Association. She is also a freelance writer specializing in the healthcare industry. She enjoys her two dogs, which add commentary to her articles by laying their heads across the keyboard while she’s writing.