Somatic symptom disorder
Somatic symptom disorder is one or more distressing or disruptive somatic symptoms accompanied by excessive, disproportionate thoughts, feelings, and behaviors about them, present for at least 6 months; the symptoms may or may not be medically explained. Management centers on one primary physician, brief regularly scheduled visits, minimized unnecessary testing, validated symptoms, and cognitive behavioral therapy, with an antidepressant such as sertraline reserved for comorbid depression or anxiety.
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What this article covers
- Overview
Definition: somatic symptom disorder is one or more somatic symptoms that are distressing or markedly disrupt daily life, together with excessive and disproportionate thoughts, feelings, and…
- Epidemiology
Prevalence: up to 4% of the general population, with primary care a common setting for presentation.
- Risk factors
Coexisting medical illness: patients with heart disease, cancer, or another medical condition can develop concerns about their symptoms that are out of proportion to the underlying illness, unlike…
- Pathophysiology
Cognitive-affective amplification of bodily sensations: excessive, disproportionate thoughts (ruminative worry), feelings (such as terror), and behaviors (such as avoidance) become attached to bodily…
- Clinical features
Core diagnostic criteria: one or more somatic symptoms that are distressing or markedly disrupt daily life, present for at least 6 months, together with excessive and disproportionate thoughts, feelings, or behaviors related to the symptoms.
- Differential diagnosis
Illness anxiety disorder: preoccupation with acquiring or having a serious illness persisting at least 6 months, but with minimal to no somatic symptoms, unlike the prominent, distressing symptoms that drive somatic symptom disorder.
- Diagnosis
Diagnostic basis: the diagnosis is clinical, established when a patient has one or more somatic symptoms causing distress or interference with daily life, excessive thoughts, feelings, and behaviors…
- Management
First action: establish one physician as the patient's primary caregiver and schedule brief monthly visits that are not contingent on new symptoms, since a consistent relationship builds rapport and limits reactive testing.
- Complications
Iatrogenic harm: repeated or invasive testing and procedures pursued mainly to reassure, rather than to evaluate a genuinely new finding, carry their own risk.
- Prognosis
Course: somatic symptoms commonly persist for months to years, and the disorder may co-occur with, rather than exclude, a genuine medical illness.
- Prevention
Scheduled, proactive visits: brief monthly visits with the same primary physician limit unplanned or reactive care-seeking and unnecessary testing.
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