Somatic symptom disorder

Somatic symptom disorder is a health condition in which body symptoms take over daily life. Symptoms such as pain, tiredness or shortness of breath come with so much worry, attention and effort that it becomes hard to do other things. The symptoms are real. People with this condition are not faking or imagining them.^1,2

What makes it a disorder is not whether doctors have found a medical cause. It is how much distress the symptoms bring and how much of a person's thinking, feeling and time they take up.¹ The condition can be treated, and many people learn to live more fully even when symptoms remain.

What is somatic symptom disorder?

The name comes from soma, the Greek word for body. The condition is listed in the DSM-5-TR, the handbook doctors in the U.S. use to diagnose mental health conditions. In plain words, a doctor looks for three things:^1,3

1. One or more body symptoms that are distressing or disrupt daily life.
2. Out-of-proportion thoughts, feelings or behaviors about the symptoms or about health. At least one must be present: ongoing thoughts that the symptoms are more serious than they are, a constant high level of anxiety about health, or too much time and energy spent on symptoms or health worries.
3. Symptoms persist, usually for more than 6 months. Any one symptom may come and go, and the symptoms may change over time.

Doctors can add notes to the diagnosis. "With predominant pain" means pain is the main symptom. "Persistent" means the condition is severe, causes major problems and has lasted more than 6 months. Severity is rated mild, moderate or severe, depending on how many of the thought, feeling and behavior signs are present and how many symptoms the person has.³

Signs of somatic symptom disorder

The main signs are in how a person feels about and responds to their symptoms. People with the condition may:²

• Feel intense anxiety about their symptoms
• Worry that mild symptoms are signs of a serious disease
• Go to doctors for many tests and procedures, but not believe normal results
• Feel that doctors do not take their symptoms seriously or have not treated them well
• Spend a lot of time and energy dealing with health concerns
• Have trouble working, keeping up a home or seeing friends because of these thoughts and feelings

The body symptoms themselves can be anything. Pain, tiredness or weakness, and shortness of breath are common. They may be mild or severe, and one symptom or many.²

What it is not

• It is not faking. People with somatic symptom disorder feel their symptoms and believe they are ill.¹ Producing or faking symptoms on purpose is a different condition, called factitious disorder.¹
• It is not "all in your head." Patients should not be told their symptoms are imaginary. Their providers should work with them on both physical and emotional symptoms.²
• It is not ordinary concern. Most people worry about a symptom for a while, see a doctor, and feel better once they know what is going on. Somatic symptom disorder is when the worry and attention persist and cause real problems in life.

How it differs from related conditions

Read more about illness anxiety disorder in Health anxiety. The two can overlap, and doctors sometimes debate which label fits best.⁴

Functional disorders are a different way of describing symptoms. Conditions such as irritable bowel syndrome (IBS), fibromyalgia and functional neurological disorder are defined by their pattern of body symptoms, not by worry or behavior.⁷ Many people with these conditions do not have somatic symptom disorder. Some do. In one study, about 1 in 4 people with fibromyalgia met the criteria.⁴ See Functional disorders.

Functional neurological disorder, also called conversion disorder, involves symptoms such as weakness, shaking, seizure-like episodes or trouble walking. They come from changes in how brain networks work.^1,6 It has its own diagnosis and treatments.

How common is it?

Good numbers are still scarce. The DSM estimates that about 5% to 7% of the general population has somatic symptom disorder, which would make it one of the most common concerns in primary care.³ A 2022 review found higher figures, about 13 in 100 in the general population and 35 in 100 in general medical clinics. But those studies mostly used questionnaires rather than full interviews, so the authors think the true numbers are lower.⁴

The condition usually begins by age 30 and is more common in women.² There is little research on how it starts or changes in later life.⁴ See Body symptoms in later life.

Causes and risk factors

No one knows exactly why some people develop somatic symptom disorder. Several things seem to play a part:

• Sensitivity to body signals. Being more aware of body sensations, and more sensitive to pain, combined with a habit of reading those sensations as signs of illness.^2,3
• Outlook and personality. A more negative outlook may raise the risk.²
• Family and genes. Family history, upbringing and genetics may be involved.²
• Hard experiences. Childhood neglect or physical or sexual abuse raise the risk of long-lasting, severe body symptoms. Not everyone with the condition has this history.^2,3 See How childhood adversity affects health.
• Stress and life strain. Recent stress is linked to body symptoms that come with depression or anxiety.⁹
• Other mental health conditions. Depression and anxiety disorders often occur alongside it.^4,9

What keeps it going

Somatic symptom disorder often runs in a loop. A symptom brings worry. Worry turns on the body's alarm system and focuses attention on the body, so sensations feel stronger. Checking, searching online, extra tests and avoiding activity bring short relief but keep attention on the symptoms.⁵ Pulling back from activities and people can also make life smaller and mood lower. Treatment works on these links. See How stress, anxiety and depression cause real body symptoms.

How it is diagnosed

There is no blood test or scan for somatic symptom disorder. Diagnosis usually involves:

• A full physical exam and tests to look for physical causes. Which tests depend on the symptoms.²
• A conversation about how the symptoms affect you: how much you worry, how much time they take, and what you do to cope.
• Questionnaires, such as the PHQ-15, which rates how much common symptoms bother you. These are a first step, not a diagnosis.³ Our WhySigh MindCheck uses the PHQ-15.
• Checking for related conditions, such as depression, panic disorder, generalized anxiety and alcohol or drug problems.³

Your doctor may refer you to a mental health professional for a fuller assessment.² This is not a sign that your doctor has given up on your body. Good care looks at both.

Treatment in brief

The goal is to help you feel better and live more fully, not only to remove every symptom.²

• One main doctor and regular visits. A steady relationship with one primary care provider, with planned check-ins, helps avoid unneeded and sometimes risky tests.^1,2
• Cognitive behavioral therapy (CBT). In a Cochrane review, CBT reduced symptoms more than usual care. The effect was small, but it held up through a year of follow-up.⁸ CBT helps you look at beliefs about symptoms, ease worry, focus less on the body, stay active and cope better.²
• Medicines. Antidepressants may help with anxiety, depression and some body symptoms.^2,3

Read more in Treatment for persistent body symptoms and Self-help for body symptoms.

Living with it

Somatic symptom disorder tends to be long-lasting. Without treatment, it can lead to problems at work and at home, money worries from medical costs, and a higher risk of depression and suicide.² With treatment and a good working relationship with a doctor, the aim is to worry less, do more and feel more in control.

Common questions

If I am diagnosed with this, will doctors stop looking for physical causes?

They should not. A good doctor keeps checking new or changing symptoms. Studies are reassuring about missed diagnoses. One review looked at 27 studies of people diagnosed with weakness, seizures or other nerve symptoms not explained by disease. In studies done since 1970, only about 4 in 100 later turned out to have a disease that explained their symptoms.¹⁰

Is somatic symptom disorder the same as hypochondria?

Not quite. The old term hypochondriasis is no longer used as a diagnosis. Fear of illness with few or no symptoms is now called illness anxiety disorder. Strong body symptoms that come with a lot of worry fit somatic symptom disorder better.^1,5

Can I have somatic symptom disorder and a real medical illness?

Yes. The two can occur together.¹ In studies, about 1 in 5 people with heart failure and about 1 in 4 people with fibromyalgia met the criteria for somatic symptom disorder.⁴

When to get help

Talk with your doctor if worry about body symptoms is so strong that you cannot get through your day, or if you have signs of anxiety or depression.² It also helps to speak up if you feel stuck in a cycle of tests and visits that does not bring relief.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.