Table of ContentsView AllTable of ContentsSomatic Symptom Disorder SymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Somatic Symptom Disorder Symptoms
Causes
Diagnosis
Treatment
When Your Doctor Tells You It’s All in Your Head
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Symptoms commonly include pain, fatigue, weakness, and shortness of breath. The degree of symptoms is not relevant to a diagnosis of SSD. For some people, symptoms can be traced to another medical condition, though often no physical cause is found.
The key feature of SSD is excessive and disproportionate thoughts, feelings, and behaviors related to the symptoms or to overall health. To be diagnosed with SSD, you must have persistent symptoms lasting for at least six months.
There is no clear cause of SSD.
A variety of factors have been found to predispose a person to develop SSD:
A diagnosis of SSD typically isn’t made until a person has experienced a stream of unexplained physical symptoms, medical tests, and treatments. However, physical symptoms do not need to be medicallyunexplainedin order for SSD to be diagnosed.
If your primary care physician suspects you have SSD, they may refer you to a psychiatrist, who will determine whether you meet the criteria established in the American Psychiatric Association’sDiagnostic and Statistical Manual of Mental Disorders, Issue 5(DSM-5).
Characteristics that differentiate SSD from other illnesses include:
Many of the emotional features of SSD—a preoccupation with symptoms or a worsening of symptoms with emotional triggers—can affect anyone who has a persistent or chronic illness.
What’s different about SSD is that the excessive thoughts, feelings, or behaviors will manifest in at least one of three characteristic ways:
If one or all of these emotional features disrupt the ability to function normally, SSD is a possible cause.
Changes to Diagnostic Criteria in the DSM-5Somatic symptom disorder was introduced in the DSM-5 in 2013 and the following diagnoses from the DSM-IV were removed:Somatization disorderHypochondriasisPain disorderUndifferentiated somatoform disorderPeople previously diagnosed with these conditions most likely meet the current criteria for SSD.Other changes to the DSM-5 include:The requirement that symptoms from four specific symptom groups—pain, gastrointestinal, sexual, and pseudo-neurological—must be present was eliminated.Doctors no longer need to decide if the symptoms are intentionally feigned or produced.
Changes to Diagnostic Criteria in the DSM-5
Somatic symptom disorder was introduced in the DSM-5 in 2013 and the following diagnoses from the DSM-IV were removed:Somatization disorderHypochondriasisPain disorderUndifferentiated somatoform disorderPeople previously diagnosed with these conditions most likely meet the current criteria for SSD.Other changes to the DSM-5 include:The requirement that symptoms from four specific symptom groups—pain, gastrointestinal, sexual, and pseudo-neurological—must be present was eliminated.Doctors no longer need to decide if the symptoms are intentionally feigned or produced.
Somatic symptom disorder was introduced in the DSM-5 in 2013 and the following diagnoses from the DSM-IV were removed:
People previously diagnosed with these conditions most likely meet the current criteria for SSD.
Other changes to the DSM-5 include:
Differential Diagnoses
Psychiatric conditions related to SSD include:
The treatment options for SDD vary. If a person recognizes that their preoccupation with symptoms is interfering with their quality of life, cognitive-behavioral therapy (CBT) may help identify and correct distorted thoughts, unfounded beliefs, and behaviors that trigger health anxiety.
This type of therapy is often used in tandem with mindfulness-based therapy, including meditation, with the aim of disengaging from self-criticism,rumination, and negative moods or thoughts.
How Effective Is Cognitive Behavioral Therapy?
When needed, selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants may be prescribed, both of which have proven effective in alleviating SSD symptoms.
Anticonvulsants and antipsychotics that are commonly used in the treatment of mood and anxiety disorders, as well as other antidepressants, such as monoamine oxidase inhibitors (MAOIs) and Wellbutrin (bupropion), are not effective for treating SSD.
A Word From Verywell
A diagnosis of SSD may be unnerving, but with proper therapy and counseling, you can begin the process of restoring your quality of life and the ability to function normally without fear about your health hanging over you. Don’t expect things to change overnight; persistence is key. If you remain uncertain about the diagnosis, don’t be afraid to seek asecond opinionfrom a certified psychiatric professional.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. National Library of Medicine: MedlinePlus.Somatic symptom disorder. Updated June 2, 2020.American Psychiatric Association.Chapter 9: Somatic symptom and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Edition 5.2013.Jason LA, Porter N, Hunnell J, Brown A, Rademaker A, Richman JA.A natural history study of chronic fatigue syndrome.Rehabil Psychol.2011;56(1):32-42. doi:10.1037/a0022595Güney ZEO, Sattel H, Witthöft M, Henningsen P.Emotion regulation in patients with somatic symptom and related disorders: A systematic review.PLoS One.2019;14(6):e0217277. doi:10.1371/journal.pone.0217277Substance Abuse and Mental Health Services Administration.Table 3.31: DSM-IV to DSM-5 somatic symptom disorder comparison. In: Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. June 2016.Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.31, DSM-IV to DSM-5 Somatic Symptom Disorder Comparison.Hedman E, Lekander M, Ljótsson B, et al.Optimal cut-off points on the health anxiety inventory, illness attitude scales and Whiteley index to identify severe health anxiety.PLoS ONE.2015;10(4):e0123412. doi:10.1371/journal.pone.0123412Aybek S, Nicholson TR, O’daly O, Zelaya F, Kanaan RA, David AS.Emotion-motion interactions in conversion disorder: An FMRI study.PLoS ONE.2015;10(4):e0123273. doi:10.1371/journal.pone.0123273Zeshan M, Cheema R, Manocha P.Challenges in diagnosing factitious disorder.Psychiatry Online.2018 Sept;13(9):6-8. doi:10.1176/appi.ajp-rj.2018.130903Campos SJ, Link D.Pseudocyesis.J Nurse Practitioners.2016 Jun:12(6):390-4. doi:10.1016/j.nurpra.2016.03.009Sipe WE, Eisendrath SJ.Mindfulness-based cognitive therapy: Theory and practice.Can J Psychiatry.2012;57(2):63-9. doi:10.1177/070674371205700202Kurlansik SL, Maffei MS.Somatic symptom disorder.Am Fam Physician.2016 Jan 1;93(1):46-54A.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. National Library of Medicine: MedlinePlus.Somatic symptom disorder. Updated June 2, 2020.American Psychiatric Association.Chapter 9: Somatic symptom and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Edition 5.2013.Jason LA, Porter N, Hunnell J, Brown A, Rademaker A, Richman JA.A natural history study of chronic fatigue syndrome.Rehabil Psychol.2011;56(1):32-42. doi:10.1037/a0022595Güney ZEO, Sattel H, Witthöft M, Henningsen P.Emotion regulation in patients with somatic symptom and related disorders: A systematic review.PLoS One.2019;14(6):e0217277. doi:10.1371/journal.pone.0217277Substance Abuse and Mental Health Services Administration.Table 3.31: DSM-IV to DSM-5 somatic symptom disorder comparison. In: Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. June 2016.Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.31, DSM-IV to DSM-5 Somatic Symptom Disorder Comparison.Hedman E, Lekander M, Ljótsson B, et al.Optimal cut-off points on the health anxiety inventory, illness attitude scales and Whiteley index to identify severe health anxiety.PLoS ONE.2015;10(4):e0123412. doi:10.1371/journal.pone.0123412Aybek S, Nicholson TR, O’daly O, Zelaya F, Kanaan RA, David AS.Emotion-motion interactions in conversion disorder: An FMRI study.PLoS ONE.2015;10(4):e0123273. doi:10.1371/journal.pone.0123273Zeshan M, Cheema R, Manocha P.Challenges in diagnosing factitious disorder.Psychiatry Online.2018 Sept;13(9):6-8. doi:10.1176/appi.ajp-rj.2018.130903Campos SJ, Link D.Pseudocyesis.J Nurse Practitioners.2016 Jun:12(6):390-4. doi:10.1016/j.nurpra.2016.03.009Sipe WE, Eisendrath SJ.Mindfulness-based cognitive therapy: Theory and practice.Can J Psychiatry.2012;57(2):63-9. doi:10.1177/070674371205700202Kurlansik SL, Maffei MS.Somatic symptom disorder.Am Fam Physician.2016 Jan 1;93(1):46-54A.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. National Library of Medicine: MedlinePlus.Somatic symptom disorder. Updated June 2, 2020.American Psychiatric Association.Chapter 9: Somatic symptom and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Edition 5.2013.Jason LA, Porter N, Hunnell J, Brown A, Rademaker A, Richman JA.A natural history study of chronic fatigue syndrome.Rehabil Psychol.2011;56(1):32-42. doi:10.1037/a0022595Güney ZEO, Sattel H, Witthöft M, Henningsen P.Emotion regulation in patients with somatic symptom and related disorders: A systematic review.PLoS One.2019;14(6):e0217277. doi:10.1371/journal.pone.0217277Substance Abuse and Mental Health Services Administration.Table 3.31: DSM-IV to DSM-5 somatic symptom disorder comparison. In: Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. June 2016.Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.31, DSM-IV to DSM-5 Somatic Symptom Disorder Comparison.Hedman E, Lekander M, Ljótsson B, et al.Optimal cut-off points on the health anxiety inventory, illness attitude scales and Whiteley index to identify severe health anxiety.PLoS ONE.2015;10(4):e0123412. doi:10.1371/journal.pone.0123412Aybek S, Nicholson TR, O’daly O, Zelaya F, Kanaan RA, David AS.Emotion-motion interactions in conversion disorder: An FMRI study.PLoS ONE.2015;10(4):e0123273. doi:10.1371/journal.pone.0123273Zeshan M, Cheema R, Manocha P.Challenges in diagnosing factitious disorder.Psychiatry Online.2018 Sept;13(9):6-8. doi:10.1176/appi.ajp-rj.2018.130903Campos SJ, Link D.Pseudocyesis.J Nurse Practitioners.2016 Jun:12(6):390-4. doi:10.1016/j.nurpra.2016.03.009Sipe WE, Eisendrath SJ.Mindfulness-based cognitive therapy: Theory and practice.Can J Psychiatry.2012;57(2):63-9. doi:10.1177/070674371205700202Kurlansik SL, Maffei MS.Somatic symptom disorder.Am Fam Physician.2016 Jan 1;93(1):46-54A.
U.S. National Library of Medicine: MedlinePlus.Somatic symptom disorder. Updated June 2, 2020.
American Psychiatric Association.Chapter 9: Somatic symptom and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Edition 5.2013.
Jason LA, Porter N, Hunnell J, Brown A, Rademaker A, Richman JA.A natural history study of chronic fatigue syndrome.Rehabil Psychol.2011;56(1):32-42. doi:10.1037/a0022595
Güney ZEO, Sattel H, Witthöft M, Henningsen P.Emotion regulation in patients with somatic symptom and related disorders: A systematic review.PLoS One.2019;14(6):e0217277. doi:10.1371/journal.pone.0217277
Substance Abuse and Mental Health Services Administration.Table 3.31: DSM-IV to DSM-5 somatic symptom disorder comparison. In: Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. June 2016.
Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.31, DSM-IV to DSM-5 Somatic Symptom Disorder Comparison.
Hedman E, Lekander M, Ljótsson B, et al.Optimal cut-off points on the health anxiety inventory, illness attitude scales and Whiteley index to identify severe health anxiety.PLoS ONE.2015;10(4):e0123412. doi:10.1371/journal.pone.0123412
Aybek S, Nicholson TR, O’daly O, Zelaya F, Kanaan RA, David AS.Emotion-motion interactions in conversion disorder: An FMRI study.PLoS ONE.2015;10(4):e0123273. doi:10.1371/journal.pone.0123273
Zeshan M, Cheema R, Manocha P.Challenges in diagnosing factitious disorder.Psychiatry Online.2018 Sept;13(9):6-8. doi:10.1176/appi.ajp-rj.2018.130903
Campos SJ, Link D.Pseudocyesis.J Nurse Practitioners.2016 Jun:12(6):390-4. doi:10.1016/j.nurpra.2016.03.009
Sipe WE, Eisendrath SJ.Mindfulness-based cognitive therapy: Theory and practice.Can J Psychiatry.2012;57(2):63-9. doi:10.1177/070674371205700202
Kurlansik SL, Maffei MS.Somatic symptom disorder.Am Fam Physician.2016 Jan 1;93(1):46-54A.
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