Somatic symptom disorder (SSD) is a condition in which a person has excessive thoughts and feelings relating to physical symptoms. SSD may cause anxiety and negative emotions.
Read on to learn more about SSD, including the causes, symptoms, diagnosis, and treatment. We also explain when to speak to a doctor.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), SSD is a type of mental illness that causes excessive feelings, thoughts, or behaviors that center around at least one somatic (physical) symptom. People may refer to SSD as hypochondria or illness anxiety disorder.
For a diagnosis of SSD, the negative thoughts and emotions must last for at least 6 months and cause one or more of the following symptoms:
- exaggerated or persistent thoughts concerning the severity of symptoms
- spending excessive time and energy on treating or handling symptoms or potential health concerns
- persistently high anxiety concerning health or symptoms
- physical symptoms that last for at least 6 months or more, significantly disrupt daily life, and cause distress
- taking excessive actions to reduce the risk of perceived danger or harm
In the DSM-V, SSD replaced other mental health conditions, including:
- somatization disorder
- pain disorder
- undifferentiated somatoform disorder
One key differentiation between SSD and the above former DSM-IV disorders is that people with SSD do not need to experience unexplainable symptoms.
Another difference from the former conditions is that SSD causes at least one chronic physical symptom. Additionally, it accompanies excessive, persistent negative feelings, thoughts, and emotions.
Currently, the cause of SSD is unknown. However, research suggests that people with SSD may have an intensified awareness of bodily symptoms and sensations. They may also perceive symptoms in a different way or describe feelings in a physical way.
In addition, these individuals may have the tendency to view these symptoms negatively or as a sign of medical illness.
In some cases, SSD is related to diagnosed medical conditions. However, to have the condition, someone must also develop associated persistent, pervasive negative emotions, thoughts, or actions.
In other cases, SSD is related to an undiagnosed medical condition, but this does not make it any less real.
No one knows why SSD really occurs, but research suggests that risk factors may include:
- sexual, emotional, or physical abuse
- childhood neglect
- a chaotic lifestyle
- a history of substance and alcohol abuse
- having an axis II personality disorder, such as obsessive-compulsive disorder
- psychosocial stressors, such as reduced occupational functioning and unemployment
- genetic factors
People with SSD experience excessive anxiety and persistent negative emotions, feelings, and behaviors in relation to at least one chronic, disabling, or distressing physical symptom. Some common physical symptoms associated with SSD include:
- increased heart rate
- gastrointestinal problems
- muscle tension, stiffness, and cramps
- trouble breathing or shortness of breath
To diagnose SSD, a doctor will ask the person about all of their symptoms, take their medical history, and perform a physical exam.
The doctor will typically then run a series of diagnostic blood, imaging, and other laboratory tests to help rule out other potential causes of the symptoms.
Doctors may diagnose someone with SSD if no other tests explain their symptoms and they have:
- at least one chronic symptom, though there may be multiple symptoms that can come and go
- at least one physical symptom that disrupts daily life
- persistent excessive thoughts, emotions, or behaviors that relate to physical symptoms or health concerns and involve at least one of the following:
- ongoing high level of anxiety focused on symptoms or health
- excessive ongoing thoughts
- spending excessive energy, time, or money on health concerns or symptom relief
A doctor may also choose to perform a mental status exam, in which they will observe the person and ask them questions to evaluate the following factors:
- appearance and affect
- attention, memory, and concentration
- presence of hallucinations or delusions
- suicidal or homicidal thoughts or imaginings
In most cases, people develop SSD by the age of 30 years. Typically, a family doctor or medical doctor will make the diagnosis, not a psychiatrist.
Treatment plans for people with SSD aim to control the symptoms and improve functioning. Treatment options for SSD include:
- regular visits with one trusted doctor or a network of connected doctors to avoid excessive testing or treatments
- antidepressant and anti-anxiety medications
- talk therapy or cognitive behavioral therapy (CBT), to change behavior and thinking patterns to help cope with physical symptoms and stress
- occupational therapy, to learn how to cope with day-to-day functioning
- physical therapy, to reduce physical symptoms and improve functioning
- St. John’s wort supplements
- electroconvulsive therapy
- mindfulness therapy and relaxation training techniques
People with SSD may look for ways to cope with their symptoms, such as by abusing drugs or alcohol. Many people with SSD also have anxiety and depression.
Physical and mental symptoms underlying or associated with SSD may also make it difficult to function. These symptoms can become disabling and generally reduce quality of life.
People with SSD may also develop something called alexithymia, which means that they have difficulty identifying and expressing emotions. Negative complications from invasive or distressing medical tests are also a possibility.
Anyone experiencing unexplained, persistent, chronic symptoms should talk with a doctor.
People should also talk to a doctor if they have:
- distressing symptoms
- symptoms that interfere with daily functioning
- excessive, out-of-control thoughts or feelings
- excessive behavioral patterns, such as going to extremes to avoid a perceived danger
- thoughts or fantasies of hurting oneself or others
- started to use negative coping mechanisms, such as drugs or alcohol, to handle symptoms
People with SSD develop excessive negative thoughts, feelings, and behaviors relating to physical symptoms.
Studies show that up to 90% of people with SSD have symptoms for 5 years or more. While some treatment options exist, reviews and meta-analyses show that therapeutic interventions for SSD typically have a small-to-moderate positive effect.
It is important to talk with a doctor about any unexplained symptoms, especially those that are chronic or disabling or that interfere with day-to-day life.
People may wish to refrain from talking to multiple, unconnected healthcare professionals to avoid excessive testing and the associated concerns and costs.