Somatic symptom disorder

Somatic symptom disorder involves focusing too much on physical symptoms such as pain or tiredness. This focus causes major emotional distress and makes it hard to function. You may or may not have another medical condition that causes these symptoms. But how you think, feel and behave because of the symptoms can be extreme.

You might often think the worst about your symptoms. You may seek medical care often, searching for a reason for the symptoms, even when other serious conditions have been ruled out. You also might spend so much time and energy focusing on your symptoms that it's hard to function, sometimes leading to more challenges in your life.

If you have somatic symptom disorder, you may have a lot of emotional and physical distress. Treatment can help ease symptoms, help you cope and make your quality of life better.

Symptoms of somatic symptom disorder may include:

• Specific symptoms, such as pain or shortness of breath.
• General symptoms, such as feeling very tired or weak.
• Symptoms not related to any medical cause.
• Symptoms related to a medical condition but that are more severe than usually expected.
• One symptom, many symptoms or symptoms that change over time.
• Mild, moderate or severe symptoms.

Pain is the most common symptom. But whatever your symptoms, you have constant stressful thoughts, feelings and behaviors related to those symptoms. This can make it hard to live your daily life and sometimes can be disabling.

For somatic symptom disorder, the way you think about and react to symptoms and how they affect your daily life are more important than which physical symptoms you have.

People with somatic symptom disorder often:

• Constantly worry about possible illness or how much the symptoms affect them.
• View usual physical sensations as a sign of severe illness.
• Fear that symptoms are serious even when illness has been ruled out.
• Think that physical sensations are threatening or harmful.
• Believe that they need more medical evaluation and treatment, but healthcare visits and treatments don't lessen their concerns.
• Fear that physical activity may cause damage to their bodies.
• Constantly check their bodies for issues.
• Limit or stay away from activities due to the stress of symptoms.
• Talk about having more-severe disability than expected from a medical condition.

When to see a doctor

Because physical symptoms can be related to a medical condition, it's important to have a healthcare professional look at you.

After a medical exam, if your healthcare professional believes that you may have somatic symptom disorder, you can talk about a referral to a mental health professional who can work with you and your healthcare team. A mental health professional can help you understand your condition and learn how to lessen your symptoms to make your quality of life better.

When it's a loved one

If a loved one has somatic symptom disorder, it can be hard to accept that a serious illness isn't the cause and that the person can still function in life despite the symptoms. Encourage the person to follow through on a mental health referral. Think about going along so you both can learn tips and strategies to help ease symptoms.

The exact cause of somatic symptom disorder isn't clear, but factors may include:

• Genetics and biology, which may cause higher sensitivity to pain, for example.
• Family influence, both genetic and environmental.
• Personality traits, such as negativity.
• Having a hard time processing emotions or feelings, leading to a focus on physical symptoms.
• Learned behavior, such as gaining attention from illness or avoiding activities due to pain, which can worsen the level of disability.

Risk factors for somatic symptom disorder include having:

• Anxiety or depression.
• A medical condition or recovering from one.
• The risk of developing a medical condition, such as having a strong family history of an illness.
• Stressful life events, trauma or violence.
• Past trauma, such as sexual abuse or childhood trauma.

Somatic symptom disorder can be linked with:

• Poor health.
• Trouble functioning in daily life, including having physical disability.
• Trouble in relationships.
• Work troubles or unemployment.
• Other mental health conditions, such as anxiety or depression.
• Increased suicide risk related to depression.
• Money concerns due to a lot of healthcare visits.

Little is known about how to prevent somatic symptom disorder. But these suggestions may help.

• Get professional help for anxiety or depression that can happen due to somatic symptom disorder.
• Learn how to identify stress and how it affects your body.
• Practice stress management and relaxation techniques.
• Choose healthy routines, such as healthy sleep habits, regular physical activity and social activities.
• Get treatment early if you think you have somatic symptom disorder.
• Follow your treatment plan to help keep symptoms from getting worse or coming back.

To make a diagnosis of somatic symptom disorder, you'll likely have a physical exam and any tests your healthcare professional recommends. Your healthcare professional can help find out whether you have any health conditions that need treatment.

Your healthcare professional also may refer you to a mental health professional, who may:

• Do a mental health exam by talking with you about your symptoms, fears or concerns; stressful situations; and situations you may be avoiding due to somatic symptoms. You also may talk about relationships and your family history.
• Have you fill out forms or answer questions to learn about your anxiety, mood and physical symptoms.
• Ask you about alcohol, drug or other substance use.

A mental health professional may diagnose somatic symptom disorder if:

• You have one or more somatic symptoms, for example, pain or extreme tiredness, that cause distress or issues in daily life.
• You constantly think about how serious your symptoms are, you're very anxious about your health or symptoms, or you spend too much time and energy on your symptoms or health concerns.
• You have symptoms that worry you for more than six months, even if symptoms vary.

The goal of treatment is to ease your symptoms and help you function better in daily life. Talk therapy, also called psychotherapy, can be helpful for somatic symptom disorder. Sometimes medicines may be added, especially if you feel depressed.

Talk therapy

Physical symptoms can be related to mental health distress and a high level of health anxiety. Talk therapy — specifically, cognitive behavioral therapy, also called CBT — can help ease physical symptoms and help you function in daily life.

CBT can help you:

• Think differently about health and physical symptoms.
• Learn how to manage stress.
• Learn how to cope with physical symptoms.
• Focus less on symptoms and lessen the number of activities you no longer do because of your symptoms.
• Take part in activities even if you have physical symptoms.
• Make daily functioning at home, at work, in relationships and in social situations better.
• Treat depression and other mental health conditions.

Family therapy also may be helpful by examining family relationships and making family support and functioning better.

Medicines

Antidepressant medicine can help ease symptoms linked with depression and pain that often occur with somatic symptom disorder.

If one antidepressant doesn't work well for your depression, your healthcare professional may recommend switching to another or adding certain medicines to boost how well antidepressants work. Keep in mind that it can take several weeks after starting a medicine to notice depression symptoms easing.

Talk with your healthcare professional about medicine options and the possible side effects and risks.

You can take these steps to help manage somatic symptom disorder:

• Work with your care team. Work with your healthcare professional and mental health professional to set a regular schedule for visits to talk about your concerns, build a trusting relationship and begin developing coping skills. Also talk about setting reasonable limits on tests, exams and specialist referrals. Don't get advice from multiple healthcare professionals or emergency room visits. This can make your care harder to coordinate and you may have the same tests repeated.
• Practice stress management and relaxation techniques. Learning stress management and relaxation techniques, such as progressive muscle relaxation, may help ease symptoms.
• Get physically active. Building up a physical activity program over time may have a calming effect on your mood, lessen your physical symptoms and help your physical functioning.
• Join in activities. Stay involved in your work and in social and family activities. Don't wait until your symptoms are gone to take part.
• Don't use alcohol and drugs. Substance use can make your condition harder to treat. Talk with a healthcare professional if you need help quitting.

After a medical exam, your healthcare professional may refer you to an expert in mental health conditions, such as a psychiatrist or psychologist, for evaluation and treatment.

Think about asking a trusted family member or friend to go with you to your appointment to lend support and help you remember information.

What you can do

Before your appointment, make a list of:

• Your symptoms, including when they first occurred and how they affect your daily life. Include what makes them better and what makes them worse.
• Key personal information, including traumatic events in your past and any stressful, major life events. Also include your support system and what you enjoy doing.
• Medical information, including other physical or mental health conditions that you have.
• All medicines, vitamins, herbs and other supplements you take, including the doses.
• Questions to ask your healthcare professional or mental health professional.

Questions to ask may include:

• Do I have somatic symptom disorder?
• What treatment approach do you recommend?
• Would talk therapy be helpful for me?
• If you're recommending talk therapy, how often will I need it and for how long?
• If you're recommending medicines, are there any possible side effects?
• For how long will I need to take medicine?
• How will you monitor whether my treatment is working?
• Are there any self-care steps I can take to help manage my condition?
• Are there print materials or websites that you'd suggest to help me learn more?

Feel free to ask any other questions during your appointment.

What to expect from your doctor

Your healthcare professional or mental health professional may ask you questions, such as:

• What are your symptoms, and when did they start?
• How do your symptoms affect your life, such as at school, at work and in personal relationships?
• What are you no longer doing because of your symptoms?
• Have you or any close relatives been diagnosed with a mental health condition?
• Have you been diagnosed with any medical conditions?
• Do you use alcohol or drugs? What do you use and how often?
• Do you get regular physical activity?

Be ready to answer questions so that you have time to talk about what's most important to you.