Somatic Symptom Disorder

This article provides an overview of somatic symptom disorder, including the symptoms, causes, commonly associated conditions, and treatment options.

Key Takeaways:

• Somatic symptom disorder involves a disproportionate response to physical symptoms. Individuals may experience distress from normal bodily functions, even if no condition is present, or they may have excessive reactions to actual medical conditions.
• Individuals with this disorder frequently worry about their symptoms, check for abnormalities, and often seek reassurance from family, friends, or medical professionals.
• Psychotherapy can help treat somatic symptom disorder, as it focuses on problematic thoughts, emotions, and behaviors that often exacerbate symptoms.

What is a Somatic Symptom?

The key features of somatic symptom disorder are somatic symptoms, also known as physical symptoms, accompanied by distress and difficulty functioning. The most common somatic symptom is pain, while other somatic symptoms include fatigue, weakness, shortness of breath, and stomach problems. Symptoms can be specific or localized, and can occur in any area of the body, so they vary from person to person. ^{[1] [2]}

Somatic symptom disorder affects approximately 5 to 7% of the general population and up to 17% of the primary care population. It is also 10 times higher in females than in males. ^[1]

Are They Psychosomatic?

Psychosomatic symptoms are physical symptoms that worsen due to mental or emotional factors, such as stress or worry. Thus, somatic symptom disorder often involves psychosomatic symptoms, since individuals with this disorder typically experience a lot of worry and anxiety due to their symptoms. They may focus intensely on them and believe that the symptoms represent serious illness, even if this isn’t the case.

Somatic Symptom vs Illness Anxiety Disorder

Illness anxiety disorder is a disorder characterized by intense worry about having or developing a serious illness or chronic condition. However, the key difference from somatic symptom disorder is that individuals with illness anxiety disorder typically don’t experience actual physical symptoms. ^[2]

Conditions Associated with Somatic Symptom Disorder

Somatic symptom disorder is associated with several conditions, including mental disorders and physical conditions.

Approximately 30 to 60% of individuals with somatic symptom disorder experience comorbid anxiety and/or depression. This disorder is also associated with an increased risk of suicidality. ^{[1] [3]}

In severe cases, somatic symptom disorder is also associated with personality disorders, such as avoidant, paranoid, self-defeating, and obsessive-compulsive disorder. This is likely due to shared vulnerabilities that affect the development and maintenance of these disorders, such as emotional dysregulation and neuroticism. ^[1]

Certain physical conditions are particularly associated with somatic symptom disorder, too, such as fibromyalgia, irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS). However, these conditions alone don’t result in a somatic symptom diagnosis; the individual has to have thoughts or feelings that are excessive or disproportionate to the physical symptoms. ^[1]

Common Symptoms

Symptoms of somatic symptom disorder all revolve around excessive or disproportionate thoughts, feelings, or behaviors related to somatic symptoms or health concerns. Common symptoms include: ^{[2] [3] [4]}

• Excessive worry about physical symptoms
• Common symptoms are pain, fatigue, breathlessness, and stomach problems
• But they can occur anywhere in the body
• If a medical disorder is present, impairments and reactions are more severe than expected
• Significant time spent each day worrying about one’s health
• Belief that physical symptoms are threatening or harmful
• Frequent checking of your body for abnormalities or issues
• Frequent health care visits that don’t relieve concerns
• Unable to be reassured, even after multiple tests
• Being unusually sensitive to medication side effects
• Attributing normal physical symptoms to a serious illness
• Avoidance of physical activity (due to fear of negative effects)

Individuals with somatic symptom disorder often seek reassurance or become dependent on others, especially for help and emotional support. They may become demanding or angry if they feel their needs aren’t met in regard to their concerns. ^[2]

Causes of Somatic Symptoms

Somatic symptoms sometimes stem from medical conditions, such as IBS, fibromyalgia, or CFS. Other times, there isn’t a clear cause. In either case, the physical symptoms are real and concerns about them are valid, but the individuals react disproportionately to these symptoms.

Certain factors may also increase the likelihood of somatic symptom disorder, such as past trauma, psychological factors, and genetics.

Childhood neglect and childhood physical and sexual abuse are known risk factors for experiencing somatic symptoms. Other environmental factors include a history of violence and alcohol and substance use. ^{[1] [3] [4]}

Psychological factors may also increase the likelihood of developing somatic symptoms. These include: ^{[3] [4]}

• Poor emotional regulation
• Tendency towards negativity/pessimism
• Severe anxiety
• Hypersensitivity/hyperawareness to bodily processes

Research also indicates that genetics accounts for 7 to 21% of the somatic symptoms. Individuals with somatic symptom disorder may also have heightened autonomic nervous system arousal, which is more likely to cause increased heart rate, digestive issues, muscle tension, pain, and other symptoms. In turn, more frequent experiences of these symptoms could increase the likelihood of one reacting to them more negatively. ^[1]

Prevention

It may not be possible to fully prevent somatic symptom disorder. However, certain things may help to prevent it and/or lessen its severity, such as:

• Treatment for anxiety, depression, or other current mental health issues
• Stress management and emotional regulation techniques
• Seeking early treatment if you think you may be experiencing symptoms
• Sticking to your treatment plan (if one is given)

Diagnosing Somatic Symptom Disorder

Diagnosing somatic symptom disorder requires several steps, including a medical history overview, physical exam, and mental status assessment. This ensures the most accurate diagnosis.

If you think you may have somatic symptom disorder, the first step is to meet with your primary care doctor. Your doctor will go over your medical history, with a particular focus on any illnesses, symptoms, and adverse effects to medications.

They will also conduct a comprehensive physical exam, which may include lab tests, such as: ^[1]

• Thyroid function tests
• Urine drug screen
• Blood work
• (Limited) radiological testing

If no medical condition is present, or if symptom severity is disproportional to the actual medical condition, then your doctor will likely refer you to a mental health provider for a psychological evaluation.

The psychological evaluation is an essential portion of diagnosis as it compares symptoms to the diagnostic requirements in the DSM-5. These criteria are: ^[1]

• One or more somatic symptoms that cause distress or significant disruption in daily life
• Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns, including at least one of the following:
• Disproportionate and persistent thoughts about the seriousness of one’s symptoms
• Persistently elevated anxiety about one’s health or symptoms
• Excessive time and energy spent on the symptoms or health concerns
• Symptoms are persistent (typically last more than 6 months)

A mental status examination is also performed to assess possible comorbid psychiatric disorders, such as anxiety, depression, and personality disorders.

Complications and Misdiagnosis

Certain medical conditions can cause symptoms that may look like somatic symptom disorder. Therefore, it’s important to identify existing medical conditions and make sure that symptoms are disproportionate to the actual conditions. This can sometimes be difficult to do, especially in milder cases.

Other disorders may also have similar symptoms, such as OCD, body dysmorphic disorder, and illness anxiety disorder, so careful evaluation is needed to determine the true cause. ^[1]

Treatment Approaches

The primary treatment for somatic symptom disorder is psychotherapy. Treatment may also consist of medication, as well as management of physical symptoms.

Psychotherapy

One form of psychotherapy that is useful for somatic symptom disorder is cognitive-behavioral therapy (CBT). This therapy helps individuals to identify, challenge, and replace their unhelpful thoughts and behaviors with balanced alternatives. In the case of somatic symptoms, CBT can help you to: ^{[1] [3]}

• Identify your feelings and beliefs about your physical symptoms and overall health
• Recognize and change the way you perceive your symptoms
• Reduce stress and anxiety surrounding your symptoms
• Reduce the focus and intensity about your symptoms and overall health
• Develop and implement coping and life functioning skills

Mindfulness-based therapy is another potentially beneficial therapy for this disorder. This therapy helps individuals to become more aware of and less threatened by their somatic symptoms, often leading to reduced anxiety and stress. ^[5]

In some cases, increased awareness of physical sensations can intensify anxiety. For treatment to be effective, it’s important to communicate whether the strategies you and your provider are implementing are helping or worsening your symptoms.

Medication

Medications may be used for somatic symptom disorder, especially to treat comorbidities, such as anxiety and depression. Examples of medications that may be used are: ^{[1] [5]}

• Selective-serotonin reuptake inhibitors (SSRIs)
• Serotonin-noradrenaline reuptake inhibitors (SNRIs)

Somatic Symptom Management

In addition to the above treatments, an important part of treatment is managing somatic symptoms. When symptoms are treatable, you should work with your provider to address them.

A goal of somatic symptom management is to increase your capacity to cope with the distress symptoms may cause. Regular (but not excessive) doctor visits and check-ups can provide reassurance or reinforcement that the symptoms aren’t as severe as the individual thinks.

Living with Somatic Symptoms

There are also several specific things you can do on a regular basis to make living with somatic symptom disorder more manageable. These tips include: ^[2]

• Stress management techniques, such as breathing exercises and mindfulness
• Schedule regular check-ups with your doctor
• Find a doctor who is supportive and trustworthy
• Tell them about any questions, comments, or concerns

*

• Streamline your care to help avoid unnecessary tests and procedures (this could look like sticking with one primary provider you trust)
• Take care of yourself with regular exercise, adequate sleep, and a balanced diet
• Seek support from friends and family
• Practice open, honest communication
• Be mindful of how your demands affect others

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Geralyn DexterPhD, LMHC

Geralyn Dexter, PhD, LMHC (she/her), is a psychology faculty member, researcher, writer, and licensed therapist with 15 years of experience providing evidence-based care.

Activity History - Medically reviewed on March 31, 2026 and last checked on March 19, 2026