Version August 2025
INTRODUCTION —
Somatic symptom disorder is characterized by one or more somatic symptoms that are accompanied by excessive thoughts, feelings, and/or behaviors related to the symptoms; the symptoms may or may not be explained by a recognized general medical condition [1,2]. In addition, the somatic symptoms cause significant distress and/or dysfunction [1-3]. Adverse consequences of somatic symptom disorder can include unnecessary surgery, divorce, and suicidal behavior [4].
The diagnosis of somatic symptom disorder was introduced in 2013 [1,2,5]. The disorder consolidates and supplants diagnoses that are no longer formally recognized, including somatization disorder, undifferentiated somatoform disorder, hypochondriasis, and pain disorder; most of the patients who previously received these diagnoses are now diagnosed in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition, Text Revision (DSM-5-TR) with somatic symptom disorder [2].
This topic reviews the epidemiology, pathogenesis, clinical features, and course of illness in somatic symptom disorder. The assessment, diagnosis, differential diagnosis, and treatment of somatic symptom disorder are discussed elsewhere. (See "Somatic symptom disorder: Assessment and diagnosis" and "Somatic symptom disorder: Treatment".)
TERMINOLOGY AND DSM-5-TR
●Overview – Somatic symptom disorder is a diagnosis that was introduced in 2013 [1,2,5]. The diagnosis largely consolidates and supplants the diagnoses of somatization disorder, undifferentiated somatoform disorder, hypochondriasis, and pain disorder, which were collectively referred to as somatoform disorders. Somatic symptom disorder also incorporates the term “somatization,” which is a broad construct (rather than a diagnosis) that has been used to describe patients with medically unexplained symptoms that cause distress and impairment. The somatoform disorders are no longer recognized in the psychiatric nosologies published by the Diagnostic and Statistical Manual, Fifth Edition, Text Revision (DSM-5-TR) and the World Health Organization’s International Classification of Diseases – 11th Revision (ICD-11) [2,6].
●DSM-5-TR – Most of the patients who were previously diagnosed with somatoform disorders are now diagnosed in DSM-5-TR with somatic symptom disorder [2,5]. As an example, the term hypochondriasis described patients who misinterpreted one or more bodily symptoms and believed that they had a serious disease or were preoccupied with fear of a disease despite appropriate medical evaluation and reassurance. Among patients previously diagnosed with hypochondriasis, most are subsumed under the DSM-5-TR diagnosis of somatic symptom disorder if physical complaints are prominent, and fewer under the DSM-5-TR diagnosis of illness anxiety disorder if physical complaints are minimal or nonexistent [2]. As an example, a retrospective study identified patients who had previously been diagnosed with hypochondriasis (n = 58), and found that 76 percent met criteria for somatic symptom disorder and 24 percent met criteria for illness anxiety disorder [7].
A review by the workgroup that developed the diagnosis of somatic symptom disorder found that the construct, descriptive, and predictive validity of somatic symptom disorder were superior to the validity of the somatoform disorders [5]. In addition, interrater and test-retest reliability for somatic symptom disorder are good to very good [1,8,9].
Although the diagnosis of somatic symptom disorder has been criticized as overinclusive and fraught with the potential for false positives [10], it appears that somatic symptom disorder may be a more restrictive diagnosis than the somatoform diagnoses that it replaced. A study of patients with symptoms that were deemed “medically unexplained” (n = 325) found that twice as many patients fulfilled diagnostic criteria for a somatoform disorder than for somatic symptom disorder (93 versus 46 percent) [11]. In addition, the diagnosis of somatic symptom disorder requires that patients exhibit excessive thoughts, feelings, or behaviors related to the somatic symptoms, and thus identifies a group with greater impairment, compared with somatoform disorders [12].
The somatoform disorders included the criterion that somatic symptoms were medically unexplained. However, the reliability for medically unexplained symptoms is poor [5,13] because it is difficult to prove that a symptom is medically unexplained (prove a negative) [2]. By contrast, DSM-5-TR somatic symptom disorder can be diagnosed in patients with known, recognized general medical disorders [1,2].
The diagnosis of somatic symptom disorder is part of a group of diagnoses collectively called somatic symptom and related disorders; this category of diagnoses is characterized by prominent somatic concerns, distress, and impaired functioning [2]. Patients with somatic symptom and related disorders typically present to primary care clinicians and general medical specialists rather than psychiatrists.
The diagnostic criteria of somatic symptom disorder, as well as illness anxiety disorder, are discussed elsewhere. (See "Somatic symptom disorder: Assessment and diagnosis", section on 'Diagnostic criteria' and "Illness anxiety disorder: Epidemiology, clinical presentation, assessment, and diagnosis", section on 'Diagnosis'.)
●ICD-11 - The ICD-11 includes the category “disorders of bodily distress or bodily experience,” which in turn includes the specific diagnosis of “bodily distress disorder” [6]. The diagnostic criteria for bodily distress disorder resemble the criteria for somatic symptom disorder [2,6].
EPIDEMIOLOGY
Prevalence — Only a few studies have examined the prevalence of somatic symptom disorder because it was introduced as a diagnosis relatively recently in 2013 [1,2,5]. (See 'Terminology and DSM-5-TR' above.)
Based upon limited data, it appears that somatic symptom disorder is common, especially in outpatients treated at hospital-based clinics [2,14]:
●General population – The prevalence of somatic symptom disorder in both adolescents and adults in the general population appears to be approximately 5 percent:
•Adolescents – A community-based study of adolescents found that 5 percent screened positive for somatic symptom disorder [15].
•Adults – Community-based studies of representative samples of adults in Taiwan and in Hong Kong suggested that the estimated prevalence of somatic symptom disorder is 5 to 6 percent [16,17].
●Primary care patients – A survey of more than 1700 German primary care clinicians indicated that somatic symptom disorder was present in 8 percent of their patients [18].
●Outpatients treated at hospital-based clinics – Among 697 patients receiving treatment in hospital-based outpatient clinics (eg, gastroenterology, neurology, or psychosomatic medicine), somatic symptom disorder was diagnosed in 236 (34 percent) [19].
Risk factors — Likely risk factors for somatic symptoms disorder include the following [2,15-17,20-29]:
●Female sex
●Fewer years of education
●Lower socioeconomic status or other social stressors
●History of childhood chronic illness
●History of sexual abuse or other childhood and adult trauma
●Concurrent general medical disorders (especially in older patients)
●Health anxiety
●Concurrent psychiatric disorder (especially anxiety or depressive disorders)
●Family history of chronic illness
●Functional disorders
As an example, prevalence rates of somatic symptom disorder are probably higher in patients with functional disorders, such as fibromyalgia, irritable bowel syndrome, and myalgic encephalomyelitis/chronic fatigue syndrome. Among these patients, the reported frequency of somatic symptom disorder ranges from 25 to 60 percent [11,30-32].
PATHOGENESIS
Overview — The pathogenesis of somatic symptom disorder is unknown because it was introduced as a diagnosis relatively recently in 2013 [1,5]. The diagnosis largely consolidates and supplants diagnoses that are no longer recognized in the psychiatric nosology maintained by the DSM-5-TR [2]. (See 'Terminology and DSM-5-TR' above.)
Hypotheses about the pathogenesis of somatic symptom disorder are to some extent based upon studies of patients who were diagnosed with disorders that served as the progenitor of somatic symptom disorder [2]. Culture may play a significant role. (See 'Cultural aspects' below.)
In addition, the pathogenesis is somewhat informed by studies of illness anxiety disorder and functional somatic syndromes (eg, fibromyalgia and irritable bowel disorder). (See "Illness anxiety disorder: Epidemiology, clinical presentation, assessment, and diagnosis", section on 'Pathogenesis' and "Pathogenesis of fibromyalgia" and "Pathophysiology of irritable bowel syndrome" and "Functional dyspepsia in adults", section on 'Epidemiology and pathophysiology'.)
Psychosocial factors — Multiple psychosocial factors may be involved in the pathogenesis of somatic symptom disorder [33].
●Developmental factors – Poor awareness of emotions (alexithymia) and higher levels of negative emotions during childhood are associated with somatic symptoms in children [34], and the tendency to report functional or somatic symptoms often persists from childhood to adulthood [35,36]. In addition, having a family member with a chronic illness during childhood may be a precursor to somatic symptom disorder as an adult [37-39]. Childhood experiences of parental neglect or indifference, such as inadequate food, clothing, or interest in the child’s well-being, may be associated with the disorder during adulthood and frequent visits to general medical outpatient clinics [38,40].
Negative or unpredictable parenting during childhood may lead to insecure attachment (emotional closeness); one hypothesis proposes that somatic symptoms represent care-seeking behavior in patients with insecure attachment [41].
●Physical and sexual abuse – Childhood sexual abuse and recent exposure to physical or sexual violence consistently appear to be associated with somatic symptom disorder in adult women [23,24]. As an example, a meta-analysis of 23 studies found that among patients with a functional syndrome (eg, fibromyalgia) and controls without the syndrome (total n >4600), sexual abuse or rape had occurred approximately three times more often in patients with functional syndromes (odds ratio 3, 95% CI 2-4) [25].
●Cognitive and perceptual distortions and behavioral abnormalities – Somatic symptom disorder may involve an overinclusive or unrealistic concept of good health, dysfunctional assumptions about the prevalence and communicability of severe illnesses, increased attention to bodily processes to detect possible signs of illness, catastrophic interpretations of bodily sensations, problematic expectations about somatic symptoms and the course and treatment of illnesses, and difficulty with information processing [39,42]. Perception of symptoms affects how they are experienced and reported, and perception is influenced by attitudes, beliefs, and psychologic distress.
Benign somatic sensations and physical symptoms may be amplified by some patients, such as those with low pain thresholds, patients who have become sensitized to pain (ie, have a heightened response to pain because of past pain experiences), and patients who pay more attention to their bodily sensations. Normal bodily sensations may thus be perceived as abnormally intense and misattributed to serious medical disease [43]. The patient may then seek assurance of good health.
Despite medical reassurance, patients with somatic symptom disorder remain anxious about their health. One reason is that patients vigilantly monitor their bodies for symptoms and become sensitive to slight homeostatic fluctuations that normally occur [43]. In addition, it is thought that health anxiety leads patients to confirm their fears through selective attention toward information that is consistent with having a disease and away from information that is consistent with good health.
●Difficulties with self-expression – Physical symptoms may offer a means to express distress when patients have difficulty expressing their emotions verbally (alexithymia) [44]. Patients may also present to nonpsychiatric clinicians with physical complaints when psychiatric symptoms are experienced as stigmatizing or when clinicians appear uninterested in hearing about psychiatric problems.
●Family conflict – Another psychosocial factor that may be involved in the pathogenesis of somatic symptom disorder is family conflict [45].
●Chronic stressors and maladaptive coping skills – Once patients develop somatic symptom disorder, it may be perpetuated by chronic stressors and maladaptive coping skills [28]. In addition, behavior related to the symptoms and sick role add another psychologic dimension that maintains the disorder [46]. The symptoms may offer benefits, such as social support, escape from obligations, disability payments, and a compromise for internal conflicts. Litigation may also perpetuate symptoms.
●Iatrogenic effects – Somatic symptom disorder may also be inadvertently amplified or maintained by clinicians [47]. Rather than pursue psychosocial clues voiced by patients, clinicians may order additional diagnostic tests despite a low probability of serious disease [46] and may also offer biomedical interventions and referrals [48,49]. (See "Somatic symptom disorder: Assessment and diagnosis", section on 'Laboratory tests'.)
Genetics — It is not known whether the pathogenesis of somatic symptom disorder has a genetic component; somewhat relevant studies suggest that there may perhaps be a small effect:
●A national registry study of monozygotic and dizygotic twins (n >28,000 individuals) found that the relative contribution of genetic factors (heritability) to somatic symptoms (eg, abdominal discomfort, dizziness, and pain) was 7 to 21 percent, and the remaining contribution was attributable to nonshared (unique) environmental factors [50].
●A prospective community study of primary care patients (n >900) found that after controlling for comorbid anxiety, depression, and pain, multiple single nucleotide polymorphisms were associated with the number of somatic symptoms [51].
Anxiety disorders and/or depressive disorders are probably common in somatic symptom disorder, and studies suggest that there may be a genetic component involved in the co-occurrence of anxiety and depression with somatic symptoms [52]. Comorbid psychopathology is discussed elsewhere. (See 'Psychopathology' below.)
CLINICAL FEATURES
Signs and symptoms — There are two core features that both occur in somatic symptom disorder [2,21]:
●One or more current somatic symptoms that are long-standing (typically more than six months) and cause distress or functional impairment.
●The somatic symptoms or health concerns are associated with excessive thoughts, worrying, or behaviors consuming substantial time and energy.
The spectrum of severity in somatic symptom disorder ranges from mild to severe [2].
Among moderately to severely ill patients, the physical symptoms can become a central feature of the patient’s identity and dominate interpersonal relationships [2]. Psychosocial and physical functioning can decline [2,11,53], and the patient’s disability can impose a significant burden upon families [53]. The most severely ill patients may become invalids [2].
●Type of somatic symptoms – Among adults with somatic symptom disorder, common somatic symptoms involve [22]:
•Pain – Joint pain, leg/arm pain, back pain, headache, chest pain, abdominal pain, dysuria, and diffuse pain. An analysis of individual patient data from nine community studies (total n >28,000) found that among all symptoms, the most frequent burdensome symptom was pain [22].
•Fatigue, syncope, and dizziness.
•Specific organ systems:
-Cardiopulmonary – Chest pain, palpitations, and shortness of breath
-Gastrointestinal – Nausea, vomiting, abdominal pain, bloating, gas, and diarrhea
-Neurologic – Movement disorders, sensory loss, weakness, and paralysis
-Reproductive organs – Dyspareunia, dysmenorrhea, and erectile dysfunction
Among adolescents who screen positive or present with somatic symptom disorder, the most common somatic symptoms include headache and stomach pain [2,15,54]. Youth with the disorder are more likely than adults to have only one prominent somatic symptom. Parental response to the symptom can often influence the level of the youth’s distress and determine the amount of time off from school for medical care [2].
●Number of symptoms – Somatic symptom disorder is not defined by the number of distressful physical symptoms that are present; however, patients who complain of multiple symptoms are more likely to have the disorder. In addition, a larger number of somatic symptoms (eg, >6, based upon clinical experience) is associated with poorer outcomes, such as diminished physical functioning [3,22,55,56].
The number of symptoms refers to the quantity that the patient spontaneously complains about without being asked, rather than the number elicited by the clinician asking symptom by symptom. As an example, a patient with congestive heart failure who does not have somatic symptom disorder may present with shortness of breath as the sole complaint. However, when asked by the clinician, the patient may affirm anorexia, dyspnea upon exertion, paroxysmal nocturnal dyspnea, peripheral edema, fatigue, and right upper quadrant discomfort.
●Checking behavior – Many patients with somatic symptom disorder engage in the same behaviors seen in illness anxiety disorder and check their bodies frequently to reassure themselves; examples include excessive breast self-examination or blood pressure and pulse monitoring. This behavior may increase during times of stress. (See "Somatic symptom disorder: Assessment and diagnosis", section on 'Illness anxiety disorder' and "Illness anxiety disorder: Epidemiology, clinical presentation, assessment, and diagnosis".)
●Insight – The degree of insight among patients with somatic symptoms disorder varies. Some patients recognize that they excessively focus upon and overreact to their physical symptoms, while others firmly maintain their conviction that they are direly ill. However, the intensity of the belief does not reach the level of a delusion. (See "Somatic symptom disorder: Assessment and diagnosis", section on 'Delusional disorder, somatic subtype'.)
●Functional impairment – Occupational/role functioning (eg, family activity and physical activity) is more impaired in individuals with somatic symptom disorder than those without the disorder [15,57].
Comorbidity
General medical disorders — Somatic symptom disorder can occur with or without a general medical illness that “explains” the somatic symptoms [2]. Many patients with a recognized general medical disorder also meet criteria for somatic symptom disorder, and in such cases, both disorders are diagnosed [2,13].
Psychopathology — The extent of comorbid psychopathology in somatic symptom disorder is not well known because it was introduced as a diagnosis relatively recently in 2013 [1,5]. Nevertheless, a community-based study of a nationally representative sample and meta-analyses derived from 43 observational studies (n>3700) suggest that comorbid anxiety disorders and/or depressive disorders occur in approximately 33 percent of individuals with somatic symptom disorder, and the prevalence of anxiety and/or depressive disorders is greater in patients with somatic symptom disorder than controls without somatic symptom disorder.
Comorbid anxiety and depression are likely common in adolescents with somatic symptom disorder [58].
Risk factors for comorbid anxiety and/or depression in somatic symptom disorder include the following:
●Greater number of somatic symptoms (rather than the specific type of symptoms) – This is a consistent risk factor for comorbid anxiety and/or depression, and there appears to be a dose response relationship: as the number of physical symptoms increase, so does the number of anxiety and depression symptoms [20,28,59]
●Greater number of excessive thoughts, feelings, and behaviors related to the somatic symptoms [11]
●Recent stress [28]
●Self-reported health status is poor [28]
Comorbid anxiety can produce its own set of somatic symptoms [60]. As an example, panic attacks are characterized by abdominal distress, chest pain, diaphoresis, dizziness, dyspnea, palpitations, paresthesia, and trembling [2]. Distinguishing somatic symptom disorder from panic disorder is discussed separately. (See "Somatic symptom disorder: Assessment and diagnosis", section on 'Panic disorder'.)
Based upon observational studies, comorbid alexithymia is more common in patients with somatic symptom disorder than controls [61]. Comorbid substance use disorders also appear to be common [2], and some patients with somatic symptom disorder may experience dissociation [62].
Health care utilization — Utilization of medical care is frequently high in patients with somatic symptom disorder and presumably greater than in patients without the disorder [2].
Evidence that suggests health care use is greater in somatic symptom disorder includes studies of patients with the disorder [57] as well as studies of patients with distressing somatic symptoms and high health anxiety, which represent the two core features of somatic symptom disorder (see 'Signs and symptoms' above):
●An analysis of individual patient data from nine community studies (total n >28,000 individuals) found that after controlling for potential confounding factors (eg, age, general medical illness, and depression), a greater number of burdensome somatic symptoms was associated with greater health care use [22].
●Separate studies of representative samples from Australia and Hong Kong each found that health anxiety was associated with increased health service utilization [17,63]. In addition, a larger number of distressing somatic symptoms was also associated with greater health care utilization, independent of health anxiety [17].
The preoccupation with symptoms and high level of health anxiety in somatic symptom disorder often leads to multiple normal examinations and tests (which do not allay the patient’s concern) [20,64]. Seeking care from multiple clinicians (“doctor-shopping”) is also common. Patients may press their clinicians to order progressively more invasive diagnostic tests and higher-risk treatments, which can reinforce the sick role and increase the probability of iatrogenic complications. The use of laboratory tests in assessing patients with a possible diagnosis of somatic symptom disorder is discussed separately. (See "Somatic symptom disorder: Assessment and diagnosis", section on 'Laboratory tests'.)
Despite extensive medical attention, patients with somatic symptom disorder are often disappointed with their care and frustrated with their clinicians [28]. Clinicians in turn may experience negative feelings (eg, frustration, doubt, dysphoria, and anger) because their efforts at managing and reassuring the patient seem futile. These patients are often viewed as “difficult” [65-67].
Some patients with somatic symptom disorder fear iatrogenic illness (eg, adverse medication effects or radiation exposure), avoid mainstream medical clinicians, and pursue a diagnosis and remedies through complementary and alternative practitioners. In addition, many patients use the internet to obtain information about unorthodox prevention and treatment of medical diseases, and consume vitamins, over-the-counter remedies, and fad diets.
Cultural aspects — Several studies in primary care and community settings have demonstrated that syndromes consisting of multiple somatic symptoms and high illness worry, along with functional impairment, anxiety, depression, and increased health care utilization, are similar across many countries and cultures [2,68,69]. In addition, the most common physical symptoms appear to be the same regardless of culture.
However, the manner in which somatic symptoms are experienced and expressed can vary across cultures [2,21,70]. Somatic symptoms can have specific meanings for a particular culture and affect how somatic symptoms are interpreted and how patients conceptualize causation of symptoms. In addition, culture may influence how and when patients seek medical care and the course of illness in somatic symptom disorder.
COURSE OF ILLNESS —
The course of illness in somatic symptom disorder is unclear because it was introduced as a diagnosis relatively recently in 2013 [1,5]. However, some understanding about the course of illness can be gleaned from the literature on patients with functional somatic symptoms and medically unexplained symptoms that cause distress and impairment [2]. (See 'Terminology and DSM-5-TR' above.)
Onset of prodromal, functional somatic symptoms may begin in childhood, adolescence, or adulthood [2].
Remission and recurrence
●Adolescents – Among adolescents with somatic symptom disorder, the majority may improve or remit. In a retrospective study of 37 youth (mean age 15 years) who were hospitalized and diagnosed with somatic symptom disorder or functional neurological symptom disorder (conversion disorder), remission at discharge [54]:
•Occurred in 49 percent
•Was 17 times more likely in patients whose parents fully accepted the diagnosis compared with patients whose parents partially accepted the diagnosis or rejected it
●Adults – Among adults with apparent somatic symptom disorder, the course of illness is likely to be chronic (eg, lasts for at least two years) and fluctuating [2]. Nevertheless, multiple reviews indicate that durable improvement or remission may eventually be expected to occur in at least 50 percent [2,20,71]. As an example, in a prospective five-year study of 32 primary care patients with three or more bothersome, medically unexplained symptoms, 78 percent no longer met criteria for somatic symptom disorder [72].
One factor associated with a decreased likelihood of improvement in apparent somatic symptom disorder is a greater number of somatic symptoms at baseline [20,71]. Other factors that may be related to unabating somatic symptom disorder include older age, severe impairment, and comorbid anxiety and depression [20] as well as maladaptive personality traits, such as harm avoidance (fearfulness, anticipatory worry, and shyness) and being less cooperative [73].
In our experience, patients with somatic symptom disorder who improve or recover may subsequently relapse with different somatic symptoms. However, the rate of recurrence is not clear.
Mortality — The risk of mortality in patients with somatic symptom disorder is unclear because relatively few studies have been conducted. Nevertheless, information about the risk can be derived in part from studies of disorders (eg, hypochondriasis) that served as the progenitor of somatic symptom disorder but are no longer recognized in the psychiatric nosology maintained by the DSM-5-TR [2]. (See 'Terminology and DSM-5-TR' above.)
Based upon studies of hypochondriasis, patients with somatic symptom disorder may be at increased risk of death. As an example, a national registry study matched patients with (n >4100) and without a diagnosis of hypochondriasis (n >41,000) and followed them for approximately eight years [74]. After adjusting for potential confounding factors, the analyses found the following:
●All-cause mortality – All-cause mortality was greater in those with hypochondriasis (hazard ratio 1.7, 95% CI 1.5-1.9), and the average age of death was five years less for those with hypochondriasis than those without hypochondriasis (70 versus 75 years). The increased risk of mortality associated with hypochondriasis was comparable in males and females and was independent of other psychiatric disorders, including anxiety, bipolar, depressive, and psychotic disorders.
In addition, the increased risk of death was nearly two times greater in patients who initially received the diagnosis of hypochondriasis as an inpatient rather than as an outpatient. This suggests a dose-response effect, such that greater severity is associated with a greater risk of death.
●Suicide – The rate of suicide was four times greater in those with hypochondriasis than those without it (hazard ratio 4.1, 95% CI 2.4-7.0).
A potential limitation of the study is that hypochondriasis was probably underdiagnosed based upon studies of its prevalence and the relatively few patients in the registry who were diagnosed with hypochondriasis [74-76]. Underdiagnosis may have led to overestimating the risk of mortality due to overrepresentation of severe cases.
SUMMARY
●Terminology – Somatic symptom disorder is a diagnosis that was introduced in 2013. The diagnosis largely consolidated and supplanted other diagnoses (eg, hypochondriasis), which are no longer recognized in psychiatric nosologies. (See 'Terminology and DSM-5-TR' above.)
●Prevalence – Although the prevalence of somatic symptom disorder is unclear because it was introduced relatively recently, the estimated prevalence in the general population is 5 percent and in primary care patients is 8 percent. Likely risk factors include female sex, history of sexual abuse or other childhood trauma, and concurrent general medical and psychiatric disorders. (See 'Epidemiology' above.)
●Pathogenesis – The pathogenesis of somatic symptom disorder is not known. Multiple psychosocial factors may perhaps be involved, including developmental factors, cognitive and perceptual distortions and behavioral abnormalities, and alexithymia (difficulty recognizing or expressing one’s emotions). (See 'Pathogenesis' above.)
●Clinical features
•Signs and symptoms – There are two core features that each occur in somatic symptom disorder:
-One or more current somatic symptoms that are long-standing and cause distress or psychosocial impairment. Multiple symptoms are typically present.
-Excessive thoughts, worrying, or behaviors related to the somatic symptoms or to health concerns.
Among moderately to severely ill patients, the physical symptoms can become a central feature of the patient’s identity and dominate interpersonal relationships. Psychosocial and physical functioning can decline, and the patient’s disability can impose a significant burden upon families.
The most frequent somatic symptom is pain. Other common symptoms include fatigue as well as gastrointestinal, cardiopulmonary, neurologic, and reproductive organ symptoms.
Somatic symptom disorder can occur with or without a general medical illness that “explains” the somatic symptoms.
Despite extensive medical attention, patients with somatic symptom disorder often are disappointed and frustrated with their clinicians. Clinicians in turn may become frustrated because their efforts at managing and reassuring the patient seem futile. (See 'Signs and symptoms' above.)
•Comorbidity – Many patients with a recognized general medical disorder also meet criteria for somatic symptom disorder; in such cases, both disorders are diagnosed. In addition, comorbid anxiety disorders and/or depressive disorders occur in approximately one-third of primary care patients with somatic symptom disorder. (See 'General medical disorders' above and 'Psychopathology' above.)
•Health care utilization – Utilization of medical care is frequently high in patients with somatic symptom disorder and presumably greater than in patients without the disorder. (See 'Health care utilization' above.)
•Cultural aspects – Syndromes consisting of multiple somatic symptoms and high illness worry along with impairment, anxiety, depression, and increased health care utilization are similar in a wide variety of countries and cultures. However, the manner in which somatic symptoms are experienced and expressed can vary across cultures. (See 'Cultural aspects' above.)
●Course of illness – It is thought that the course of illness in adults with somatic symptom disorder is typically chronic and fluctuating but that improvement or remission of somatic symptom disorder may eventually be expected to occur in at least 50 percent of patients. However, patients who remit may subsequently relapse. (See 'Remission and recurrence' above.)
The risk of all-cause mortality and suicide may be elevated in somatic symptom disorder. (See 'Mortality' above.)
