What is Somatic Symptom Disorder?

This video describes somatic symptom disorder. When we talk about somatic symptom disorder we're talking about a mental disorder in the Diagnostic and Statistical Manual (DSM). It is in a section called “somatic symptom and related disorders,” so it's in the same section as other disorders like factitious disorder, conversion disorder, and illness anxiety disorder. The first symptom criterion is one or more somatic symptoms that are distressing or cause significant disruption. Criterion B has a few symptom criteria under it and only one of these have to be met. Here we see excessive thoughts, feelings, or behaviors related to somatic symptoms or health concerns and at least one of the following three criteria would have to be met: disproportionate and persistent thoughts about the seriousness of the symptoms, persistently high level of anxiety about health concerns or about the symptoms, and the third is excessive time and energy is devoted to the symptoms or to health concerns. Criterion C is that the state of being symptomatic is persistent. We think of this as usually more than six months. What is interesting here about criterion C is that the somatic complaint can change over the course of these six months. It doesn't have to be the same somatic complaint, but just the general state of being symptomatic would be persistent for six months. Somatic symptom disorder also has a few specifiers: with predominant pain, persistent, mild, moderate, and severe. Some other characteristics we see with somatic symptom disorder include checking behavior, a need for continual reassurance, and avoiding physical activity. There is a variety of comorbidity we see with somatic symptom disorder including a number of medical disorders and mental disorders.

[rachelblackwell]

So common. Whenever I talk to someone who experienced childhood trauma like me, this often comes up. Yet so many general practitioners just blow our symptoms off because they can’t find an immediate answer.

[Yashtcm]

Welp... I got pretty much 100% of the symptoms mentioned here, my psychologist just diagnosed me with this and it fits me to a T

[Jess-knvl]

I was diagnosed with chronic fatigue syndrome with unknown cause. Then I finally saw a functional medicine doctor and found out I have hashimotos thyroiditis eventhough my thyroid is still working. I also have chronic pain and PTSD. Personally I think the mental, emotional and physical trauma I have experienced in my life causes these "somatic" fibromyalgia like pain. But it is there and people dont understand it if they dont have it.

[indigenous]

I was diagnosed with Chronic Pain from a service-connected injury. It is very physical. The VA only rates that as Somatic with pain... a mental health issue.

[kikixiong]

I think this is a complicated and tricky disorder to diagnose. I would like to see cases and how mental health professionals diagnose this disorder, as well as some of the treatments.

[kiaa.]

I can't handle this. Lord. It's too much emotions.. Either depression or aggressive irritable. I already call the suicide line a week ago. I want my own energy. But I want my life back.

[jsan]

Just so Im sure I I understand, can someone have a legitimate medical condition and/or diagnosis and also have this disorder? My ex alwas showed extreme obsessiveness, anxiety, and depression when he became physically symptomatic or unwell throughout his life. Bit of background, in college his friends called him "cancer boy" (horrible, I know) because in his second semester he became obsessed with his fatigue and ended up not leaving his room unless he was going to the library to reseach cancer, etc or going to a doctor. This happened multiple times in our marriage. He would be mostly fine, then something like a migraine would happen and he would turn into an entirely different person lasting days. The anxiety and depression would be horrible, to the point of suicidal. The worst was when he developed chronic and sometimes severe back pain. This pain changed him, and this time, his old self never re-emerged. He exhibits the most anxiety, depression, and obsessiveness I have ever witnessed in another human being. He has remained in this state because the physical symptoms were/are chronic. He literally could not & cannot think of anything else, stopped working, interacting with his family, literally everything unless it was about his pain. It destroyed our marriage and has very negatively impacted his relationships with his kids. He seems unable to see that his response to physical symptoms is unusual, extreme, or obsessive. Im thinking he has a severe form of this condition. His father had it as well and ended up committing suicide. I am terrified my sons will have it but at 19 and 15 I havent seen any of the behaviors even when they are ill. Please forgive me if I spoke about this incorrectly, mischaracterized anything or said anything that sounds offensive. I have no background in psychology and know very little about conditions like this. I feel awful for him. I wish there was some way to help him.

[andreanichols]

I agree with you Ryan, it does become problematic to label physical symptoms as a mental illness when it can not be diagnosed from a physician. With Somatic Symptom Disorder you do run the risk of diagnosing someone who could be "faking" their symptoms. More research needs to be done on somatic. As far as treatment goes, do you you attempt to fix the physical ailments or do you treat the anxiety?

[gymnasticlife]

I have a question... I have been failed by numerous health care professionals in my past and therefore I do advocate for myself by researching my symptoms and how to help myself... but according to this, I would be accused of a disorder for this action..?? How can we as patients best advocate for ourselves in a world where health care professionals do not listen to their patients..???

[yarlodek]

Anxiety meds are the only option for me. No matter how hard me and my therapist tried, I never got over it. Its like there’s something in my head blocking me from thinking everything is okay, and I have no idea how people can just accept that they are fine. For most of my childhood, I just thought that that’s what everyone thought and that I just wasn’t handling it well. Yes, some people have lived their entire lives like this.

[suzgen]

I think this disorder from the information provided in this video to be conflicting in a way that I hope for a diagnosis the person would have extreme impairment and function before diagnosed. I think that a person with persistent pain would be concerned with knowing the medical cause of the pain. Along with the concern and pain, distress may not necessarily be an abnormal affect.

[tsbcmhc]

I found it interesting that the somatic symptom does not need to be the same thing for 6 months just that the anxiety pertaining to any somatic event is present. Thank you!

[scottwebb]

It's Soo funny how I get these insane pains in my abdomen and almost feel like I'm gonna pass out and the doctors tell me it's anxiety, and then I go on a weeks later s new pain comes up. It's hard to say what I'm feeling is wrong cause of my illness. I know what physical pain feels like and doctors don't seem to care about digging deep into personal healthcare of individuals and look at people as a generalized society

[adambrowne]

I can see how this disorder would be difficult to diagnose because of all the criterion necessary and the levels of severity. I think it would be very helpful to see an example of a person with somatic symptom disorder or perhaps their intake form/case notes that led to a diagnosis.

[asmr_nostalgia]

Hi Dr. Grande,
I’m wondering if there are any treatments facilities in North America that specializes in somatic disorders.
I have a relative who struggles with multiple symptoms of multiple somatic disorders. This is someone who has been in a lot of therapy over the past couple decades, but seems to only become more dysfunctional even though they’ve tried lots of out of pocket new, and experimental treatments with specialists. This person also has almost unlimited resources but has refused residential tx. Any direction would be greatly appreciated. Thanks!

[cheechcarriero]

Can burning mouth syndrome be a somatic disorder I have seen 24 Dr tried meds and never get better after 16 months my neurologist and a psychiatrist said I have this

[kelly]

It is a good thing other criteria need to be met, if I base my feelings off of my need for continual reassurance and more often than not avoiding physical activity this could definitely apply to me. The mind is very interesting in how it works and how things are brought up inside different individuals.

[janicedixon]

The three different criteria helps determine whether a person can be diagnosed with somatic symptom disorder; however, I’m not quite sure I have a complete understanding what the disorder is.

[jmegee]

If you are diagnosed this with post concussion, anxiety, mixed mood and adhd. What then? I feel this dsm diagnosis seems more like hypochondriac. 😞

[sammyjo]

Is there a high incidence of this with personality disorders? Specifically curious with ocpd.