What Is Somatic Symptom Disorder DSM-5 Criteria?

Reviewed by Aaron Horn, LMFT

Published 12/22/2020

Somatic symptom disorder is a mental health condition that involves a preoccupation with one’s physical symptoms to the point where it causes distress and disrupts a person’s ability to function. In this article, you will learn more about the details surrounding somatic symptom disorder, its symptoms, and treatment options.

Somatic Symptom Disorder: What Is An Example Of A Somatic Symptom?

As mentioned in the introduction, somatic symptom disorder is a condition that involves real physical symptoms that are affected by your mindset.

Somatic refers to “of the body,” which distinguishes it from the mind; therefore, the definition of the somatic symptom can involve things such as aches and pain, breathing troubles, headaches, fatigue, to name a few examples.

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However, in somatic symptom disorder, these physical symptoms can certainly cause mental distress, which affects their thoughts, feelings, and behaviors. Most of the time, the reaction to these symptoms is excessive and disproportionate to what is happening. [1]

In the past, these indicators would be signs of hypochondriasis, and someone with this condition would be known as a hypochondriac. This has changed as of the DSM-5, and hypochondriac was split into two conditions - somatic symptom disorder and illness anxiety disorder.

This happened to reduce stigma involving the term hypochondria and try to provide better and more accurate diagnoses for what people are experiencing. [2]

In contrast with the somatic disorder, illness anxiety disorder doesn’t emphasize the physical symptoms, and instead, anxiety and excessive worry are more dominant. In fact, some people with illness anxiety disorder don’t have symptoms at all but will try to check to make sure that they don’t have an issue (i.e., looking for lumps that can be tumors) or try to prevent something from happening. [2]

Essentially, those who have an illness anxiety disorder are extremely afraid of getting a disease or illness. In contrast, those with somatic symptom disorder will have symptoms, but their reaction to the somatic complaints is blown out of proportion, causing them to experience significant distress.

Everyone experiences anxiety from time to time about physical symptoms. Still, the main difference is that the disorders are chronic and disrupt a person’s way of life, and it can also lead to other mental health concerns like anxiety disorders and depression.

Nonetheless, it is still very common, and approximately 5 to 7 percent of the general population will have somatic symptom disorder. Many will start to see signs by the age of 30 years old. Women are also more likely than men to develop somatic symptom disorder, but it can still happen to anyone. [1] [3]

Now that you have a general overview of the disorder, you can see how somatic symptom disorder is diagnosed using the Diagnostic and Statistical Manual 5th edition by the American Psychiatric Association in the next section.

Somatic Symptom Disorder DSM-5 Criteria

Below, you will find the criteria used by mental health professionals to diagnose somatic symptom disorder: [4]

  1. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
  2. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

Persistently high level of anxiety about health or symptoms.

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Excessive time and energy devoted to these symptoms or health concerns.

  1. Although anyone somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than six months).

Specify if:

  • With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.

Specify if:

  • Persistent: A persistent course is characterized by severe symptoms, marked impairment, and a long duration (more than six months).

Specify current severity:

  • Mild: Only one of the symptoms specified in Criterion B is fulfilled.
  • Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
  • Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

What Are Some Complications of Somatic Symptom Disorder

Somatic symptom disorder can disrupt just about every aspect of a person’s life. Still, one of the unique issues to this disorder than some others is that it can cause people to take too many unnecessary visits to the doctor’s office.

When people with somatic symptom disorder visit a doctor, they often won’t receive the answer that they are looking for. The doctor may say that everything seems normal, that they don’t have a life-threatening illness, or may even be prescribed something to help deal with their physical symptoms, yet their anxiety persists.

These doctor visits can cause people with the disorder to run into financial troubles if they frequently make appointments or if it causes them to get terminated from their job.

People can also run into issues with their social relationships, especially their friends and family members who want to be supportive but don’t know how to help their loved one, especially if they are unaware of the signs and symptoms of somatic symptom disorder.

Because of these problems, people can develop depression and anxiety disorders, which can lead to using substance abuse to cope with or have thoughts of suicide. [3] [5]

What Are The Causes & Risk Factors for Somatic Symptom Disorder?

There are multiple reasons why someone may develop somatic symptom disorder, and not one single cause has been identified yet.

However, like most mental health disorders, genetics, and biology are believed to be contributors. People with this disorder may have someone in their family who also has it or might even have an increased sensitivity to pain. [5]

On the other hand, social and environmental factors are always a possibility, and emotional stress can be part of the issue. [3]

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Trauma and neglect can lead to developing emotional coping mechanisms that are not beneficial later in life. For example, someone might be too preoccupied with the physical symptoms they are having, but they cannot identify the emotional issues they are facing. [3] [5]

Sometimes, the behaviors can be learned as well. Some individuals may subconsciously crave more attention from loved ones and develop very real pain in order to remain connected to their families.

Addressing these issues will require psychological treatment to change these thinking patterns and behaviors and replace them with healthy coping skills to improve their ability to function daily.

Treating Somatic Symptom Disorder

One of the primary issues that come with diagnosing and treating somatic symptom disorder is that patients who struggle with it often go to primary care doctors or urgent care facilities instead of visiting a psychiatrist or other mental health professional who can recognize the symptoms.

The problem with this is that those who visit general practitioners don’t often realize that their fear and anxiety is excessive. It might even worsen when the doctor says that they don’t have anything to worry about, and the symptoms don’t indicate a serious illness. [1]

Therefore, addressing somatic symptom disorder typically involves visiting a mental health specialist who can help give a full evaluation and address the stress and anxiety. Still, for this to occur, the patients often need to recognize that their physical symptoms are the source of their anxiety and that there may be a possibility that it’s disproportionate to what is happening in their body.

Once a diagnosis has been made, patients with somatic symptom disorder are recommended psychotherapy as a first-line treatment.

As with many mental health concerns, cognitive behavioral therapy is an effective choice because it can help identify their negative and unhelpful thinking patterns and behaviors towards health, leading them to become anxious.

By understanding them and learning how to cope, people can become less preoccupied with the physical symptoms they’re experiencing and learn how to function better in various aspects of life. [5]

Therapy can also help people deal with their symptoms of depression and anxiety. People may also be prescribed medication, such as antidepressants or anti-anxiety drugs, to help with these common mental health conditions that are often comorbid with somatic symptom disorder.

Do You Have Somatic Symptom Disorder?

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As mentioned before, it can be difficult to realize that your anxiety is the primary issue and not the physical symptoms you are having.

If you or a loved one may be struggling with somatic symptom disorder, you can take this quick, free somatic symptom disorder test and determine if the signs and symptoms match with what you are currently dealing with.

Once you receive the results and determine that you have the disorder, you are immediately encouraged to seek treatment from a mental health professional.

The sooner that someone reaches out for help, the sooner they can start living a more productive and fulfilling life and start mending their relationships with the people that they care about.

Conclusion

With consistent effort, people can overcome somatic symptom disorder. However, it first requires a person to find the proper professional who can give them the right diagnosis. Hopefully, the article's information has helped you understand this condition better and will possibly get you on the path to treatment if you need it.

References

  1. American Psychiatric Association. (2018, November). What Is Somatic Symptom Disorder? Retrieved from https://www.psychiatry.org/patients-families/somatic-symptom-disorder/what-is-somatic-symptom-disorder
  2. Brakoulias, V. (2014, October 08). Hypochondriasis Replaced In The DSM-5. Retrieved from https://www.anxiety.org/hypochondriasis-replaced-by-two-new-disorders-in-dsm-5
  3. Cleveland Clinic. (2018, November 7). Somatic Symptom Disorder in Adults. Retrieved from https://my.clevelandclinic.org/health/diseases/17976-somatic-symptom-disorder-in-adults
  4. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.31, DSM-IV to DSM-5 Somatic Symptom Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t31/
  5. Mayo Clinic Staff. (2018, May 08). Somatic symptom disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/diagnosis-treatment/drc-20377781