Overview of Somatic Symptom and Related Disorders

ByJoel E. Dimsdale, MD, University of California, San Diego

Reviewed/Revised Jul 2024

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Somatic symptom and related disorders are mental health conditions characterized by an excessive, intense focus on physical (somatic) symptoms that causes significant distress and/or interferes with daily functioning.

Most mental health conditions are characterized by mental health symptoms. That is, people have unusual or disturbing thoughts, moods, and/or behaviors. However, in somatic symptom disorders, psychological factors are expressed as physical symptoms—a process called somatization—and the person's main concern is with physical symptoms, such as pain, weakness, fatigue, nausea, or other bodily sensations. The person may or may not have a physical disorder that causes or contributes to the symptoms. However, when a physical disorder is present, a person with somatic symptom or a related disorder responds to it disproportionately.

It is not unusual to have an emotional reaction to physical symptoms. However, people with a somatic symptom disorder have exceptionally intense thoughts, feelings, and behaviors in response to their symptoms. To distinguish a disorder from a normal reaction to feeling ill, the responses must be intense enough to cause significant distress to the person (and sometimes to others) and/or make it difficult for the person to function in daily life.

In the standard psychiatric diagnostic manual, the different responses people have define the specific disorder they have, as in the following:

In somatic symptom disorder, people's symptoms concern and preoccupy them, worry them constantly, and/or drive them to see doctors very frequently.
In illness anxiety disorder (previously known as hypochondria or hypochondriasis), people are excessively preoccupied and worried about the possibility of having or getting a serious illness.
In functional neurological symptom disorder (formerly known as conversion disorder), physical symptoms that resemble those of a nervous system disorder develop.
Sometimes attitudes or behaviors can have a negative effect on a physical illness that a person has—a disorder called psychological factors affecting other medical conditions.
In factitious disorders (either imposed on self or imposed on another), people pretend that they or someone else has symptoms even when there is no obvious external benefit to be gained (such as to get time off from work)

Because people with these disorders think they have physical symptoms, they tend to go to a doctor rather than to a mental health care professional.

Somatic symptom or related disorders may also occur in children.

Treatment varies according to which disorder a person has but usually involves psychotherapy.

Mind and Body

How the mind and body interact to influence health has long been discussed. Although people speak casually about mind and body as though they were distinct, they are actually so interrelated that it is hard to separate their effects, as in the following cases:

Social and psychological stress can aggravate many physical disorders, including diabetes mellitus, coronary artery disease, and asthma.
Stress and other mental processes can aggravate or prolong physical symptoms. For example, people who are depressed or anxious may suffer more if they become ill or injured than people who are in a better frame of mind.
Stress sometimes can contribute to physical symptoms even when no physical disorder is present. For example, children may develop abdominal pain or nausea because they are anxious about going to school, or adults may develop a headache when they are under emotional stress.
Thoughts and ideas can influence how a disorder progresses. For example, people with high blood pressure may deny that they have it or that it is serious. Denial may help reduce their anxiety, but it may also prevent them from following their treatment plan. For example, they may not take their prescribed medications, thus worsening their disorder.
A physical disorder can influence or lead to a mental health issue. For example, people with a life-threatening, recurring, or chronic physical disorder may become depressed. The depression, in turn, may worsen the impact of the physical disorder.
A disease of the brain, such as Alzheimer disease, can affect someone's personality and/or ability to think clearly.

When physical symptoms result from stress or psychological factors, doctors may have difficulty identifying the cause. Various diagnostic tests may be required to clarify the situation.

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