Individuals with somatic symptom disorder typically have multiple, current, somatic symptoms
that are distressing or result in significant disruption of daily life (Criterion A), although
sometimes only one severe symptom, most commonly pain, is present. Symptoms
may be specific (e.g., localized pain) or relatively nonspecific (e.g., fatigue). The symptoms
sometimes represent normal bodily sensations or discomfort that does not generally signify
serious disease. Somatic symptoms without an evident medical explanation are not
sufficient to make this diagnosis. The individual’s suffering is authentic, whether or not it
is medically explained.
The symptoms may or may not be associated with another medical condition. The diagnoses
of somatic symptom disorder and a concurrent medical illness are not mutually
exclusive, and these frequently occur together. For example, an individual may become seriously
disabled by symptoms of somatic symptom disorder after an uncomplicated myocardial
infarction even if the myocardial infarction itself did not result in any disability. If
another medical condition or high risk for developing one is present (e.g., strong family
history), the thoughts, feelings, and behaviors associated with this condition are excessive
Individuals with somatic symptom disorder tend to have very high levels of worry
about illness (Criterion B). They appraise their bodily symptoms as unduly threatening,
harmful, or troublesome and often think the worst about their health. Even when there is
evidence to the contrary, some patients still fear the medical seriousness of their symptoms.
In severe somatic symptom disorder, health concerns may assume a central role in
the individual’s life, becoming a feature of his or her identity and dominating interpersonal
Individuals typically experience distress that is principally focused on somatic symptoms
and their significance. When asked directly about their distress, some individuals describe
it in relation to other aspects of their lives, while others deny any source of distress
other than the somatic symptoms. Health-related quality of life is often impaired, both
physically and mentally. In severe somatic symptom disorder, the impairment is marked,
and when persistent, the disorder can lead to invalidism.
There is often a high level of medical care utilization, which rarely alleviates the individual’s
concerns. Consequently, the patient may seek care from multiple doctors for the same
symptoms. These individuals often seem unresponsive to medical interventions, and new
interventions may only exacerbate the presenting symptoms. Some individuals with the disorder
seem unusually sensitive to medication side effects. Some feel that their medical assessment
and treatment have been inadequate.