AKT · Psychiatry/Personality & otherlow yield

Somatic symptom disorder

Overview

One or more distressing somatic symptoms PLUS excessive thoughts, feelings or behaviours about them (health anxiety, disproportionate time/energy), persisting >6 months — regardless of whether a medical explanation exists.

Recognise

Real, distressing physical symptoms
Disproportionate worry, health-related anxiety and behaviour
High healthcare use; symptoms not intentionally produced

Red flags

Do not miss genuine organic disease — somatic symptom disorder can coexist

Differentials & how to tell them apart

Illness anxiety disorderpreoccupation with HAVING illness with few/no actual symptoms

Factitious disordersymptoms intentionally produced for the sick role

Malingeringintentional, for external gain (not a mental disorder)

Conversion (functional neurological) disorderneurological symptoms incompatible with disease

Investigations

Targeted (not endless) investigation to exclude organic disease; avoid iatrogenic harm from over-investigation.

Management

1Single trusted clinician, regular brief scheduled reviews, validate distress, limit unnecessary tests/referrals.
2CBT; treat comorbid anxiety/depression.

Treat comorbid depression/anxiety — SSRIs for comorbidity; no specific cure

Key points

The discriminators across the cluster: intent (none vs intentional) and motive (sick role vs external gain).

Monitor & prognosis

Function, healthcare use, comorbid mood.

Often chronic; consistent care reduces harm.

Source: DSM-5; StatPearls