Somatic Symptom Disorder

What is Somatic Symptom Disorder (SSD)?

Somatic symptom disorder describes both a psychological and physical condition. The physical aspect of the disorder predominantly involves persistent pain, accompanied by psychological symptoms of disproportionate and persistently high levels of anxiety and distress regarding the individual’s own physical symptoms.

The physical symptoms themselves may or may not be medically explained; it is important to note that this has not always been the diagnosis criteria. Traditionally SSD has been regarded as manifestation of psychological stress into physical symptoms, and was previously only diagnosed when the patient presented various symptoms indicative of either a medical or neurological condition, with no supporting medical explanation for such physical symptoms, following detailed examination and investigation.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association shows revised and significant changes to the definition of SSD, providing more clarity on this complex area, which encapsulates both mental and physical health.

Diagnosis Criteria

Under the DSM-5 classification by the American Psychiatric Association, Somatic Symptom Disorder is characterised by the following attributes (300.82), ICD-10 F5.1:

  • 1 or more somatic symptoms that are distressing or result in significant disruption of daily life.
  • Excessive thought, feeling or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
    • Disproportionate persistent thoughts about the seriousness of one’s symptoms.
    • Persistently high level of anxiety about health or symptoms.
    • Excessive time and energy devoted to these symptoms or health concerns.
  • Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent to be more than 6 months.
  • With predominant pain (previously pain disorder).  This specifies for individuals whose somatic symptoms predominantly involve pain.  They are persistent and they are mild to moderate in severity.

Medical Conditions Associated With SSD

There are a number of medical conditions which highlight patterns of somatic symptoms – some examples include:

Irritable Bowel Syndrome (IBS)

A disorder of the digestive system, IBS is a common condition causing bouts of stomach cramps, diarrhoea, bloating or constipation – the exact cause of IBS is poorly understood.

Chronic Fatigue Syndrome (CFS)

Ongoing fatigue and exhaustion which persists following sleep or rest –  there are many possible theories as to the cause of CFS, the exact cause is however, unknown.


Fibromyalgia is a chronic pain condition causing widespread discomfort all over the body, ranging in severity, with multiple tender points – the specific cause is currently unknown.

Chronic Pelvic Pain

A common condition causing persistent intense pain around the pelvic region, it may be the symptom of another medical condition such as pelvic inflammatory disease, or a condition in its own right.

Non-Specific Lower Back Pain

Many people suffer from chronic back pain in the lumbar region with no specific cause.

Tension Headaches

Also referred to as stress headaches, chronic tension headaches occur frequently in monthly episodes, but have no discernible cause. 

Psychological and Physical Wellbeing – Depression and Anxiety

The complex nature of the relationship between psychological and physical wellbeing, can at times complicate diagnosis and categorisation, causing confusion for both the physician and the patient.

Depression is a broad and varied diagnosis – typically characterised however, by low mood and a loss of interest in pleasures and activities. Anxiety, likewise presents itself in many different forms, although it generally describes feelings of severe stress, worry, restlessness and difficulty concentrating (due to excessive worrying).

In some cases, it can be difficult to distinguish whether depression and anxiety occur as a result of a pain related physical condition (suffering from constant pain is depressing and anxiety inducing) or, whether suffering from either depression or anxiety can heighten or even produce painful physical symptoms.

Regardless of whether the physical symptoms have a discernible medical diagnosis or not, the pain felt by those suffering from SSD is real, and the combination of both the psychological and physical symptoms can have an extremely negative impact on the individual’s quality of life, hindering everyday activities such as work and social life.

Pre-Existing Medical Conditions and SSD

It is not uncommon for patients suffering from a serious physical condition such as coronary heart disease or cancer to experience persistently elevated levels of anxiety and disproportionate thoughts regarding the condition of their health – they may also be diagnosed with SSD, and subsequently provided with the appropriate treatment for this disorder as well as their pre-existing medical condition.

Possible Treatment for SSD

Treatment plans for SSD offer appropriate evidence based therapy including: pharmacological, specific medication may be prescribed to help manage painful symptoms; physical treatment, this will vary depending on the symptoms, but often incorporates amongst other treatments, physio-therapy and specific exercises; psychological treatment, this may involve Cognitive Behavioural Therapy (CBT) or other forms of therapy, to help patients manage symptoms of distress and anxiety.

Pain Management

The pain management clinic adopts an interdisciplinary approach towards the management of both the physical and psychological symptoms, regarding the biopsychosocial model. Rather than understanding pain in purely biological terms (physical symptoms), this model considers the psychological (thought patterns, behaviours and emotions) as well as the social (socio-economic, socio environmental), allowing a more comprehensive treatment plan which takes into consideration all aspects of the sufferer’s individual circumstances.

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