Somatoform Disorders

What are Somatoform Disorders?

Somatoform disorders are characterized by an extreme focus on physical symptoms such as pain or fatigue.¹

Symptoms are sensations or feelings that may or may not have a physical cause identified. 

Somatoform symptoms cause significant emotional distress and issues functioning. You may or may not have another medical problem linked to these symptoms. 

Those with a somatoform disorder often think the worst about their symptoms. They may seek medical care frequently. Or, they may look for an explanation even when other serious conditions have been discounted.

Health worries may become such a central focus of a person’s life that it’s hard for them to function. This can develop into a disability.

You may go through significant emotional and physical distress if you have somatoform disorder. 

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Symptoms of Somatoform Disorder (Somatic Symptom disorder) 

Symptoms of somatic symptom disorder include:¹

• Certain sensations such as pain or shortness of breath
• General symptoms such as fatigue or weakness

Symptoms of somatic symptom disorder include:

• Unrelated to any medical cause that can be diagnosed
• Single, multiple, or varying
• Mild, moderate, or severe

Pain is the most common symptom of the condition. 

Whatever the symptoms, someone with the disorder will have excessive thoughts, feelings, or behaviors towards those symptoms.

This causes significant problems. It can make it difficult for a person to function and can sometimes be disabling.

These thoughts, feelings, and behaviors can include:¹

• Constant worrying about potential illness
• Viewing normal physical sensations as serious physical illness
• Worrying that symptoms are indicative of severe illness (even when there’s no evidence)
• Believing physical sensations are threatening or harmful
• Thinking medical evaluation and treatment are not adequate
• Fearing physical activity may damage your body
• Repeatedly checking your body for problems 
• Being unresponsive to medical treatment 
• Having a more severe symptom than is typically expected from a medical condition

For somatic disorder, the way you interpret and react to your symptoms is more important than the physical symptoms of the condition.

Types of Somatoform Disorders

There are different types of somatoform disorders. They’re distinguished by thoughts, actions, and emotions linked to somatic symptoms.

Somatoform disorders are commonly grouped into six different categories:

1. Somatization disorder 
2. Conversion disorder 
3. Pain disorder 
4. Hypochondriasis (Illness Anxiety Disorder)
5. Other specified somatic symptom and related disorder 
6. Unspecified somatic symptom and related disorder

1. Somatization Disorder

Somatization disorder develops when a person constantly complains of physical symptoms. This is even when there’s no physical condition causing the symptoms.

A diagnosis of somatization disorder requires that a person must experience:

• Unexplained physical symptoms that begin before age 30
• Symptoms that continue for several years (e.g., pain, as well as stomach, sexual, and neurological problems)

2. Conversion Disorder

Conversion disorder develops when physical symptoms mimic symptoms of a neurological disorder. This occurs even though there is no known or diagnosed disorder.

Symptoms may include:

• Paralysis
• Vision or hearing loss
• Seizures

A conversion disorder often occurs following a traumatic physical or mental event. 

3. Pain Disorder

A somatoform pain disorder involves recurring pain in one or more parts of the body with no apparent cause. 

A pain disorder diagnosis is given when: 

• A medical or other disorder cannot account for pain
• When pain causes significant stress
• When psychological factors have a significant role in the onset, strength, and duration of the pain

4. Hypochondriasis (Illness Anxiety Disorder)

Illness anxiety disorder develops when people believe that minor symptoms are due to a severe illness. This occurs even when medical tests and assessments prove otherwise.²

Physical symptoms may be real or imagined.

5. Other Specified Somatic Symptom and Related Disorder

This is a diagnosis for symptoms that meet many of the required criteria for a somatoform disorder. However, it doesn’t meet all of the requirements.

6. Unspecified Somatic Symptom and Related Disorder

Unspecified somatoform disorder applies to people who have symptoms of a somatic disorder but don’t meet the complete criteria for a specific somatoform disorder.

It’s different from the other specified somatic symptoms and related disorders.

The diagnosis of unspecified somatic symptom and related disorder should only be made in unusual situations. It can also be given in cases of insufficient information to make a diagnosis.

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What Causes Somatoform Disorder?

There isn’t an exact cause of a somatoform disorder.

However, any of these factors may play a role:¹

• Genetic and biological factors: For example, increased sensitivity to pain.
• Family influence: This could be genetic, environmental, or both
• Personality: A personality trait of negativity can affect how you identify and perceive illness and symptoms.
• Problems processing emotions: Problems processing emotions may cause physical symptoms to become a focus to a person instead of emotional issues.
• Learned behavior: For example, the attention or other benefits from having an illness. This also includes ‘pain behaviors’ in response to symptoms like excessive avoidance of activity. These learned behaviors can increase your level of disability.

Diagnosing Somatoform Disorder 

A doctor should take a thorough history and perform a physical exam. This is to exclude the diagnosis of a specific illness causing the symptoms, and to diagnose a somatoform disorder. 

They may also run some tests. Often, a doctor will ask for another physician to reassess the patient, looking for specific causes that were not initially discovered.

Then, your doctor can help determine if you have any health conditions that require treatment. They might also refer you to a mental health professional. 

Many patients are resistant to mental health evaluations, as they believe their doctor is discounting the seriousness of their symptoms. 

They would prefer to continue evaluation looking for an undiagnosed physical cause. But it’s often advised to continue evaluation for physical causes during the mental health evaluation.

A mental health professional may:¹

• Perform a psychological evaluation to talk about your symptoms, fears or worries, relationship problems, family history, and stressful situations, including your alcohol, drug and illicit substance use
• Have you complete a psychological self-assessment or questionnaire

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) notes these five points in the diagnosis of somatic symptom disorder:¹

1. A person has one or more somatic symptoms that are distressing or cause problems in daily life. For example, pain or tiredness.
2. A person has excessive and persistent thoughts about the seriousness of their symptoms.
3. A person has a persistently high level of anxiety about their health or symptoms.
4. A person devotes too much time and energy to their symptoms or health concerns. 
5. A person continues to have symptoms that concern them. These symptoms typically persist for more than six months. The symptoms may vary.

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Somatoform Disorder Treatment 

Somatoform disorder treatment aims to improve symptoms and a person’s ability to function daily.

Psychotherapy is also known as talk therapy. Talk therapy can be useful for somatic symptom disorder.

If the mental health evaluation finds a specific psychological cause, such as depression, treatments for the illness may be needed.

Psychotherapy

Physical symptoms can link to psychological distress. Psychotherapy can help improve symptoms, even when there is no underlying psychological illness identified.

Psychotherapy can help you:¹

• Examine and change your beliefs and expectations about health and physical symptoms
• Discover how to reduce stress 
• Learn how to deal with physical symptoms 
• Lessen preoccupation with symptoms 
• Reduce avoidance of situations and activities because of uncomfortable physical symptoms 
• Improve daily functioning at home, work, in relationships, and social situations
• Address depression and other mental health conditions 

Family therapy can also help. This form of therapy examines relationships and improves family support and functioning.

Medications

Antidepressants can help treat symptoms linked with depression and pain. Other medications may be required for other psychological illnesses.

If one medication doesn’t work for you, your doctor may suggest switching to another. Or, they may advise combining certain medications to boost effectiveness.

Consider that it may take several weeks to months after starting a medication to notice an improvement in symptoms.

Speak with your doctor about medication options and the possible side effects and risks.

Prevention & Management Tips

Many somatic symptom disorders benefit from professional treatment.

However, some lifestyle and self-care tips can help prevent and manage the disorder.

These tips include:¹

• Work with your healthcare provider and mental health professional. This helps you plan a regular schedule for visits to discuss your concerns. It also enables you to build a trusting relationship. 
• Avoid ‘doctor hopping’ (seeking advice from various doctors) or making several emergency room visits. Doing this can make your care more difficult to coordinate. It may subject you to duplicate testing. 
• Learn stress management and relaxation techniques. Practicing stress management and relaxation techniques, like progressive muscle relaxation, may improve symptoms. 
• Get physically active. An activity program may have a calming effect on your mood. It may also improve your physical symptoms and enhance your physical function.
• Join activities. Get involved in your work and social and family activities. Don't wait until your symptoms go away to do so. 
• Avoid alcohol and recreational drugs. Alcohol and drug use can make your care more difficult. Speak with your health care provider if you need help quitting.

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