For an individual to be diagnosed with somatic symptom disorder, he or she must ________

Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.

Conversion disorder symptoms may occur because of a psychological conflict.

Symptoms usually begin suddenly after a stressful experience. People are at risk of conversion disorder if they also have:

• A medical illness
• A dissociative disorder (escape from reality that is not on purpose)
• A personality disorder (inability to manage feelings and behaviors that are expected in certain social situations)

People who have conversion disorder are not making up their symptoms in order to obtain shelter, for example (malingering). They are also not intentionally injuring themselves or lying about their symptoms just to become a patient (factitious disorder). Some health care providers falsely believe that conversion disorder is not a real condition and may tell people that the problem is all in their head. But this condition is real. It causes distress and cannot be turned on and off at will.

The physical symptoms are thought to be an attempt to resolve the conflict the person feels inside. For example, a woman who believes it is not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming so angry that she wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting someone, she experiences the physical symptom of numbness in her arms.

Symptoms of a conversion disorder include the loss of one or more bodily functions, such as:

• Blindness
• Inability to speak
• Numbness
• Paralysis

Common signs of conversion disorder include:

• A debilitating symptom that begins suddenly
• History of a psychological problem that gets better after the symptom appears
• Lack of concern that usually occurs with a severe symptom

The provider will do a physical exam and may order diagnostic tests. These are to make sure there are no physical causes for the symptom.

Talk therapy and stress management training may help reduce symptoms.

The affected body part or physical function may need physical or occupational therapy until the symptoms go away. For example, a paralyzed arm must be exercised to keep the muscles strong.

Symptoms usually last for days to weeks and may suddenly go away. Usually the symptom itself is not life threatening, but complications can be debilitating.

See your provider or mental health professional if you or someone you know has symptoms of a conversion disorder.

Functional neurological symptom disorder; Hysterical neurosis

American Psychiatric Association. Conversion disorder (functional neurological symptom disorder). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:318-321.

Cottencin O. Conversion disorders: psychiatric and psychotherapeutic aspects. Neurophysiol Clin. 2014;44(4):405-410. PMID: 25306080 pubmed.ncbi.nlm.nih.gov/25306080/.

Gerstenblith TA, Kontos N. Somatic symptom disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 24.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Somatic Symptom and Related Disorders

By Misha Jan, published May 09, 2022 | Fact Checked by Saul Mcleod, PhD

Key Points

• Somatization is the expression of mental experiences into physical responses. Somatic symptom disorder (SSD) is a psychiatric disorder characterized by an obsession with unexplained physical symptoms, commonly physical pain, which cannot be explained by medical disorders.
• SDD that affects roughly 7% percent of adults in the US. While SDD is more commonly seen in women, individuals with a preexisting mental health condition or family history of SDD are at increased risk of developing the disorder.
• SDD imparts significant distress and challenge to the patient as well as the physician.

What is Somatic Symptom Disorder?

Somatic symptom disorder is a term introduced in the DSM-5 to replace somatization disorder, and hypochondriasis. It is characterized by one or more somatic symptoms (relating to the body) which interfere with everyday life, accompanied by anxiety and worry relating to the symptoms.

Somatic symptom disorder (SSD) falls under the umbrella of somatoform disorders. Somatoform disorders are disorders in which thoughts, actions, and emotions correlate to somatic symptoms. The DSM-5 outlines 7 main variations of Somatoform disorders as follows:

• Somatization disorder
• Conversion disorder
• Pain disorder
• Hypochondriasis
• Other specified somatic symptoms and related disorder
• Unspecified somatic symptoms and related disorder

In SDD, a person has an excessive preoccupation on their physical symptoms, such as pain, weakness, or shortness of breath, that it impairs optimal daily functioning.

Oftentimes patients have disproportionate amounts of anxiety correlated to their physical symptoms.

These physical symptoms may or may not be associated with an underlying medical condition. In SDD, individuals may experience excessive thoughts, feelings, and behaviors relating to the symptoms, making them believe they are sick.

These patients frequently seek care and continue to search for an explanation for their symptoms even when other serious conditions have been excluded.

Factors that make a person more at risk of having somatic symptom disorder include:

• Previous history of anxiety and depression
• Having a medical condition, recovering from one, or a strong family history of a medical condition
• Stressful life experiences, such as trauma, violence, child abuse, sexual abuse, etc
• Poor socioeconomic status and low education level

Symptoms of Somatic Symptom Disorder

• Pain in any area of the body
• Pain during sexual activity or menstruation
• Headaches
• Fatigue
• Dizziness
• Fainting
• Weakness
• Constipation
• Diarrhea
• Digestive issues
• Breathing difficulties

• Excessive preoccupation with physical symptoms
• Physical health concerns are the main focus in life
• Constantly visiting physician
• Reporting normal sensations or discomfort to the physician due to catastrophizing the symptom
• Irrationally worrying about medical conditions that have been ruled out
• Dissatisfied with health treatment and assuming that the physician is not taking you seriously
• Sensitive to the side effects of drugs

• Intrusive thoughts about physical symptoms
• Feeling anxious
• Seek to be taken care of
• Depression
• Fear and anxiety, even when they are shown evidence of no serious illness.

Diagnosis

To be diagnosed with SDD, a person must exhibit one of the following criteria:

• One or more physical symptoms, that disturb and disrupt the normal functioning of daily life.
• Excessive thoughts, feelings, and behaviors related to physical symptoms (such as ongoing thoughts that are out of proportion to the seriousness of symptoms, ongoing high level of anxiety, and excessive time/energy spent on health concerns).
• Although symptoms may be different, at least one of them must be constant, and symptoms may come and go.

The main aim of treatment is to enhance a person’s daily functioning by reducing their physical symptoms or improving their ability to cope with them. The plan usually consists of medication, psychotherapy, or hypnosis.

If left untreated, somatic symptom disorder can lead to poor health, problems functioning in daily life, physical disability, relationship problems, work problem, and unemployment.

Other complications may include co-occurring mental health disorders, such as anxiety, depression, and personality disorders, and increased suicide risk related to depression.

These individuals also face financial problems due to recurrent health care visits, and excessive medication usage.

Medication

In case of a co-occurring condition, such as anxiety or depression, antidepressant medications may be used.

These medications alone cannot resolve somatic symptoms, but they help alleviate the symptoms of associated co-occurring conditions, particularly when combined with psychotherapy.

Psychotherapy

Cognitive-behavioral therapy (CBT) is the most commonly used treatment option and is focused on helping people better manage their thoughts and behaviors.

CBT can help them learn how to decrease the preoccupation with their symptoms and engage more optimally in their daily routine.

Hypnosis

Hypnosis is a systematic procedure conducted by a trained psychotherapist during which a person, responding to suggestions, experiences changes in memory, perception and/or voluntary action.

Hypnosis has been shown to be effective in pain relief, which is the most frequently reported symptom in those struggling with SDD.

When to see a doctor?

Somatic symptom disorder affects the daily life of many individuals, and you should contact your healthcare provider if you feel so concerned about physical symptoms that you can't function, or if you have symptoms of anxiety or depression.

The doctor will evaluate you accordingly and will ensure proper treatment according to the symptoms and underlying cause.

Co-Occurring Conditions associated with Somatic Symptom Disorder (SSD)

SDD often co occurs with psychological disorders such as anxiety and depression, which may be the cause of SDD. It is crucial for these conditions to be addressed for an optimal recovery.

In order to cope with the uncomfortable feelings associated with SDD, many individuals may turn to drugs and alcohol. Hence why substance abuse is a common co-occurring condition in SDD.

Somatic Symptom Disorder vs Illness Anxiety Disorder

Illness anxiety disorder (IAD), previously known as hypochondriasis, the obsession with the idea of being ill. It does not typically involve any somatic symptoms, but individuals complain about having a medical illness.

In contrast, SDD is characterized by at least one specific somatic symptom that is causing significant disruption in one’s life.

IAD is the focus on an illness while SDD is the focus on a specific symptom. According to the DSM-5, two types of patients fall under illness anxiety disorder, the care-seeking ones, and the care-avoidant ones.

Both SDD and IAD are preoccupied with a medical illness, but in SDD there is a somatic expression of complaint and in illness anxiety disorder, it is dominated by anxiety about acquiring a serious medical illness.

Both cases are characterized by frequent doctor visits and increased worry and anxiety due to failure in making a diagnosis.

Somatic Symptom Disorder vs Conversion Disorder

Conversion disorder, also known as Functional Neurological Symptom Disorder, is a psychological condition in which patients present involuntary neurological symptoms which do not fit any neurological disorder.

An example of this is pseudo seizures in which a person is displaying signs of convulsions or jerking that match a seizure yet there is no abnormal EEG activity.

The term conversion disorder was developed by Sigmund Freud who believed that neurological symptoms arise as a result of repressed psychological conflict.

Conversion disorder differs from somatic symptom disorder in that patients are disturbed by physical consequences.

In SDD, symptoms are usually catastrophized and much of the impairment to daily functioning is a result of the emotional consequences.

Misha Jan is a member of the 2024 class at Carleton University majoring in Psychology with a minor in Neuroscience and Mental Health. On campus, she contributes science articles to the university’s blog and newspaper, The Charlatan. She is a also research assistant at the Royal Ottawa Mental Health Centre and a certified Crisis Responder working with KidsHelpPhone. Upon graduation, she plans to pursue a PhD in Clinical Psychology.

Content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

Jan, M. (2022, May 09). Somatic Symptom and Related Disorders. Simply Psychology. www.simplypsychology.org/somatic-symptom-disorder.html

• Further Information

  Dimsdale, J. E., Creed, F., Escobar, J., Sharpe, M., Wulsin, L., Barsky, A., ... & Levenson, J. (2013). Somatic symptom disorder: an important change in DSM. Journal of psychosomatic research, 75(3), 223-228. Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic pain, psychopathology, and DSM-5 somatic symptom disorder. The Canadian Journal of Psychiatry, 60(4), 160-167. Kurlansik, S. L., & Maffei, M. S. (2016). Somatic symptom disorder. American family physician, 93(1), 49-54.

Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). American Psychiatric Association.

Frances, A. (2013). The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. Bmj, 346.

French, J. H., & Hameed, S. (2021). Illness Anxiety Disorder. In StatPearls. StatPearls Publishing.

Hasin, D., & Katz, H. (2007). Somatoform and substance use disorders. Psychosomatic Medicine, 69(9), 870–875.

Henningsen P. (2018). Management of somatic symptom disorder. Dialogues in Clinical Neuroscience, 20(1), 23–31.

Hurwitz T. A. (2004). Somatization and conversion disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 49(3), 172–178.

Kallivayalil, R. A., & Punnoose, V. P. (2010). Understanding and managing somatoform disorders: Making sense of non-sense. Indian journal of psychiatry, 52(Suppl 1), S240–S245.

Kurlansik, S. L., & Maffei, M. S. (2016). Somatic Symptom Disorder. American family physician, 93(1), 49–54.

Thompson, T., Terhune, D. B., Oram, C., Sharangparni, J., Rouf, R., Solmi, M., Veronese, N., & Stubbs, B. (2019). The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials. Neuroscience and biobehavioral reviews, 99, 298–310.

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