In somatic symptom disorder a person has one or more physical symptoms, such as pain or fatigue, along with excessive thoughts, worry and time spent on them. The symptoms are real and distressing, and the problem is how much they take over daily life, whether or not a medical cause is found.
Key symptoms
- Pain, fatigue, dizziness or stomach symptoms for at least 6 months
- Constant worry that the symptoms mean a serious disease
- Many visits, tests and specialists without relief
- Large amounts of time and energy spent on health concerns
- Often depression or anxiety at the same time
What you find on exam
- Take every symptom seriously and do a focused, complete exam
- Look for signs of a real medical disease that has been missed
- Screen for depression, anxiety and past trauma
- Note how the symptoms affect work, family and daily function
Tests
- Reasonable tests guided by the history and exam
- Avoid repeated tests that do not change care
- PHQ-9 or similar tools for mood and somatic symptoms
- Review past records before ordering more workup
Treatment basics
- One main clinician with regular, scheduled visits rather than urgent ones
- Acknowledge the symptoms and focus on function, not on cure
- Cognitive behavioral therapy
- An antidepressant such as an SSRI if depression or anxiety coexist
- Limit opioids and unnecessary procedures
Red flags
- New or changing symptoms such as weight loss, fever or bleeding
- Abnormal exam findings or lab results
- Suicidal thoughts
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.