Somatic symptom disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]


Somatic symptom disorder is characterized by the presence of one or more somatic symptoms with excessive thoughts and behaviors associated with health concerns. [1]

Differential Diagnosis

Epidemiology and Demographics


The prevalence of somatic symptom disorder is 5,000 to 7,000 per 100,000 (5-7%) of the overall population.[1]

Risk Factors

Natural History, Complications and Prognosis

Poor prognostic factors include:

Diagnostic Criteria

DSM-V Diagnostic Criteria for Somatic Symptom Disorder[1]

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.


B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

  1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
  2. Persistently high level of anxiety about health or symptoms.
  3. Excessive time and energy devoted to these symptoms or health concerns.


C. Although anyone somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Specify if:

With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.

Specify if:

Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).

Specify current severity:

Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

Diagnostic scales

Most accurate diagnosis is be combining a somatic scale with a B symptoms scale, "Optimal combined cutpoints were ⩾9 for the PHQ-15 or SSS-8, and ⩾23 for the SSD-12 (sensitivity and specificity = 69% and 70%)"[2].

Somatic scales

Compared to the PHQ-15, the SSS-8 only has 8 questions, but the SSS-8 has 5 anchors for responses whereas the PHQ-15 is easier with only 3 anchors.


Area under the curve (AUC) 70[2]

Somatic Symptom Scale-8 (SSS-8)[4].

Area under the curve (AUC) 70[2] For the SS-8, a score of[2]:

  • <= 6 makes somatic symptom disorder unlikely
  • >= 19 makes somatic symptom disorder likely

B symptoms

The has been validated Somatic Symptom Disorder-B Criteria Scale (SSD-12)[5].


Measurement-based care is guided by the somatic symptom scale-8[4]. . A small randomized controlled trial [6] and a non-randomized study[7] has addressed treatment.

Trials[8] and reviews[9] of cognitive behavioral therapy show benefit.

Short-term psychodynamic psychotherapy may help[10].


  1. 1.0 1.1 1.2 1.3 1.4 1.5 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  2. 2.0 2.1 2.2 2.3 Toussaint A, Hüsing P, Kohlmann S, Löwe B (2020). "Detecting DSM-5 somatic symptom disorder: criterion validity of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8) in combination with the Somatic Symptom Disorder - B Criteria Scale (SSD-12)". Psychol Med. 50 (2): 324–333. doi:10.1017/S003329171900014X. PMID 30729902.
  3. Kroenke K, Spitzer RL, Williams JB (2002). "The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms". Psychosom Med. 64 (2): 258–66. doi:10.1097/00006842-200203000-00008. PMID 11914441.
  4. 4.0 4.1 Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Zenger M, Brähler E; et al. (2014). "The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden". JAMA Intern Med. 174 (3): 399–407. doi:10.1001/jamainternmed.2013.12179. PMID 24276929.
  5. Toussaint A, Murray AM, Voigt K, Herzog A, Gierk B, Kroenke K; et al. (2016). "Development and Validation of the Somatic Symptom Disorder-B Criteria Scale (SSD-12)". Psychosom Med. 78 (1): 5–12. doi:10.1097/PSY.0000000000000240. PMID 26461855.
  6. Smith RC, Gardiner JC, Luo Z, Schooley S, Lamerato L, Rost K (2009). "Primary care physicians treat somatization". J Gen Intern Med. 24 (7): 829–32. doi:10.1007/s11606-009-0992-y. PMC 2695533. PMID 19408058.
  7. Smith GR, Monson RA, Ray DC (1986). "Psychiatric consultation in somatization disorder. A randomized controlled study". N Engl J Med. 314 (22): 1407–13. doi:10.1056/NEJM198605293142203. PMID 3084975.
  8. Magallón R, Gili M, Moreno S, Bauzá N, García-Campayo J, Roca M; et al. (2008). "Cognitive-behaviour therapy for patients with Abridged Somatization Disorder (SSI 4,6) in primary care: a randomized, controlled study". BMC Psychiatry. 8: 47. doi:10.1186/1471-244X-8-47. PMC 2443798. PMID 18570681.
  9. Kroenke K (2007). "Efficacy of treatment for somatoform disorders: a review of randomized controlled trials". Psychosom Med. 69 (9): 881–8. doi:10.1097/PSY.0b013e31815b00c4. PMID 18040099.
  10. Abbass A, Kisely S, Kroenke K (2009). "Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials". Psychother Psychosom. 78 (5): 265–74. doi:10.1159/000228247. PMID 19602915.

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