What are examples of symptoms of Somatic Symptom Disorder (SSD)?

Examples of Symptoms in Somatic Symptom Disorder

Somatic Symptom Disorder most commonly presents with neurologic, pain, autonomic, or gastrointestinal symptoms that are vague, poorly described, and fluctuate with activity or stress. 1

Most Common Symptom Categories

Neurologic Symptoms

• Headaches (account for 20-55% of pediatric office visits) 1
• Dizziness 1
• Fatigue 2, 3
• Pseudoseizures or conversion symptoms 1

Pain Symptoms

• Recurrent abdominal pain (accounts for 5% of pediatric office visits) 1
• Chest pain (9.2% of emergency department visits for chest pain are attributed to somatization) 1
• Back pain 1
• Leg pain 3
• Muscle tension 1

Gastrointestinal Symptoms

• Abdominal cramping 1
• Bowel symptoms 1
• Indigestion 1
• Non-specific gastrointestinal complaints 1

Autonomic/Cardiorespiratory Symptoms

• Palpitations 1
• Shortness of breath 2
• Difficulty breathing 1
• Sweating 1

Characteristic Features of These Symptoms

Symptom Quality

• Vague and poorly described complaints that lack specific anatomic localization or clear temporal patterns 1
• Multiple concurrent symptoms across different body systems, with patients often reporting numerous somatic complaints simultaneously 1, 3
• Symptoms fluctuate with activity or stress levels, worsening during periods of psychological distress and improving with distraction 1

Associated Psychological Features

The symptoms must be accompanied by excessive thoughts, feelings, or behaviors including: 1, 4

• Disproportionate thoughts about symptom seriousness (catastrophizing about what symptoms mean) 4
• Persistently high anxiety levels about health or symptoms 4
• Excessive time and energy devoted to symptoms or health concerns, including extensive time researching symptoms or seeking medical care 4

Temporal Pattern

• Symptoms are persistent, typically lasting more than 6 months 4
• Episodes may be intermittent but the overall pattern is chronic 2

Medical Evaluation Findings

• Lack of physical findings on examination that explain the severity or nature of complaints 1
• Laboratory abnormalities are absent or do not correlate with symptom intensity 1
• Multiple prior medical encounters with extensive diagnostic testing that fails to identify organic pathology 4, 3

Important Distinguishing Features

What These Symptoms Are NOT

• Not intentionally produced (which would indicate factitious disorder) 1, 4
• Not associated with material gain (which would suggest malingering) 1, 4
• The patient genuinely experiences distress and believes they are ill, regardless of whether physical symptoms connect to a diagnosable medical condition 2

Functional Impact

All presentations result in significant psychosocial impairment including: 1, 4

• Disrupted relationships with family or friends 1, 4
• Academic difficulties or school absenteeism 1, 4
• Occupational dysfunction or work disability 1, 4
• Reduced quality of life across multiple domains 1

Clinical Context

Between 10-15% of adult primary care patients and up to 35% of some primary care populations have SSD, making recognition of these symptom patterns clinically essential 1, 5. Among pediatric patients with medically unexplained chest pain, 81% meet criteria for anxiety disorders, highlighting the strong psychiatric comorbidity 1, 4. The key to diagnosis is recognizing the pattern of persistent somatic complaints combined with disproportionate cognitive-emotional responses, rather than focusing solely on whether symptoms have medical explanation 6.