|
| differential = [[Adjustment disorder]], [[body dysmorphic disorder]], [[Obsessive–compulsive disorder|obsessive-compulsive disorder]], [[conversion disorder]], and [[Hypochondriasis|illness anxiety disorder]].<ref name=StatPearls/>
| treatment = [[Cognitive behavioral therapy|Cognitive-behavioral therapy]],<ref name=Psychopharmacotherapy/> [[psychiatric medication]], and [[Interpersonal therapy|brief psychodynamic interpersonal psychotherapy]].<ref name="PIT"/>
| medication = [[Selective serotonin reuptake inhibitor]]s and [[serotonin–norepinephrine reuptake inhibitor]]s.<ref name=Psychopharmacotherapy>{{cite journal |last1=Somashekar |first1=Bettahalasoor |last1last2=SomashekarJainer |first2=Ashok |last2last3=JainerWuntakal |first3=Balaji|last3=Wuntakal |title=Psychopharmacotherapy of somatic symptoms disorders|url=http://www.tandfonline.com/doi/full/10.3109/09540261.2012.729758 |journal=International Review of Psychiatry |date=February 2013|issn=0954-0261|pages=107–115 |volume=25 |issue=1 |pages=107–115 |doi=10.3109/09540261.2012.729758 |pmid=23383672 |s2cid=25646632 }}</ref>
| prognosis = Often chronic but can be managed with the proper treatment.<ref name=StatPearls/>
| frequency = About 13–23% of the general population.<ref name="Sauer Witthöft Rief 2023 p. ">{{cite journal | last1=Sauer | first1=Karoline S. | last2=Witthöft | first2=Michael | last3=Rief | first3=Winfried | title=Somatic Symptom Disorder and Health Anxiety | journal=Neurologic Clinics | publisher=Elsevier BV | year=2023 | volume=41 | issue=4 | pages=745–758 | issn=0733-8619 | doi=10.1016/j.ncl.2023.02.009 | pmid=37775202 | s2cid=258266448 }}</ref>
Manifestations of somatic symptom disorder are variable; symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms as rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing [[Chronic condition|chronic illness]] or medical condition.<ref name=mayo/>
Several studies have found a high rate of comorbidity with [[major depressive disorder]], [[generalized anxiety disorder]], and [[phobia]]s.<ref name=comorbid>{{cite journal |last1=Brown |first1=F. W. |last1last2=BrownGolding |first2=J. M. |last2last3=GoldingSmith |first3=G. R.|last3=Smith |title=Psychiatric comorbidity in primary care somatization disorder|url=https.://pubmed.ncbi.nlm.nih.gov/2399295/ |journal=Psychosomatic Medicine |date=July 1990|issn=0033-3174|pages=445–451 |volume=52 |issue=4 |pmidpages=2399295445–451 |doi=10.1097/00006842-199007000-00006 |pmid=2399295 |s2cid=30954374 }}</ref> Somatic symptom disorder is frequently associated with [[Psychogenic pain|functional pain syndromes]] like [[fibromyalgia]] and [[Irritable bowel syndrome|IBS]].<ref name=fibromyalgia1>{{cite journal |last1=Häuser |first1=Winfried |last1last2=HäuserBialas |first2=Patric |last2last3=BialasWelsch |first3=Katja |last3last4=WelschWolfe |first4=Frederick|last4=Wolfe |title=Construct validity and clinical utility of current research criteria of DSM-5 somatic symptom disorder diagnosis in patients with fibromyalgia syndrome|url=https://pubmed.ncbi.nlm.nih.gov/25864805/ |journal=Journal of Psychosomatic Research |date=June 2015|issn=1879-1360|pages=546–552 |volume=78 |issue=6 |pmidpages=25864805546–552 |doi=10.1016/j.jpsychores.2015.03.151 |pmid=25864805 }}</ref> Somatic symptom disorder typically leads to poor functioning, [[Interpersonal relationship|interpersonal]] issues, [[unemployment]] or problems at work, and financial strain as a result of excessive health-care visits.<ref name=mayo/>
The cause of somatic symptom disorder is unknown. Symptoms may result from a heightened awareness of specific physical sensations paired with a tendency to interpret these experiences as signs of a medical ailment.<ref name=StatPearls/> The diagnosis is controversial, as people with a medical illness can be mislabeled as mentally ill. This is especially true for women, who are more often dismissed when they present with physical symptoms.<ref name="Frances A 2013 f1580" />
==Signs and symptoms==
Somatic symptom disorder can be detected by an ambiguous and often inconsistent history of symptoms that are rarely relieved by medical treatments. Additional signs of somatic symptom disorder include interpreting normal sensations for [[Disease|medical ailments]], avoiding [[physical activity]], being disproportionately sensitive to medication side effects, and seeking medical care from several physicians for the same concerns.<ref name=StatPearls>{{cite book |last1=D'Souza |first1=Ryan S. |last1last2=D'SouzaHooten |first2=W. M.|last2=Hooten |title=SomaticStatPearls Syndrome|date=2024 Disorders|chapterpublisher=SomaticStatPearls Symptom DisorderPublishing |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK532253/|publisher=StatPearls Publishing|datechapter=JanuarySomatic 2023|location=TreasureSymptom IslandDisorder (FL)|pmid=30335286 |via=PubMed}}</ref>
Manifestations of somatic symptom disorder are highly variable. Recurrent ailments usually begin before the age of 30; most patients have many somatic symptoms, while others only experience one. The severity may fluctuate, but symptoms rarely go away completely for long periods of time.<ref name=merck>{{cite web|access-date=2023-08-01|title=Somatic Symptom Disorder — Psychiatric Disorders|url=https://www.merckmanuals.com/en-ca/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/somatic-symptom-disorder|website=Merck Manuals Professional Edition}}</ref> Symptoms might be specific, such as regional pain and localized sensations, or general, such as [[fatigue]], [[Myalgia|muscle aches]], and [[malaise]].<ref name=mayo>{{cite web|access-date=2023-08-01|title=Somatic symptom disorder — Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/symptoms-causes/syc-20377776|website=Mayo Clinic}}</ref>
Most research that looked at additional [[Mental disorder|mental illnesses]] or self-reported psychopathological symptoms among those with somatic symptom disorder identified significant rates of [[comorbidity]] with [[Depression (mood)|depression]] and [[anxiety]], but other psychiatric comorbidities were not usually looked at.<ref name=StatPearls/> [[Major depressive disorder|Major depression]], [[generalized anxiety disorder]], and [[phobia]]s were the most common concurrent conditions.<ref name=comorbid/>
In studies evaluating different physical ailments, 41.5% of people with [[semantic dementia]], 11.2% of subjects with [[Alzheimer's disease]],<ref name=Dementia>{{cite journal |last1=Gan |first1=Joanna J. |last1last2=GanLin |first2=Andrew |last2last3=LinSamimi |first3=Mersal S. |last3last4=SamimiMendez |first4=Mario F.|last4=Mendez |title=Somatic Symptom Disorder in Semantic Dementia: The Role of Alexisomia|url=https://pubmed.ncbi.nlm.nih.gov/27647568/ |journal=Psychosomatics |date=November 2016|issn=1545-7206|pages=598–604 |volume=57 |issue=6 |pmidpages=27647568598–604 |doi=10.1016/j.psym.2016.08.002 |pmid=27647568 }}</ref> 25% of female patients suffering from [[Lipodystrophy|non-HIV lipodystrophy]],<ref name=lipodystrophy>{{cite journal |last1=Calabrò |first1=Pasquale Fabio |last1last2=CalabròCeccarini |first2=Giovanni |last2last3=CeccariniCalderone |first3=Alba |last3last4=CalderoneLippi |first4=Chita |last4last5=LippiPiaggi |first5=Paolo |last6=Ferrari |first6=Federica |last7=Magno |first7=Silvia |last8=Pedrinelli |first8=Roberto |last9=Santini |first9=Ferruccio |title=Psychopathological and psychiatric evaluation of patients affected by lipodystrophy|url=https://pubmed.ncbi.nlm.nih.gov/31144218/ |journal=Eating and Weight Disorders: EWD- Studies on Anorexia, Bulimia and Obesity |date=August 2020|issn=1590-1262|pages=991–998 |volume=25 |issue=4 |pmidpages=31144218991–998 |doi=10.1007/s40519-019-00716-6 |first5pmid=Paolo|last5=Piaggi|first6=Federica|last6=Ferrari|first7=Silvia|last7=Magno|first8=Roberto|last8=Pedrinelli|first9=Ferruccio|last9=Santini31144218 |s2cid=169040646 }}</ref> and 18.5% of patients with [[Heart failure|congestive heart failure]]<ref name=heart>{{cite journal |last1=Guidi |first1=Jenny |last1last2=GuidiRafanelli |first2=Chiara |last2last3=RafanelliRoncuzzi |first3=Renzo |last3last4=RoncuzziSirri |first4=Laura |last4last5=SirriFava |first5=Giovanni A. |title=Assessing psychological factors affecting medical conditions: comparison between different proposals|url=https://pubmed.ncbi.nlm.nih.gov/23122485/ |journal=General Hospital Psychiatry |date=March 2013|issn=1873-7714|pages=141–146 |volume=35 |issue=2 |pmidpages=23122485141–146 |doi=10.1016/j.genhosppsych.2012.09.007|first5=Giovanni A.|last5pmid=Fava23122485 }}</ref> fulfilled somatic symptom disorder criteria. 25.6% of [[fibromyalgia]] patients met the somatic symptom disorder criteria exhibited higher depression rates than those who did not.<ref name=fibromyalgia1/> In one study, 28.8% of those with somatic symptom disorder had [[asthma]], 23.1% had a [[Cardiovascular disease|heart condition]], and 13.5% had [[gout]], [[rheumatoid arthritis]], or [[osteoarthritis]].<ref name=hypochondriasis>{{cite journal |last1=Newby |first1=Jill M. |last1last2=NewbyHobbs |first2=Megan J. |last2last3=HobbsMahoney |first3=Alison E. J. |last3last4=MahoneyWong |first4=Shiu (Kelvin) |last4last5=WongAndrews |first5=Gavin |title=DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis|url=https://pubmed.ncbi.nlm.nih.gov/28867421/ |journal=Journal of Psychosomatic Research |date=October 2017 |issnvolume=1879-1360101 |pages=31–37|volume=101|pmid=28867421 |doi=10.1016/j.jpsychores.2017.07.010 |first5pmid=Gavin|last5=Andrews28867421 }}</ref><ref name=empiricalevidence>{{cite journal |last1=Löwe |first1=Bernd |last1last2=LöweLevenson |first2=James |last2last3=LevensonDepping |first3=Miriam |last3last4=DeppingHüsing |first4=Paul |last4last5=HüsingKohlmann |first5=Sebastian |last6=Lehmann |first6=Marco |last7=Shedden-Mora |first7=Meike |last8=Toussaint |first8=Anne |last9=Uhlenbusch |first9=Natalie |last10=Weigel |first10=Angelika |title=Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis |journal=Psychological Medicine |date=March 2022|issn=0033-2917|pages=632–648 |volume=52 |issue=4 |pages=632–648 |doi=10.1017/S0033291721004177|first5=Sebastian|last5=Kohlmann|first6=Marco|last6=Lehmann|first7=Meike|last7=Shedden-Mora|first8=Anne|last8=Toussaint|first9=Natalie|last9=Uhlenbusch|first10=Angelika|last10=Weigel |pmid=34776017 |pmc=8961337 }}</ref>
===Complications===
[[Alcohol abuse|Alcohol]] and [[Substance abuse|drug abuse]] are frequently observed, and sometimes used to alleviate symptoms, increasing the risk of [[Substance dependence|dependence]] on [[controlled substance]]s.<ref name=substances>{{cite journal|first1=Deborah |last1=Hasin |first2first1=HilaDeborah |last2=Katz |first2=Hila |title=Somatoform and substanceSubstance useUse Disorders disorders|url=https://pubmed.ncbi.nlm.nih.gov/18040097/|journal=Psychosomatic Medicine |date=DecemberNovember 2007|issn=1534-7796|pages=870–875 |volume=69 |issue=9 |pmidpages=18040097870–875 |doi=10.1097/PSY.0b013e31815b00d7 |pmid=18040097 |s2cid=1280316 }}</ref> Other complications include poor functioning, problems with relationships, [[unemployment]] or difficulties at work, and financial stress due to excessive hospital visits.<ref name=mayo/>
==Causes==
Somatic symptoms can stem from a heightened awareness of sensations in the body, alongside the tendency to interpret those sensations as [[Disease|ailments]]. Studies suggest that risk factors of somatic symptoms include [[Child neglect|childhood neglect]], [[sexual abuse]], a chaotic lifestyle, and a history of substance and alcohol abuse.<ref name=afp>{{cite journal |last1=Kurlansik |first1=Stuart L. |last1last2=KurlansikMaffei |first2=Mario S.|last2=Maffei |title=Somatic Symptom Disorder|url=https://pubmed.ncbi.nlm.nih.gov/26760840/ |journal=American Family Physician |date=1 January 2016|issn=1532-0650|pages=49–54 |volume=93 |issue=1 |pages=49–54 |pmid=26760840 }}</ref><ref name=personality>{{cite journal |last1=Rost |first1=K.Kathryn M. |last1last2=RostAkins |first2=R.Richard N. |last2last3=AkinsBrown |first3=F.Frank W. |last3last4=BrownSmith |first4=G.Richard R.|last4=Smith|title=The comorbidity of DSM-III-R personality disorders in somatization disorder|url=https://pubmed.ncbi.nlm.nih.gov/1521787/ |journal=General Hospital Psychiatry |date=September 1992|issn=0163-8343|pages=322–326 |volume=14 |issue=5 |pmidpages=1521787322–326 |doi=10.1016/0163-8343(92)90066-j |pmid=1521787 }}</ref> [[Psychosocial]] stressors, such as unemployment and reduced job performance, may also be risk factors.<ref name=StatPearls/><ref name=disability>{{cite journal|first1=Ashley M.|last1=Harris|first2=E. John|last2=Orav|first3=David W.|last3=Bates|first4=Arthur J.|last4=Barsky|title=Somatization increases disability independent of comorbidity|journal=Journal of General Internal Medicine|date=February 2009|issn=1525-1497|pages=155–161|volume=24|issue=2|pmid=19031038|pmc=2629001|doi=10.1007/s11606-008-0845-0}}</ref> There could also be a [[Genetics|genetic]] element. A study of [[Twin|monozygotic]] and [[Twin|dizygotic]] twins found that genetic components contributed 7% to 21% of somatic symptoms, with the remainder related to [[Environmental factors of mental health|environmental factors]].<ref name=twins>{{cite journal|first1=Kenji|last1=Kato|first2=Patrick F.|last2=Sullivan|first3=Nancy L.|last3=Pedersen|title=Latent class analysis of functional somatic symptoms in a population-based sample of twins|journal=Journal of Psychosomatic Research|date=May 2010|issn=1879-1360|pages=447–453|volume=68|issue=5|pmid=20403503|pmc=2858068|doi=10.1016/j.jpsychores.2010.01.010}}</ref> In another study, various [[Single-nucleotide polymorphism|single nucleotide polymorphisms]] were linked to somatic symptoms.<ref name=StatPearls/>
===Psychological===
Evidence suggests that along with more broad factors such as early [[childhood trauma]] or [[Attachment theory|insecure attachment]], negative psychological factors including [[Exaggeration|catastrophizing]], [[negative affectivity]], [[Rumination (psychology)|rumination]], [[Avoidance coping|avoidance]], [[Hypochondriasis|health anxiety]], or a poor [[Self-concept|physical self-concept]] have a significant impact on the shift from unproblematic somatic symptoms to a severely debilitating somatic symptom disorder.<ref name=empiricalevidence/> Those who experience more negative psychological characteristics may regard [[Medically unexplained physical symptoms|medically unexplained symptoms]] to be more threatening and, therefore, exhibit stronger cognitive, emotional, and behavioral awareness of such symptoms.<ref name=recentdevelop>{{cite journal|first1=Ricarda|last1=Mewes|title=Recent developments on psychological factors in medically unexplained symptoms and somatoform disorders|journal=Frontiers in Public Health|date=2022 |issn=2296-2565|volume=10|doi=10.3389/fpubh.2022.1033203 |pmid=36408051 |pmc=9672811 |doi-access=free }}</ref> In addition, evidence suggests that negative psychological factors have a significant impact on the impairments and behaviors of people suffering from somatic symptom disorder, as well as the long-term stability of such symptoms.<ref name=followup>{{cite journal |last1=Klaus |first1=Kristina |last1last2=KlausRief |first2=Winfried |last2last3=RiefBrähler |first3=Elmar |last3last4=BrählerMartin |first4=Alexandra |last4last5=MartinGlaesmer |first5=Heide |last6=Mewes |first6=Ricarda |title=Validating psychological classification criteria in the context of somatoform disorders: A one- and four-year follow-up|url=https://pubmed.ncbi.nlm.nih.gov/26280303/ |journal=Journal of Abnormal Psychology |date=November 2015|issn=1939-1846|pages=1092–1101 |volume=124 |issue=4 |pmidpages=262803031092–1101 |doi=10.1037/abn0000085 |first5pmid=Heide|last5=Glaesmer|first6=Ricarda|last6=Mewes26280303 }}</ref><ref name=cogandbehave>{{cite journal|first1=Alexandra |last1=Martin |first2first1=WinfriedAlexandra |last2=Rief |first2=Winfried |title=Relevance of cognitiveCognitive and behavioralBehavioral factorsFactors in medicallyMedically unexplainedUnexplained syndromesSyndromes and somatoformSomatoform Disorders disorders|url=https://pubmed.ncbi.nlm.nih.gov/21889679/|journal=The Psychiatric Clinics of North America |date=September 2011|issn=1558-3147|pages=565–578 |volume=34 |issue=3 |pmidpages=21889679565–578 |doi=10.1016/j.psc.2011.05.007 |pmid=21889679 }}</ref><ref name=PsychosomaticMedicine>{{cite journal |last1=Rief |first1=Winfried |last1last2=RiefMewes |first2=Ricarda |last2last3=MewesMartin |first3=Alexandra |last3last4=MartinGlaesmer |first4=Heide |last4last5=GlaesmerBraehler |first5=Elmar |title=Are psychologicalPsychological featuresFeatures usefulUseful in classifyingClassifying patientsPatients withWith somaticSomatic symptomsSymptoms?|url=https://pubmed.ncbi.nlm.nih.gov/20368474/ |journal=Psychosomatic Medicine |date=September 2010|issn=1534-7796|pages=648–655 |volume=72 |issue=7 |pmidpages=20368474648–655 |doi=10.1097/PSY.0b013e3181d73fce |first5pmid=Elmar|last5=Braehler20368474 |s2cid=86067 }}</ref>
===Psychosocial===
Those raised in environments where expressing emotions during stages of development is discouraged face the highest risk of somatization.<ref name=biosocial/> In [[primary care]] settings, studies indicated that somaticizing patients had much greater rates of unemployment and decreased [[Employment|occupational functioning]] than non-somaticizing patients.<ref name=afp/>
Traumatic life events may cause the development of somatic symptom disorder. Most people with somatic symptom disorder originate from [[Dysfunctional family|dysfunctional]] homes. A [[Meta-analysis|meta-analysis study]] revealed a connection between sexual abuse and functional gastrointestinal syndromes, [[chronic pain]], [[non-epileptic seizure]]s, and [[Pelvic pain|chronic pelvic pain]].<ref name=biosocial>{{cite journal |last1=çEti̇N |first1=Şahabettin |last1last2=ÇetinSöZeri̇ Varma |first2=Gülfizar Sözer|last2=Varma|title=Somatik Somatic SymptomBelirti DisorderBozukluğu: HistoricalTarihsel ProcessSüreç andve BiopsychosocialBiyopsikososyal Yaklaşım Approach|url=http://www.cappsy.org/archives/vol13/no4/cap_13_04_12_en.pdf|journal=Psikiyatride Güncel Yaklaşımlar — Current|date=25 ApproachesDecember in2021 Psychiatry|year=2021|pages=790–804|volume=13 |issue=4 |pages=790–804 |doi=10.18863/pgy.882929 }}</ref>
===Physiological===
The [[Hypothalamic–pituitary–adrenal axis|hypothalamo pituitary adrenal axis]] (HPA) has a crucial role in [[Fight-or-flight response|stress response]]. While the [[Hypothalamic–pituitary–adrenal axis|HPA axis]] may become more active with depression, there is evidence of [[Adrenal insufficiency|hypocortisolism]] in somatization.<ref name=hpa>{{cite journal |last1=Tak |first1=Lineke M. |last1last2=TakRosmalen |first2=Judith G. M.|last2=Rosmalen |title=Dysfunction of stress responsive systems as a risk factor for functional somatic syndromes|url=https://www.sciencedirect.com/science/article/pii/S0022399909005091 |journal=Journal of Psychosomatic Research |date=1 May 2010|issn=0022-3999|pages=461–468 |volume=68 |issue=5 |pages=461–468 |doi=10.1016/j.jpsychores.2009.12.004 |pmid=20403505 |s2cid=7334435 }}</ref> In somatic disorder, there is a negative connection between elevated pain scores and [[5-Hydroxyindoleacetic acid|5-hydroxy indol acetic acid]] (5-HIAA) and [[tryptophan]] levels.<ref name=biosocial/>
It has been suggested that [[Inflammation|proinflammatory]] processes may have a role in somatic symptom disorder, such as an increase of non-specific somatic symptoms and sensitivity to painful [[Stimulus (physiology)|stimuli]].<ref name=proinflammatory>{{cite journal|first1=Winfried |last1=Rief |first2first1=AnikaWinfried |last2=Hennings |first3first2=SabineAnika |last3=Riemer |first4first3=FrankSabine |last4=Euteneuer |first4=Frank |title=Psychobiological differences between depression and somatization|url=https://pubmed.ncbi.nlm.nih.gov/20403510/ |journal=Journal of Psychosomatic Research |date=May 2010|issn=1879-1360|pages=495–502 |volume=68 |issue=5 |pmidpages=20403510495–502 |doi=10.1016/j.jpsychores.2010.02.001 |pmid=20403510 }}</ref> [[Inflammation|Proinflammatory]] activation and [[anterior cingulate cortex]] activity have been shown to be linked in those who experienced stressful life events for an extended period of time. It is further claimed that increased activity of the anterior cingulate cortex, which acts as a bridge between attention and emotion, leads to increased sensitivity of unwanted stimuli and bodily sensations.<ref name=cingulate>{{cite journal|first1=Neil A.|last1=Harrison|first2=Lena|last2=Brydon|first3=Cicely|last3=Walker|first4=Marcus A.|last4=Gray|title=Inflammation causes mood changes through alterations in subgenual cingulate activity and mesolimbic connectivity|journal=Biological Psychiatry|date=1 September 2009|issn=1873-2402|pages=407–414|volume=66|issue=5|pmid=19423079|pmc=2885494|doi=10.1016/j.biopsych.2009.03.015|first5=Andrew|last5=Steptoe|first6=Hugo D.|last6=Critchley}}</ref>
[[Pain]] is a multifaceted experience, not just a sensation. While [[nociception]] refers to afferent [[Neurotransmission|neural activity]] that transmits [[Sense|sensory information]] in response to stimuli that may cause [[Tissue (biology)|tissue damage]], pain is a conscious experience requiring [[Cerebral cortex|cortical]] activity and can occur in the absence of nociception.<ref name=biosocial/> Those with somatic symptoms are thought to exaggerate their somatic symptoms through choice perception and perceive them in accordance with an ailment. This idea has been identified as a [[Cognition|cognitive]] style known as "somatosensorial amplification".<ref name=somatosensorialamplification>{{cite journal|first1=A. J.|last1=Barsky|title=Amplification, somatization, and the somatoform disorders|journal=Psychosomatics |date=1992 |issn=0033-3182|pages=28–34|volume=33|issue=1|pmid=1539100|doi=10.1016/S0033-3182(92)72018-0|doi-access=free}}</ref> The term "[[central sensitization]]" has been created to describe the [[Neuroscience|neurobiological]] notion that those predisposed to somatization have an overly sensitive [[neural network]]. Harmless and mild [[Stimulus (physiology)|stimuli]] stimulate the [[Nociception|nociceptive]] specific [[posterior grey column|dorsal horn cells]] after [[central sensitization]]. As a result, pain is felt in response to stimuli that would not typically cause pain.<ref name=biosocial/>
===Genetic===
Genetic investigations have suggested modifications connected to the [[monoaminergic]] system, in particular, may be relevant while a shared genetic source remains unknown. Researchers take into account the various processes involved in the development of somatic symptoms as well as the interactions between various [[Biology|biological]] and psychosocial factors.<ref name=biosocial/> Given the high occurrence of trauma, particularly throughout childhood, it has been suggested that the [[Epigenetics|epigenetic]] changes could be explanatory.<ref name=epigenetics>{{cite book|first1=T.|last1=Frodl|title=Functionaljournal Neurologic Disorders |chapter=Do (epi)genetics impact the brain in functional neurologic disorders?|chapter-url=https://pubmed.ncbi.nlm.nih.gov/27719836/|series=Handbook of Clinical Neurology|year= 2016 |issn=0072-9752|pages=157–165|volume=139|pmid=27719836|doi=10.1016/B978-0-12-801772-2.00014-X|isbn=9780128017722 }}</ref> Another study found that the [[glucocorticoid receptor]] gene ([[Glucocorticoid receptor|NR3C1]]) is [[Hypomethylating agent|hypomethylated]] in those with somatic symptom disorder and in those with depression.<ref name=biosocial/>
==Diagnosis==
===Somatic Symptom Scale – 8===
{{main|Somatic Symptom Scale - 8}}
[[Somatic Symptom Scale - 8|The Somatic Symptom Scale – 8 (SSS-8)]] is a short self-report questionnaire that is used to evaluate somatic symptoms. It examines the perceived severity of common somatic symptoms.<ref name=sss8>{{cite journal |last1=Gierk |first1=Benjamin |last1last2=GierkKohlmann |first2=Sebastian |last2last3=KohlmannKroenke |first3=Kurt |last3last4=KroenkeSpangenberg |first4=Lena |last4last5=SpangenbergZenger |first5=Markus |last6=Brähler |first6=Elmar |last7=Löwe |first7=Bernd |title=The Somatic Symptom Scale–8 (SSS-8): A Brief Measure of Somatic Symptom Burden|url=https://doi.org/10.1001/jamainternmed.2013.12179 |journal=JAMA Internal Medicine |date=1 March 2014|issn=2168-6106|pages=399–407 |volume=174 |issue=3 |pages=399 |doi=10.1001/jamainternmed.2013.12179|first5=Markus|last5=Zenger|first6=Elmar|last6=Brähler|first7=Bernd|last7=Löwe |pmid=24276929 }}</ref> The [[Somatic Symptom Scale - 8|SSS-8]] is a condensed version of the well-known [[Patient Health Questionnaire|Patient Health Questionnaire-15]] ([[Phq9 questionnaire|PHQ-15]]).<ref name=sss8valid>{{cite journal |last1=Kroenke |first1=Kurt |last1last2=KroenkeSpitzer |first2=Robert L. |last2last3=SpitzerWilliams |first3=Janet B. W.|last3=Williams |title=The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms|url=https://journals.lww.com/psychosomaticmedicine/Abstract/2002/03000/The_PHQ_15__Validity_of_a_New_Measure_for.8.aspx |journal=Psychosomatic Medicine |date=March 2002|issn=0033-3174|pages=258–266 |volume=64 |issue=2 |pages=258–266 |doi=10.1097/00006842-200203000-00008 |pmid=11914441 |s2cid=28701848 }}</ref>
On a five-point scale, respondents rate how much [[Gastrointestinal disease|stomach or digestive issues]], [[Back pain|back discomfort]], pain in the legs, arms, or [[Arthralgia|joints]], [[headache]]s, [[chest pain]] or [[shortness of breath]], [[dizziness]], [[Fatigue|feeling tired or having low energy]], and [[Insomnia|trouble sleeping]] impacted them in the preceding seven days. Ratings are added together to provide a sum score that ranges from 0 to 32 points.<ref name=sss8/>
* Reduce preoccupation with symptom
(ECT) has been used in treating somatic symptom disorder among the elderly; however, the results were still debatable with some concerns around the side effects of using ECT.<ref name="pmid3042587">{{cite journal | vauthors = Zorumski CF, Rubin EH, Burke WJ | title = Electroconvulsive therapy for the elderly: a review | journal = Hospital & Community Psychiatry | volume = 39 | issue = 6 | pages = 643–647 | date = June 1988 | pmid = 3042587 | doi = 10.1176/ps.39.6.643 }}</ref> Overall, psychologists recommend addressing a common difficulty in patients with somatic symptom disorder in the reading of their own emotions. This may be a central feature of treatment; as well as developing a close collaboration between the GP, the patient and the mental health practitioner.<ref name = Kenny>{{cite journal |vauthors=Kenny M, Egan J| date = February 2011 | title = Somatization disorder: What clinicians need to know | journal = The Irish Psychologist | volume = 37 | issue = 4 | pages = 93–96 |urlhdl=http://www.lenus.ie/hse/bitstream/10147/121822/1/SomatizationDis.pdf | access-date = 9 December 2011 }}</ref>
==Outlook==
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