Somatic symptom disorder: persistent physical symptoms and how they are treated

Somatic symptom disorder is a diagnostic term for a pattern in which a person has one or more physical symptoms that are distressing or disruptive, together with excessive thoughts, feelings or behaviours about them. In UK health information the broader and more commonly used phrase is medically unexplained symptoms, which the NHS describes as persistent physical symptoms, such as dizziness or pain, that last for more than a few weeks and for which doctors cannot find a problem with the body that may be the cause.

The Royal College of Psychiatrists says that diagnoses such as somatisation disorder and somatoform disorder are used where stress is thought to be a major cause, especially when symptoms go on for a long time or are severe. It also says it is common to use a general term such as medically unexplained symptoms, or the word functional, meaning that the way the body is functioning has changed even though its structure is normal.

Both organisations emphasise the same message: the symptoms are genuine. Not understanding the cause can make them more distressing and difficult to cope with, and it can feel as though other people think the problems are imaginary.

The NHS lists the most common medically unexplained symptoms, and the Royal College of Psychiatrists gives a similar list.

• Pains in the muscles or joints, back pain and headaches.

• Tiredness and feeling faint.

• Chest pain and heart palpitations.

• Stomach problems, such as pain, bloating, diarrhoea and constipation.

• Less commonly: fits (seizures), breathlessness, weakness and paralysis, numbness and tingling.

The Royal College of Psychiatrists explains that there is two-way communication between the brain and body, through nerves and through hormones. Thoughts, feelings and stress change the body every day: we blush when embarrassed, feel butterflies in the stomach when worried and a lump in the throat when upset. Long-term stress can make pain feel worse and can contribute to conditions such as high blood pressure.

It describes the fight or flight response, which readies the body for action with a faster heartbeat, quicker breathing and tense muscles. When there is nowhere for this energy to go, it can cause palpitations, chest tightness, dizziness, shakiness, indigestion, tingling and headaches. These sensations can feel alarming, which causes more stress and more symptoms, a vicious circle. Worry about health can make symptoms worse, particularly if a person has had illness before or has seen relatives ill, and anxiety and depression themselves can cause bodily symptoms.

The NHS adds that some symptoms may be part of a poorly understood syndrome, such as chronic fatigue syndrome (ME), irritable bowel syndrome, fibromyalgia or functional neurological disorders.

The NHS says a GP will aim to rule out all possible conditions that might cause the symptoms, through a thorough examination and blood tests, and will consider whether any medicine you take may be causing them, for example long-term painkillers causing headaches. They should also look for an associated problem such as depression or anxiety.

It suggests telling the GP what your symptoms are like and when they started, what you think is the cause and what you expect from tests and treatments, how the symptoms affect what you can do, and how upsetting they are. If you think a condition has been missed, you can ask for a second opinion. The Royal College of Psychiatrists says your doctor can discuss which investigations are worthwhile and when enough tests have been done.

Treatment is practical and combines several approaches. The NHS says you and the GP may identify lifestyle changes and goals, such as regular physical activity and better rest, and that you may be referred for a talking therapy such as cognitive behavioural therapy (CBT), whose aim is to help you manage symptoms by understanding the links between symptoms, worries, feelings and coping.

The NHS says the body has a remarkable ability to recover and there is a good chance that symptoms will improve in time, even without specific treatment. It notes that medicine is not always the answer: painkillers or sedatives, for example, may lead to dependence, and the benefits always need weighing against side effects.

Persistent symptoms that disrupt daily life, work or relationships are worth discussing with a GP, because treating associated anxiety or depression often helps. If you have thoughts of harming yourself, tell a clinician urgently, or call 999 or go to A&E in an emergency.

The NHS route starts with the GP, who can arrange tests, a talking therapy referral or specialist assessment. NHS talking therapy services for anxiety and depression are often accessible without waiting for specialist review.

Some people choose private psychological therapy, or a private consultant for tests. Because the main benefit comes from a coordinated plan, it helps to make sure a single clinician keeps overview of tests and treatments, so that repeated investigations are avoided.