Somatoform disorders—now known as somatic symptom and related disorders—are mental health conditions that involve extreme health-related anxiety and a preoccupation with persistent somatic (physical) symptoms. These symptoms cause a person a disproportionate amount of distress and impair their daily functioning. 

Mental and physical health are interdependent and interconnected. The mind-body connection likely plays a role in the development of certain somatoform disorders, which can be related to stress, depression, and/or trauma in addition to debilitating physical symptoms.

Read on to learn more about somatoform disorders, including types, symptoms, and treatment options.

What Are Somatoform Disorders?

In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), somatoform disorders referred to a group of mental health conditions involving both troubling physical symptoms and a lack of underlying medical evidence for their cause. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the category of somatoform disorders was replaced by somatic symptom and related disorders. 

People with somatic symptom and related disorders are extremely preoccupied with and distressed by their health concerns and physical symptoms. These symptoms can be debilitating, leading to problems in daily functioning at work, in school, and within relationships.

Some people constantly research their health condition(s), seek out excessive specialized testing, and/or visit providers frequently. On the other hand, some people with the disorder go out of their way to avoid medical treatment because of their health anxiety.

It’s important to realize that people with somatic symptom disorder are not faking their symptoms. If you have a somatoform disorder, your distress—both physical and mental—is not “all in your head.”

According to the DSM-5 criteria, someone with somatic symptom disorder may or may not have a medical condition that’s causing them symptoms. Still, they have a disproportionate reaction to the symptoms and devote excessive amounts of time and energy to thinking about, worrying about, and monitoring their health.

Types of Somatoform Disorders

The DSM-5 includes the following diagnoses within the category of somatic symptom and related disorders (previously known as somatoform disorders):

Somatoform Disorders and Stigma

People with somatoform disorders are often concerned about potential stigma, both within the clinical setting and in their everyday lives. Studies suggest that there is an ongoing bias against people with somatoform disorders, which can lead some people with medically unexplained symptoms to internalize stigma and avoid seeking help.

  • Somatic symptom disorder (SSD): Somatic symptom disorder—previously known as somatization disorder—involves an ongoing preoccupation with physical symptoms. These symptoms (which commonly include pain, fatigue, dizziness, shortness of breath, a rapid heart rate, and/or nausea) may or may not be related to a diagnosed medical condition. People with somatic symptom disorder feel extreme distress about their symptoms and may significantly alter their day-to-day behaviors to accommodate them.
  • Illness anxiety disorder (IAD): Illness anxiety disorder—previously known as hypochondriasis— involves persistent worries about having or acquiring a serious illness. People with IAD may not have accompanying physical symptoms, or their symptoms might be relatively mild compared to their level of distress and concern about them. They may visit many specialists or frequently “check” their bodies to make sure they are healthy.
  • Conversion disorder: People with conversion disorder—also known as functional neurological symptom disorder—experience serious physical or neurological problems that have no biological explanation. These symptoms (such as paralysis, difficulty walking, difficulty talking, or vision loss) typically appear suddenly, often after a period of extreme stress or a traumatic event. The symptoms may last for days, weeks, or longer. People with conversion disorder are not lying about or exaggerating their symptoms.
  • Factitious disorder: People with factitious disorder—also called Munchausen syndrome—may feign or exaggerate physical symptoms, or harm themselves, to get unnecessary medical attention and treatment. These behaviors allow them to take on the “sick” role. Factitious disorder imposed on another person—also known as Munchausen syndrome by proxy—involves lying about someone else’s physical health (typically, that of a minor child or another dependent). People with factitious disorder imposed on another assume the role of a medical “patient” by proxy.

Psychological factors affecting other conditions—such as denying the presence of symptoms or avoiding necessary treatment due to mental health concerns—are also included under the umbrella of somatic symptom and related disorders.

Mental health providers may use the categories of “other somatic symptom and related disorder” or “unspecified somatic symptom and related disorder” to refer to conditions that fit some, but not all, of the diagnostic criteria of one of the above disorders.

Body dysmorphic disorder (BDD)—in which a person has an overwhelming, persistent preoccupation with perceived flaws in their physical appearance—was previously included within the category of somatoform disorders. In the DSM-5, BDD was recategorized under the umbrella of “obsessive-compulsive and related disorders.”

Somatoform Disorder Symptoms

The specific symptoms of somatoform disorders, or somatic symptom and related disorders, vary by condition. According to the DSM-5, common symptoms of somatic symptom disorder may include:

How Common Is Somatic Symptom Disorder?

Within the general population, an estimated 5%-7% of people meet the criteria for somatic symptom disorder.

  • Having one or more somatic symptoms that cause a great deal of distress and impair daily functioningExcessive, persistent, and disproportionate thoughts or worries about one’s physical symptoms and related health concernsSpending excessive amounts of time, energy, and money to diagnose or treat the somatic symptomsHaving symptoms that persist for at least 6 months

Common symptoms of illness anxiety disorder include:

  • Overwhelming preoccupation with having or developing a serious health condition
  • Accompanying somatic symptoms are nonexistent or mild
  • Disproportionate responses to mild symptoms
  • Persistent, extreme anxiety about one’s health
  • Either avoiding healthcare providers and clinical settings or excessively performing “checks” on one’s health or seeking care frequently

The symptoms of conversion disorder, or functional neurological symptom disorder, include:

  • A serious, sudden-onset physical or neurological symptom (e.g., blindness, numbness, paralysis, difficulties with coordination, loss of pain or touch, or the inability to speak) without any biological causeSymptoms typically last a few days or weeksLack of concern or shock that would typically accompany a severe symptomPsychological symptoms that suddenly go away after the appearance of physical symptoms

The signs and symptoms of factitious disorder include:

  • Intentionally pretending to have physical symptoms to take on the “sick” or “patient” role
  • Excessive visits to various healthcare providers for tests and other procedures
  • Reporting symptoms that do not show up in tests or appear in clinical settings
  • Altering blood or urine samples to change test results
  • In factitious disorder imposed on another (Munchausen syndrome by proxy), intentionally lying about or creating physical symptoms in a child or another dependent person

Causes

There is no single underlying cause of somatic symptom disorder and related conditions. However, some of the risk factors for somatoform disorders include:

  • A history of physical illness: People who have a history of severe illness, especially during childhood, are significantly more likely to develop a somatoform disorder (especially somatic symptom disorder or illness anxiety disorder). An estimated 20%-25% of people who experience acute somatic symptoms go on to develop somatic symptom disorder at some point.
  • Comorbid mental health conditions: Having at least one other mental illness—such as anxiety, depression, a mood disorder, a substance use disorder (SUD), or a personality disorder—is a risk factor for being diagnosed with a somatoform disorder. People with a dissociative disorder, which involves involuntarily escaping from reality—also have a higher chance of developing conversion disorder.
  • Childhood trauma: People who experienced childhood abuse—including sexual, emotional, or physical abuse, as well as prolonged neglect—may develop somatic symptom disorder.
  • Lifestyle and environmental factors: Trauma and other environmental factors, such as a period of extreme stress at home or work, increase your risk of experiencing health anxiety and distressing somatic symptoms. The symptoms of conversion disorder typically appear suddenly after a particularly stressful event.
  • Sex: Anyone can have a somatoform disorder but they appear to be more common among cisgender females. For example, about 10 times as many cisgender females as males are diagnosed with somatic symptom disorder.
  • Genetics: Studies suggest that genetics may play a role in the development of somatoform disorders, accounting for up to 30% of the variance in the risk of developing one.

Diagnosis

Many people are diagnosed with somatic symptom disorder or related disorders after initially visiting another healthcare provider, such as a primary care physician, about their physical symptoms. Your provider may refer you to a psychiatrist or therapist if they think that your symptoms are causing you a disproportionate level of anxiety and distress, or if your preoccupation with your health concerns is impairing your day-to-day functioning.

Your provider can diagnose you with somatic symptom disorder, illness anxiety disorder, or functional neurological symptom disorder using the criteria in the DSM-5.

To meet the criteria, your symptoms must not be better explained by another condition, mental or physical. A mental health professional may classify your condition as mild, moderate, or severe, depending on how much your symptoms are affecting your everyday life.

Treatment

If you are experiencing any physical symptoms—such as dizziness, pain, fatigue, or a racing heart— it’s important to see a healthcare provider for a thorough medical examination. Up to 8% of people diagnosed with somatic symptom disorder have an organic disease, meaning a health condition that is observable and can be found through medical tests. 

You may also have a treatable functional disorder—a medical condition that causes physical symptoms with no single known, quantifiable cause—such as fibromyalgia or irritable bowel syndrome (IBS). Your provider may refer you to a specialist who can treat your specific symptoms.

Once any underlying organic disease has been ruled out, treatment for somatic symptom disorder may involve one or more of the following approaches:

  • Psychotherapy (e.g., cognitive-behavioral therapy or trauma therapy)
  • Developing coping skills (e.g., self-management through positive thinking and symptom journaling)
  • Self-help groups (for support and valuable resources)
  • Relaxation exercises (e.g., deep breathing techniques)
  • Medication (e.g., antidepressants or anti-anxiety medications)

Summary

People with somatoform disorders, now called somatic symptom and related disorders, experience both physical symptoms—such as dizziness, pain, and gastrointestinal discomfort—and extreme anxiety or distress about those symptoms.

Seek Help

If you or a loved one is struggling with symptoms of a mental health condition, you can find accessible resources at our National Helpline Database.

The category of somatic symptom and related disorders includes somatic symptom disorder (SSD), illness anxiety disorder (IAD), conversion disorder, and factitious disorder, as well as psychological factors affecting other conditions.

There’s no agreed-upon, universal cause for somatic symptom and related disorders. Genetics, environment, stress, trauma, and a history of severe illness may increase your risk. People with comorbid mental health conditions are more likely to develop both unexplained medical symptoms and health-related anxiety. 

Treatment for somatic symptom and related disorders typically involves psychotherapy and/or medication. You should also be tested and treated for any possible underlying physical conditions.

A Word from Verywell

You might be afraid to reach out to a healthcare provider for help if you have worrying physical symptoms, but it’s important that you do. If you think you may have a somatoform disorder, talk to your provider about diagnosis and treatment.

Frequently Asked Questions

  • How many types of somatoform disorders are there?
  • Within the category of somatic symptom and related disorders (which replaced somatoform disorders in the DSM-5) there are four main disorders: somatic symptom disorder, illness anxiety disorder, conversion disorder (functional neurological symptom disorder), and factitious disorder.The category also includes other specified somatic symptom and related disorders, psychological factors affecting other conditions, and unspecified somatic symptom and related disorders.
  • What are some examples of somatic disorder behavior?
  • People with somatic symptom disorder typically experience extreme emotional distress in response to troubling medical symptoms.Common symptoms associated with somatic symptom disorder include shortness of breath, dizziness, weakness, and pain. There may or may not be an underlying physical condition associated with the symptoms.
  • Should you see a psychiatrist for unexplained physical symptoms?
  • If you have unexplained medical symptoms, it’s important to talk to your primary healthcare provider to rule out any underlying physical causes. They can refer you to a mental health provider, such as a therapist or psychiatrist, if necessary. Your symptoms may also have both physical and psychological causes, so it’s important to treat them both.

Within the category of somatic symptom and related disorders (which replaced somatoform disorders in the DSM-5) there are four main disorders: somatic symptom disorder, illness anxiety disorder, conversion disorder (functional neurological symptom disorder), and factitious disorder.

People with somatic symptom disorder typically experience extreme emotional distress in response to troubling medical symptoms.

If you have unexplained medical symptoms, it’s important to talk to your primary healthcare provider to rule out any underlying physical causes. They can refer you to a mental health provider, such as a therapist or psychiatrist, if necessary. Your symptoms may also have both physical and psychological causes, so it’s important to treat them both.