Somatic symptoms

Mr. Haque built three factories and retired to a flat in Gulshan with a view of the lake. He also has a folder of reports two inches thick: stomach pain, then back pain, then palpitations. This year alone, scans in Dhaka, an endoscopy in Bangkok, two ECGs in Singapore. Each result is normal, and each one brings a week of relief before the next symptom arrives and the worry starts again.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding somatic symptom disorder

Physical symptoms are often how distress first shows itself, especially where talking about feelings is not easy. Bodily distress disorder, as ICD-11 calls it (somatic symptom disorder in the American DSM-5, formerly somatoform disorders), involves real, distressing physical symptoms together with persistent worry about them, much time spent on them, and repeated medical visits that do not bring lasting reassurance. Some people instead live in fear of having a serious illness despite normal tests, which doctors call health anxiety.

How common is somatic symptom disorder?

In Bangladesh, the national mental health survey of 2018–19 found somatic symptom and related disorders in 2.3% of adults.

Signs and symptoms of somatic symptom disorder

• Physical symptoms that cause great distress, whatever their cause
• Worry about health that returns soon after every normal result
• Many consultations and investigations in a short time
• Daily life organised around symptoms

Treatment for somatic symptom disorder

Good care starts by taking the symptoms seriously and agreeing on one doctor to coordinate, so that tests are done when needed and not just for reassurance. Cognitive behavioural therapy can modestly reduce somatic symptoms, and any depression or anxiety underneath is treated too.

What getting better can look like

For someone like Mr. Haque, it might be a season with no flights for tests, a walk round the lake after dinner, and the folder of reports left in a drawer.

Common questions about somatic symptom disorder

Can emotional distress show up as physical symptoms?

Yes, often. Physical symptoms are a common way for distress to show itself first, especially where talking about feelings is not easy, and the symptoms are real. When they come with persistent worry, much time spent on them and repeated tests that never bring lasting reassurance, doctors may call it bodily distress disorder. New or changing symptoms should always be checked by a doctor.

What is health anxiety, and can it be treated?

Health anxiety is a persistent fear of having a serious illness that returns despite normal tests. It responds to cognitive behavioural therapy: in a 2019 meta-analysis of 19 randomised trials, the pooled response rate to CBT was 66%, and the benefits were largely sustained 12 to 18 months after treatment.

When to see a psychiatrist

If symptoms and worry about your health are taking over your life, a consultation can help. New or changing symptoms should always be checked by a doctor.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Alam et al., Asian Journal of Psychiatry, 2023 (PMID 38199203), from the National Mental Health Survey of Bangladesh 2018–19
• van Dessel et al., Cochrane Review, 2014
• Axelsson and Hedman-Lagerlöf, Expert Review of Pharmacoeconomics and Outcomes Research, 2019 (PMID 31859542)