When the Body Carries What Words Cannot

Somatic Symptom & Related Disorders

Somatic Symptom Disorder

Characterized by: distressing physical symptoms with excessive thoughts, feelings, or behaviors

Somatic Symptom Disorder is diagnosed when a person has one or more physical symptoms that are distressing or that disrupt daily life — and when their response to those symptoms involves excessive thoughts, feelings, or behaviors related to their health. The symptoms themselves may or may not have a clear medical explanation. What matters diagnostically is the disproportionate response to them.

This is an important distinction. Somatic Symptom Disorder is not a diagnosis of exclusion — it does not require that doctors be unable to find a cause. A person with a genuine medical condition can also have Somatic Symptom Disorder if their preoccupation and distress about symptoms goes well beyond what the condition itself would typically produce. The suffering is real. The amplification is also real.

People with Somatic Symptom Disorder often feel dismissed by medical providers who cannot find a clear physical cause — and dismissed by mental health providers who don't take their physical symptoms seriously. Effective treatment requires holding both realities at once: the symptoms are real and the psychological dimension deserves attention. Therapy focused on the relationship between thoughts, emotions, and physical sensations can be genuinely helpful.

Somatic Symptom & Related Disorders

Illness Anxiety Disorder

Formerly known as: hypochondria or hypochondriasis

Illness Anxiety Disorder involves a preoccupation with having or acquiring a serious, undetected illness — despite having little or no actual physical symptoms. The person is not worried about the symptoms themselves so much as the possibility that something serious is lurking undetected beneath the surface. Normal bodily sensations — a headache, a twinge, a racing heart — become potential evidence of catastrophic disease.

People with Illness Anxiety Disorder may seek frequent reassurance from doctors, only to find that the relief it provides is temporary. The next worry replaces the last one. Some go in the opposite direction — avoiding doctors entirely out of fear of what they might find. In either case, the anxiety about illness significantly impairs quality of life.

Illness Anxiety Disorder is distinct from reasonable health concern. We all worry about our health sometimes. What makes this a disorder is the persistence, the intensity, and the degree to which it takes over daily life. Cognitive-behavioral therapy has a strong evidence base for this condition, helping people develop a different relationship with uncertainty about their health.

Somatic Symptom & Related Disorders

Functional Neurological Symptom Disorder

Previously called: conversion disorder

Functional Neurological Symptom Disorder involves neurological symptoms — weakness, paralysis, tremors, seizures, blindness, difficulty speaking or swallowing — that cannot be explained by a neurological disease or medical condition. The symptoms are real and can be profoundly disabling. They are not consciously produced or faked.

The term "conversion disorder" reflected an older theory that psychological distress was being "converted" into physical symptoms. The newer name — Functional Neurological Symptom Disorder — reflects a better understanding: these are real disruptions in how the nervous system is functioning, not psychological symptoms wearing a physical costume. Neuroimaging research has shown that the brains of people with this condition show genuine differences in how they process and regulate motor and sensory signals.

People with this condition frequently feel disbelieved — told that their symptoms are psychological as if that means they are somehow less real or less worthy of treatment. This dismissal often delays care and worsens outcomes. Functional neurological symptoms respond to specific rehabilitation approaches and therapy, particularly when treated by providers who understand the condition and take it seriously.

Somatic Symptom & Related Disorders

Psychological Factors Affecting Medical Condition

When the mind worsens a real physical illness

This diagnosis recognizes something that most people intuitively understand but medicine has historically underestimated: psychological states affect physical health in measurable, clinically significant ways. When a person has a documented medical condition and specific psychological or behavioral factors are directly worsening it — delaying recovery, increasing symptom severity, or interfering with treatment — this diagnosis may apply.

Examples might include someone with severe asthma whose symptoms are significantly worsened by anxiety, a person with diabetes whose blood sugar management is derailed by depression, or someone with heart disease whose denial of symptoms prevents them from seeking timely care. The psychological factors are not causing the medical condition — they are making it measurably worse.

Somatic Symptom & Related Disorders

Factitious Disorder

When illness is produced or feigned — not for external gain

Factitious Disorder is among the most ethically complex and clinically challenging presentations in mental health. It involves falsifying or inducing medical or psychological symptoms in oneself — or in another person, most commonly a child — in the absence of any external incentive such as financial gain or avoiding legal consequences. The motivation is psychological: a need to assume the sick role.

This is not malingering — where symptoms are faked for tangible external gain. And it is critically different from somatic symptom disorder, where symptoms are genuinely experienced. In factitious disorder, the person knows at some level that they are producing or exaggerating symptoms — but the psychological need driving the behavior is real and often rooted in profound early experiences of abandonment, trauma, or unmet needs for care.

When factitious disorder involves a caregiver producing illness in a child — formerly called Munchausen syndrome by proxy — it constitutes a form of child abuse and requires immediate protective intervention. This is one of the most serious clinical situations in this category.