1. In patients with recurrent unexplained or confusing symptoms:
    • Do not attribute symptoms to somatization unless an adequate workup rules out any medical or psychiatric condition (e.g., depression)
    • Reassess the symptoms periodically as they may evolve into diagnosable medical conditions/mental health diagnoses or remain unexplained
  2. When a patient presents with symptoms that may be somatoform (e.g., caused by emotional distress) clearly distinguish between the stressed individual with somatoform traits and somatic symptom disorder by using established diagnostic criteria.
  3. In patients with a previously diagnosed somatic symptom disorder do not assume that somatization is the cause of new or ongoing symptoms.
  4. In patients who somatize acknowledge the illness experience and strive to find common ground with them concerning their diagnosis and management, including investigations.
  5. When a patient presents frequently with medically inconsistent or confusing symptoms that are not worrisome:
    • Order investigations judiciously
    • Educate the patient about the connection between physical symptoms and psychological distress
  6. In a patient with existing mental health conditions do not dismiss new physical symptoms as somatization without appropriate assessment.
  7. When caring for a patient with somatization identify and manage your own emotional responses.
  8. When somatic symptom disorder has been established as the most likely diagnosis recommend and discuss evidence-informed psychotherapy and refer when appropriate, ensuring appropriate ongoing care and follow-up.
  9. In patients who have somatic symptoms inquire about the use of and suggest therapies that may provide symptomatic relief and/or help them cope with their symptoms.

Somatic Symptom Disorder

  • One or more somatic symptoms that are distressing or result in significant disruption of daily life.
  • Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
    1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
    2. Persistently high level of anxiety about health or symptoms.
    3. Excessive time and energy devoted to these symptoms or health concerns.
  • Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Illness Anxiety Disorder

  • Preoccupation with having or acquiring a serious illness.
  • Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
  • There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
  • The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
  • Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

Conversion Disorder (Functional Neurological Symptom Disorder)

  • One or more symptoms of altered voluntary motor or sensory function.
  • Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
  • The symptom or deficit is not better explained by another medical or mental disorder.
  • The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.


  • Rule out comorbid psychiatric disorders that require treatment (Anxiety, Depression)
  • Schedule regular visits
    • Acknowledging symptoms
      • Focus on psychosocial and not just physical symptoms
    • Assessing and treating diagnosable medical and psychiatric disorders
    • Limiting tests and referrals
    • Reassuring the patient that grave medical diseases have been ruled out (emphasize mind-body connection)
    • Functional improvement the goal of treatment
  • Pharmacotherapy (eg. Fluoxetine 20mg PO daily and titrate up, or Amitriptyline)
  • Psychotherapy (CBT or Mindfulness-based therapy)
  • Consult Psychiatry once to clarify diagnosis and reduce investigations