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# Somatic symptom and illness anxiety disorders

Excessive worry about physical symptoms or about having a serious illness, causing distress and repeated medical visits, whether or not a disease is present.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Insula](https://durgical.com/en/anatomy/insula/)
- [Cingulate gyrus](https://durgical.com/en/anatomy/cingulate-gyrus/)
- [Amygdala](https://durgical.com/en/anatomy/amygdaloid-body/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Thalamus](https://durgical.com/en/anatomy/thalamus/)

## What it is

In somatic symptom disorder, one or more distressing physical symptoms are accompanied by excessive thoughts, feelings and behaviours about them (disproportionate concern, high health anxiety, excessive time spent) for at least 6 months. In illness anxiety disorder, the person is preoccupied with having or acquiring a serious illness while bodily symptoms are absent or mild. The symptoms are not faked.

## Who gets it

Somatic symptom disorder is estimated in about 5–7% of the general population and is much more frequent in primary care. Illness anxiety disorder affects about 1–5%. Both are common reasons for repeated consultations, tests and emergency visits in health systems of Latin America.

## Causes

- Heightened attention to and catastrophic interpretation of normal bodily sensations
- Childhood experience of serious illness in self or family
- Childhood adversity or trauma
- Learned illness behaviour reinforced by attention or medical testing

## Risk factors

- Anxiety or depressive disorders
- History of childhood abuse or neglect
- Recent stressful life events
- Chronic medical illness
- Fewer years of formal education and lower socioeconomic level (somatic symptom disorder)

## Pathophysiology

Thought to involve amplified processing of bodily signals (interoception) in the [insula](https://durgical.com/en/anatomy/insula/) and anterior cingulate cortex, together with anxious, catastrophic beliefs about health. Checking, reassurance seeking and repeated testing reduce anxiety briefly but reinforce the cycle.

## Classification

- Somatic symptom disorder: distressing somatic symptoms plus disproportionate thoughts, feelings or behaviours; mild, moderate or severe; with predominant pain specifier
- Illness anxiety disorder, care-seeking type: frequent consultations and tests
- Illness anxiety disorder, care-avoidant type: avoids doctors and hospitals because of fear

## Symptoms and signs

- One or more physical symptoms (pain, fatigue, gastrointestinal, neurological) that cause distress
- Persistent, disproportionate worry about the seriousness of symptoms
- Preoccupation with having a serious illness despite reassurance
- Frequent body checking, internet searches and requests for tests
- Doctor shopping or, conversely, avoidance of medical care

## Red flags

- New, changing or objective signs (weight loss, fever, bleeding, focal neurological deficits) that need full evaluation
- Depression or suicidal thoughts
- Harm from repeated invasive tests or procedures
- Dependence on opioids, sedatives or other medicines

## Diagnosis

**Clinical**
Diagnosis is based on positive features (excessive thoughts, feelings and behaviours about symptoms or illness for at least 6 months), not merely on the absence of a medical explanation. A thorough initial history and examination should rule out medical disease; the presence of a disease does not exclude the diagnosis if the response is disproportionate.

**Tests**
Reasonable baseline tests guided by the symptoms; avoid repeated testing driven only by the patient's anxiety.

**Imaging**
Only when clinically indicated by new or objective findings.

## Differential diagnosis

- Undiagnosed medical illness (multiple sclerosis, lupus, thyroid disease, porphyria)
- Panic disorder and generalised anxiety disorder
- Major depressive disorder
- Functional neurological symptom disorder (conversion disorder)
- Factitious disorder and malingering (symptoms are intentionally produced)

## Goal of treatment

Reduce distress and health-related anxiety, improve functioning and avoid unnecessary tests and harm, rather than eliminate every symptom.

## Treatment

**Conservative**
A single, consistent primary care provider with regular scheduled visits (not only when symptoms arise), a brief examination each time and validation that the symptoms are real.

**Conservative**
Cognitive behavioural therapy, including mindfulness-based approaches, is the treatment with best evidence; it targets catastrophic thinking and checking or reassurance seeking.

**Medical**
Antidepressants (SSRIs or SNRIs) when depression, anxiety or pain coexist.

**Follow-up**
Coordination between services to limit unnecessary tests and procedures, careful review of medicines and periodic reassessment for new organic disease.

## Complications

- Iatrogenic harm from unnecessary tests, procedures and medicines
- Depression and anxiety disorders
- Disability and loss of work
- High health care costs

## Prognosis

Often chronic with fluctuations, especially with many symptoms and comorbid depression or anxiety. Outcomes improve with a stable therapeutic relationship and cognitive behavioural therapy; illness anxiety disorder may remit in a substantial proportion of people.

## Test yourself

Think of the answer, then tap the question to see it.

## Does the presence of a real medical disease exclude somatic symptom disorder?

No; the diagnosis rests on disproportionate thoughts, feelings and behaviours about the symptoms.

## How does illness anxiety disorder differ from somatic symptom disorder?

In illness anxiety disorder somatic symptoms are absent or mild; the problem is the fear of having a serious illness.

## What is the key management strategy in primary care?

One consistent provider with regular scheduled visits, avoiding unnecessary tests.

## In which disorders are symptoms intentionally produced?

Factitious disorder (to assume the sick role) and malingering (for external gain).

## Which psychotherapy has the best evidence?

Cognitive behavioural therapy.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/somatic-symptom-and-illness-anxiety-disorders/)

## Related conditions

- [Functional neurological symptom disorder (conversion disorder)](https://durgical.com/en/conditions/functional-neurological-symptom-disorder/)
- [Generalized anxiety disorder](https://durgical.com/en/conditions/generalized-anxiety-disorder/)
- [Panic disorder](https://durgical.com/en/conditions/panic-disorder/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Obsessive-compulsive disorder (OCD)](https://durgical.com/en/conditions/obsessive-compulsive-disorder/)
- [Irritable bowel syndrome](https://durgical.com/en/conditions/irritable-bowel-syndrome/)
- [Fibromyalgia](https://durgical.com/en/conditions/fibromyalgia/)
- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Somatic symptom disorder](https://medlineplus.gov/ency/article/000955.htm) (MedlinePlus (U.S. National Library of Medicine), 2025); [Illness anxiety disorder](https://medlineplus.gov/ency/article/001236.htm) (MedlinePlus (U.S. National Library of Medicine), 2025).

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Source: https://durgical.com/en/conditions/somatic-symptom-and-illness-anxiety-disorders/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/somatic-symptom-and-illness-anxiety-disorders/