312 Somatic Symptom and Related Disorders
Individuals typically experience distress that  is principally focused on somatic symp-
toms and their significance. When asked direct ly about their distress, some individuals de-
scribe it in relation to other aspects of thei r lives, while others deny any source of distress
other than the somatic symptoms. Health-relat ed quality of life is often impaired, both
physically and mentally. In severe somatic symptom disorder, the impairment is marked,
and when persistent, the diso rder can lead to invalidism.
There is often a high level of medical care utilization, which rarely alleviates the individ-
ual’s concerns. Consequently, the patient may se ek care from multiple doctors for the same
symptoms. These individuals often seem unre sponsive to medical interventions, and new
interventions may only exacerbate the presenting symptoms . Some individuals with the dis-
order seem unusually sensitive to medication si de effects. Some feel that their medical as-
sessment and treatment have been inadequate. 
Associated Features Supporting Diagnosis
Cognitive features include at tention focused on somatic symptoms, attribution of normal
bodily sensations to physical illness (possibly with catastrophic interpretations), worry
about illness, and fear that any physical activity may damage the body. The relevant as-
sociated behavioral features may include repe ated bodily checking for abnormalities, re-
peated seeking of medical help and reassurance, and avoidance of physical activity. These
behavioral features are most pronounced in severe, persistent somatic symptom disorder.
These features are usually associated with freq uent requests for medical help for different
somatic symptoms. This may lead to medical consultations in which individuals are so fo-
cused on their concerns about somatic symptom( s) that they cannot be redirected to other
matters. Any reassurance by the doctor that the symptoms are not indicative of serious