The Validity of Somatic Symptom Disorder in Patients With Gastrointestinal Complaints

J Clin Gastroenterol. 2021 Sep 1;55(8):e66-e76. doi: 10.1097/MCG.0000000000001505.


Background and goal: The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD-) along sociodemographic, clinical, and psychological characteristics.

Study: This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD-) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD- patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD- patients.

Results: About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits.

Conclusions: Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.

MeSH terms

  • Anxiety / diagnosis
  • Anxiety / epidemiology
  • Anxiety / etiology
  • Cross-Sectional Studies
  • Humans
  • Medically Unexplained Symptoms*
  • Mental Disorders*
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / epidemiology
  • Surveys and Questionnaires