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    Mayo Clinic Q and A: Worrying about your health — what’s normal, what’s too much

Doctor and worried female patient at office during consultation

DEAR MAYO CLINIC: What is the difference between occasionally worrying that something is wrong with me and somatic symptom disorder? How can I stop worrying that I’m not as healthy as my doctor says?

ANSWER: A little worry over your health is normal. But for some people, fear and concern over symptoms can get out of control. These people can become convinced that they have a particular illness, even when test results are normal. These are common features of somatic symptom disorder, a mental health concern that’s thought to affect roughly 5% of the population.

People with somatic symptom disorder develop an excessive preoccupation with physical symptoms, including pain or fatigue, that results in significant emotional distress or disruptions to daily living. Stress responses to these uncomfortable symptoms, such as dizziness, heart palpitations, nausea, chest pain or shortness of breath, may further amplify worries. These symptoms may or may not be attributed to a diagnosed medical condition.

The thoughts, feelings and behaviors of somatic symptom disorder may manifest in several ways, including constant worrying about illness; interpreting normal sensations as potentially threatening or harmful; and fearing that symptoms are serious or life-threating, despite exams or testing that suggest otherwise. It’s also common for people with somatic symptom disorder to feel that medical evaluations or treatments haven’t been adequate. Repeatedly checking the body for abnormalities, researching symptoms online, and frequent health care visits or testing that doesn’t relieve concerns — or makes them worse — also are signs of the disorder.

Women are more likely to show signs of somatic symptom disorder, as are people with more than one health condition. People with a history of childhood illness, sexual abuse or other trauma are at increased risk of developing the disorder, as are those with depression or an anxiety disorder.

Several related disorders share common features with somatic symptom disorder, including illness anxiety disorder (formerly known as hypochondriasis) and functional neurologic disorders, which consist of neurological symptoms that can’t be explained by a neurological disease or other condition.

If you’re experiencing unusual symptoms, it’s important to be evaluated by a health care provider to rule out any medical problems. Your health care provider can perform a comprehensive examination that focuses on your specific concerns. However, keep in mind that evaluations may need to be limited, as repeated or extensive testing may worsen your level of distress.

A questionnaire may be used to assess the presence of somatic symptoms. Regardless of whether an identifiable medical diagnosis is present, if you’re in distress, you may be given a questionnaire to evaluate your level of health anxiety. Or you may be referred to a psychologist or psychiatrist.

The symptoms of somatic symptom disorder and related disorders often come and go. But recovery is possible — studies suggest that 50% to 75% of people with somatic symptom disorder show eventual improvement.

The main goal of managing these disorders is to improve your ability to cope with your symptoms, tolerate uncertainty and reduce health anxiety. The most effective treatment is psychotherapy, particularly cognitive behavioral therapy. Individual or group cognitive behavioral therapy can help you change behaviors, such as learning how to resist the urge to do excessive reassurance seeking. Therapy also can provide social support and challenge any disease-related worries and beliefs, such as learning alternate ways to interpret unusual and uncomfortable physical sensations. Help also can be given to restore your work, social or volunteer activities.

Antidepressants such as amitriptyline (Endep) and fluoxetine (Prozac or Sarafem) may be recommended for these disorders. However, they have shown only limited benefit. At Mayo Clinic, we recommend that antidepressant and anti-anxiety drugs be used to treat only the mood or anxiety-related disorders that often coexist. (adapted from Mayo Clinic Health Letter) — Dr. Craig Sawchuk, Psychology, Mayo Clinic, Rochester, Minnesota