Understanding Somatic Symptom Disorders in Modern Health Care

Dr. Felicity Monroe

Hey everyone, and welcome back to the Professional Communication podcast. I'm Dr. Felicity Monroe, and as always, I’m joined by my favorite nurse and reluctant world traveler, Evelyn Harper. Today’s conversation is all about somatic symptom disorders—those tricky conditions where patients experience real, often distressing physical symptoms that don’t always add up with what we can measure or see. Evelyn, you ready for this one?

Evelyn Harper

Born ready! These cases are the ones that always keep you on your toes. And honestly, if you’ve ever worked ER nights, you know how often somatic symptoms show up, especially in folks who just want answers—or at least, some relief.

Dr. Felicity Monroe

Absolutely. Maybe we can start by briefly laying out the main types you see in DSM-5-TR: there’s somatic symptom disorder, illness anxiety disorder—that used to be hypochondriasis—functional neurological disorder, and factitious disorder. They have overlapping features but also key differences. Basically, all involve some combination of physical complaints, health concerns, and, well, a lot of anxiety about those symptoms. Sometimes there’s excessive thoughts about illness, or persistent demands for medical tests even when nothing turns up.

Evelyn Harper

Yeah, so think of it like this—somatic symptom disorder is when someone has one or more actual physical symptoms, and these really disrupt daily life. It’s not “all in their head,” but the level of worry and time spent on these symptoms is excessive. Illness anxiety disorder is different; that’s where a person is mostly preoccupied with having or developing a serious illness, even if they hardly have symptoms. They bounce from doctor to doctor but, you know, their blood work comes back totally normal.

Dr. Felicity Monroe

Exactly. Then you have functional neurological disorder—which you might know as “conversion disorder.” People might experience things like paralysis, tremors, or even seizures, but neurologic workup and imaging don’t explain what’s happening. And then factitious disorder, which is genuinely rare, but in those cases, the person consciously produces, feigns, or exaggerates symptoms, sometimes even going to great lengths—like self-injury—to get medical attention.

Evelyn Harper

It’s wild stuff. And I mean, some of those overlaps—like high anxiety about health, repeated requests for validation or diagnostic testing, missing work, and sometimes just a genuine inability to explain day-to-day suffering—show up pretty regularly across these disorders.

Dr. Felicity Monroe

Right, and the risk factors are nuanced. There’s a lot of stress—sometimes past trauma, health beliefs that everything is a sign of something awful, maybe a history of difficult medical experiences. I actually had a patient—let’s call her Adeline—who’d show up every few weeks needing another scan or a blood test. She’d been fired a couple times for missing work, couldn’t keep up with relationships, and felt constantly exhausted. No test results ever clarified what was “wrong.” But from her perspective, the threat of illness was deeply real. Managing that distress is both a medical and a psychological challenge.

Evelyn Harper

It’s heartbreaking, honestly. Because as a nurse, you want to do everything, but sometimes, all the labs in the world don’t help. And with the high level of service use, it really stretches the system. Like, frequent ER visits, tons of specialist appointments—and the result can be this sense of invisibility or even frustration on both sides.

Evelyn Harper

So Felicity, building off that—care for these patients really can’t rest on one set of shoulders. You’ve got providers, case managers, nurses, social workers, sometimes psychiatrists or psychologists, even community health centers. Each team member brings a different lens, right?

Dr. Felicity Monroe

For sure. The provider might initially rule out organic causes, but what’s just as important is noticing the patterns: missed appointments, frequent calls about new symptoms, and so on. Nurses—you all really are the eyes and ears—picking up on the subtle stuff like how patients describe their symptoms or how daily activities are affected. Psychiatrists and therapists can support emotional processing and introduce coping skills. And then community health centers sometimes serve as the glue for coordinate care, especially for folks without regular access to primary physicians.

Evelyn Harper

You said it—coordination is everything. We need clear communication, robust shared care plans, and honestly, some humility that no one person has the silver bullet. In one of my cases, there was this patient—we’ll call him Chris—who landed in the ER three times in two weeks, convinced he was having heart attacks. After the full workup, the team realized there was a big element of anxiety going mostly unchecked. The hospitalist looped in psych, I kept tabs with follow-up calls, his PCP joined an online case review, and social work addressed his housing worries. Suddenly, the number of ER visits dropped because Chris knew we had his back. It was genuinely collaborative.

Dr. Felicity Monroe

That’s a fantastic example. And it highlights why communication strategies are central—like regular updates, shared notes, even case conferences when things get particularly complex. It also cuts down on high-cost, unnecessary tests and ensures care stays patient-centered.

Evelyn Harper

But let’s be honest: balancing validation with boundaries is tough. The patient wants to feel heard—you can’t just keep running tests forever. So sometimes one of the most healing things you can do is say, “Hey, your experience is real, and you’re not alone, but let’s also focus on your quality of life, not just chasing more results.”

Dr. Felicity Monroe

That’s it. Kindness, clarity, and consistency—three words I keep coming back to. And I might be biased, but I really think a creative, flexible team can truly transform care, especially for people who’ve spent years seeking answers.

Dr. Felicity Monroe

Speaking of transformation, it’s not just about the team—it’s what that team actually does. Nursing interventions are crucial: consistent communication, validation of patient experiences, being honest about what’s known and what isn’t, and building structured care plans. These things can go a long way to prevent that cycle of unnecessary admissions and pointless tests.

Evelyn Harper

Totally. If you can create trust and consistency, folks are a lot less likely to keep showing up in crisis. I worked with a patient who struggled with constant anxiety and health worries. The team made sure discharge planning wasn’t just “here’s your paperwork, goodbye.” Instead, we scheduled a follow-up before they left the floor, shared a care plan, and linked them to a community mental health program. Over the next year, their ER visits dropped, and they even got back into part-time work.

Dr. Felicity Monroe

There’s real evidence that coordinated discharge planning improves outcomes, especially for patients anxious about illness. The best discharge plans aren’t just about prescriptions and appointments; they’re about what actually matters in a person’s life—meaningful goals, support systems, and clear communication points. For some of my patients, creative therapies like journaling, art, or narrative therapy have been a turning point. It helps them reframe their health journey—moves the story from one of suffering to one of agency.

Evelyn Harper

I love that! Sometimes, a sense of purpose or just having someone listen—really listen—makes all the difference. And building on what we’ve talked about in earlier episodes, these approaches don’t just help the patient—they help the whole system keep quality high and costs in check. Win-win, right?

Dr. Felicity Monroe

Right. Collaborative practice, creative problem-solving, and respect for patients’ experiences are central if we want to keep pushing for affordable, quality care. Alright, Evelyn, I think that’s a good note to wrap this up. Any last thoughts?

Evelyn Harper

Just that, honestly, these conversations are what keep me inspired. Thanks, Felicity, for sharing your stories and insight—and big thanks to everyone listening. We’ll be back soon with more on how interprofessional teams can tackle the next set of healthcare challenges.

Dr. Felicity Monroe

Thanks, Evelyn. And thanks to all of you for joining us once again. Take care of yourselves—body and mind. We’ll see you next time on the Professional Communication podcast!