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Somatic symptom disorder matters because the diagnosis rests on how a person RESPONDS to physical symptoms, not on whether those symptoms have a proven medical cause. It describes distressing physical symptoms accompanied by excessive thoughts, feelings, or behaviours related to those symptoms. For example, imagine two patients with the same mild chest pain: one mentions it briefly and moves on, while the other spends hours researching it and repeatedly seeks reassurance from doctors. In practice, that excessive preoccupation, not the symptom itself, is what defines the disorder.

Somatic symptom disorder requires at least one distressing physical symptom plus disproportionate thoughts about its seriousness, high health-related anxiety, or excessive time and energy spent on it. Crucially, the diagnosis does NOT require the symptom to be medically unexplained: it can occur alongside a real, diagnosed physical illness. Say a patient with confirmed diabetes also has excessive, disabling anxiety about every minor blood sugar fluctuation, checking it dozens of times a day. In practice, both the diabetes and the somatic symptom disorder can be diagnosed together, since the second condition is about the response, not the presence of real disease.

• Which psychological treatment has the best evidence in somatic symptom disorder?
• Why is repeatedly arranging further investigations harmful in somatic symptom disorder?
• Which comorbidity should be actively looked for in a patient with somatic symptom disorder?

• Somatic symptom disorder, excessive worry or behaviour about physical symptoms, unlike medically unexplained symptoms, which focuses on the absence of a cause.
• Illness anxiety disorder, preoccupation with HAVING a serious illness despite minimal or no physical symptoms, rather than distress driven by the symptoms themselves.
• Factitious disorder, symptoms are deliberately produced or feigned for the internal sick role, whereas somatic symptom disorder symptoms are not consciously manufactured.
• Malingering, deliberate feigning for external gain such as money, unlike somatic symptom disorder's genuine, non-deliberate distress.

• Long-term psychoanalysis does not carry this evidence base.
• Family therapy may support care but is not the primary evidenced treatment.
• Applied tension is specific to blood-injection-injury phobia.
• Habit reversal is used for tic disorders and body-focused repetitive behaviours.
• Ordering tests raises no confidentiality issue.

• Extract the defining phenomenology, duration, severity and functional-impact clues.
• Match the pattern to the most specific diagnostic or assessment construct.
• Actively test the closest look-alike against the missing or contradictory clue.
• Choose the precise term rather than a broader category that is merely compatible.