Somatic symptom disorder in patients with IBS or ulcerative colitis – Cross-sectional baseline findings from the SOMA.GUT-RCT 2025 Peters et al

[Andy]

Highlights

• Research on somatic symptom disorder (SSD) using diagnostic interviews in gastrointestinal diseases is currently lacking
• In this study 55.0% of patients with IBS and 29.6% with UC met diagnostic interview-based SSD criteria
• Across conditions SSD was linked to higher psychosocial burden but not gastrointestinal symptom severity or disease activity
• Findings highlight the need to reconsider the ICD-11 exclusion of bodily distress disorder in the diagnosis of IBS

Abstract

Background
Somatic symptom disorder (SSD) is characterised by distressing somatic symptoms accompanied by excessive symptom-related thoughts, emotions, or behaviour. While initial evidence supports SSD's relevance in gastrointestinal conditions like irritable bowel syndrome (IBS) and ulcerative colitis (UC), structured interview-based data are lacking. This study examined SSD frequency and its associations with biopsychosocial variables in patients with IBS or UC recruited in the context of a psychological intervention trial.

Methods
Cross-sectional baseline data from a randomised controlled trial of patients with UC or IBS were analysed. SSD was diagnosed using structured DSM-5-based diagnostic interviews. Measures included illness-related anxiety (WI-7), neuroticism (BFI-10), illness perceptions (B-IPQ), symptom-related disability (adapted PDI), and gastrointestinal symptom severity (IBS-SSS). Between-group comparisons and multiple logistic regression analysis were conducted.

Results
SSD was diagnosed in 41.5 % (95 % CI 35.6–47.9) out of 236 patients, including 125 patients with UC and 111 with IBS (73.7 % female; Mage = 40.14, SD = 13.8). SSD was more frequent in IBS (55.0 %; 95 % CI 44.4–64.9) than in UC (29.6 %; 95 % CI 21.7–37.1) (χ2(1) = 15.67, p < .001), and linked to higher illness-related anxiety, negative illness perceptions, and symptom-related disability in both groups. Gastrointestinal symptom severity was highest in patients with IBS and SSD. Regression analysis showed IBS diagnosis, illness-related anxiety, and neuroticism correlated with SSD.

Conclusions
A substantial number of patients with IBS or UC met SSD criteria in structured interviews. SSD occurred more commonly in IBS and was associated with psychological distress in both conditions. Findings highlight SSD's diagnostic relevance in functional and inflammatory bowel diseases. Future studies should investigate whether targeted SSD diagnosis and treatment in these conditions could improve clinical outcomes.

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[Utsikt]

They’ve chosen the most generic symptoms out there to include in their concept, and keep complaining that other diagnoses don’t want anything to do with their concept.

It’s like a cough syrup producer complaining that they are not included in the treatment recommendations for COPD or lung cancer because clearly those patients are coughing!

 

[Hoopoe]

Maybe "somatizing" is just "complaining too much about how horrible the illness is" (from the perspective of the person listening to the complaints). Those who lack compassion because they have never experienced that illness could think that patients are complaining too much about something that cannot truly be this bad.

 

[Liie]

For fun I looked up the diagnostic criteria for "somatic symptom disorder":

one of the following:

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.

So it's basically all subjective and up to the psychiatrist.

Maybe "somatizing" is just "complaining too much about how horrible the illness is"

Exactly.

The linked page contains an interesting comparion between DSM-4 and DSM-5. The criteria have been made more gereral, abstract and wide. But agruable less weird.

Table 3.31DSM-IV to DSM-5 Somatic Symptom Disorder Comparison​

Name: Somatization Disorder	Name: Somatic Symptom Disorder
Disorder Class: Somatoform Disorders	Disorder Class: Somatic Symptom and Related Disorder
A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.	B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: Disproportionate and persistent thoughts about the seriousness of one’s symptoms. Persistently high level of anxiety about health or symptoms. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance: four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination) two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods) one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy) one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis, or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)	A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
C. Either (1) or (2): after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings	DROPPED
D. The symptoms are not intentionally feigned or produced (as in factitious disorder or malingering).	DROPPED

 

[rvallee]

Findings highlight SSD's diagnostic relevance in functional and inflammatory bowel diseases.

Literally the opposite. This ideology is mad. They don't even understand what they're doing and have long stopped bothering to pretend any of this makes any sense.