People with somatic symptom disorder (also called somatoform disorder) experience physical pain for which no cause can be identified. Somatic symptom disorder is thought to be a mental illness that causes real physical symptoms such as weakness or paralysis, difficulty with swallowing, vision, hearing, or breathing, abnormal movements or sensations, pseudo-seizures, or other physical complaints not caused by a physical disorder.
The exact cause of somatic symptom and related disorders is unknown. However, research suggests the possibility that people with these disorders experience and process pain differently than those without the disorder. Stress and anxiety usually worsen the symptoms. Many people suffering from somatic symptom or related disorder are preoccupied with having a serious medical condition that has not yet been diagnosed.
Disorders that are related to somatic symptom disorder include:
Treatment options for somatic symptom and related disorders include cognitive behavioral therapy (CBT) and the use of antidepressants or antianxiety medication.
Because the symptoms of somatic symptom disorder are subjective (based on the claimant's perspective and not documented by labs or tests), when you apply for disability benefits based on this disorder, it is particularly important that your complaints of pain and physical problems are believable and that you provide the Social Security Administration (SSA) with the right evidence. Of course, a patient with a somatoform disorder often has a lack of clinical evidence, but a judge in a recent federal court case on conversion disorder confirmed that this is to be expected due to the nature of the condition, and he emphasized the importance of an applicant's credibility.
Evidence you should submit to the SSA includes:
You should also prepare a detailed activities of daily living (ADL) form that describes how your condition affects you. You should include a description of how your life has changed since your symptoms became disabling. If you need assistance from other people to do things like grocery shopping, paying bills, or getting to doctors' appointments, make sure you include this as well. Also make sure you give the SSA the complete contact information for any medical providers you have seen for treatment.
Sometimes people with somatic symptom disorders are believed to be faking or exaggerating their symptoms. A malingerer is someone who fakes or exaggerates his or her symptoms for some material benefit (such as disability benefits). Sufferers of somatic symptom disorders feel genuine pain that is not exaggerated or faked for a benefit, so a person who has been diagnosed with somatic symptom disorder by a doctor who specializes in psychiatric disorders is not considered a malingerer. To rule out the suspicion that you may be a malingerer, a good MRFC form (discussed below) will ask this question of your psychiatrist or psychologist to ensure that the SSA understands the nature of your illness.
Doctor shopping is when a person goes to multiple physicians looking for medications or trying to get a diagnosis that will help win a disability claim. However, it is not unusual for people with somatic symptom disorders to see multiple physicians over a course of several years in an effort to get a correct diagnosis or for treatment for their symptoms. This is not doctor shopping, but the SSA may interpret it as such. Make sure that you try and stay with one doctor as much as you can. Consistent treatment and a strong doctor patient relationship is an important factor in winning your claim.
Whether you can get disability benefits from Social Security depends on whether Social Security accepts that you have a somatic symptom disorder and the severity of your condition. The agency will assess whether you meet the official disability listing for somatic symptom or a related disorder or whether your functional capacity is so low that you can't work.
Social Security updated its disability listing for somatic symptom and related disorders significantly in 2017. The new listing, listing 12.07, requires one of the following to be present:
Once a diagnosis of a somatic symptom or related disorder is made by a psychologist or psychiatrist under the above criteria, Social Security then determines if the disorder limits your ability to function, by looking at the following criteria.
You must have either an extreme limitation in one of the following areas or a "marked" (severe) limitation in two of the following areas:
If you don't currently suffer from any extreme or severe limitations in the above areas because you are living in a highly protected or supervised situation or you are undergoing intense therapy, you can provide certain documentation to fulfill the listing. You must show that:
You can still get approved for disability even if your somatic symptom disorder doesn't meet the requirements of listing 12.07, but it can be harder to win your case. The SSA will look at the medical records you submitted to them to determine whether you can still do your old job despite your symptoms. If the agency thinks you can still do your old job, or any other less demanding job, you will be denied.
To make these decisions, the SSA will determine what types of jobs you have the mental and emotional capacity to do on a regular and sustained basis (full-time). This is called your mental residual functional capacity (MRFC). To determine your MRFC, the SSA will use your medical records to prepare a report that describes your ability to do the mental and emotional requirements of a job, including:
While the SSA will use its own doctors to prepare your MRFC assessment, it is vital that the doctor who treats you for your somatoform disorder fill out an MRFC assessment for you as well. Also, it is much better to have a psychiatrist prepare the report as opposed to a general practitioner. This is because the SSA will give much more weight to the opinion of a doctor who specializes in somatic symptom disorders than to one who doesn't.
Someone with a somatic symptom disorder might experience gastrointestinal complaints that might take time away from work, anxiety and embarrassment that might lead to social withdrawal or emotional outbursts, and chronic pain such as headaches or shoulder pain that distracts the person from their work. In addition, medication prescribed for the disorder or symptoms of pain and anxiety may further impact focus and concentration. Depending on the severity of the symptoms, Social Security might agree that a person with such symptoms has moderate or extreme limitations on:
If these limitations are extreme, Social Security may agree that there is no job that someone with the combined effect of these limitations can do on a regular and sustained basis.
The main hurdle you'll face in winning a disability claim for somatic symptom disorders is getting Social Security to believe you have a "medically determinable impairment." For help on proving this, read our article on credibility and factors that help and hurt your credibility with Social Security.
With a somatic symptom disorder, you may be denied benefits initially and will have to appeal to an administrative law judge. Winning a disability hearing with somatic symptom disorder is challenging, but it can be done. Your chances of winning go up considerably if you have a disability attorney to represent you; consider speaking with an experienced disability attorney before you attend your hearing.