In the ever-evolving landscape of psychiatric and psychosomatic medicine, a provocative question has emerged recently within academic circles and clinical practice alike: Can somatic symptom disorder (SSD) be considered an iatrogenic disease? A compelling case report published in the 2025 volume of BMC Psychiatry brings critical insights to this debate, highlighting the intricate interplay between medical intervention, patient perception, and the persistence of somatic symptoms that defy conventional diagnostic resolution.
Somatic symptom disorder, as defined by contemporary psychiatric nosology, encapsulates a condition marked by persistent, clinically significant physical symptoms that are often accompanied by disproportionate and maladaptive thoughts, feelings, and behaviors related to health concerns. This disorder is distinguished not merely by the presence of physical complaints but by the psychological and behavioral burden it imposes, often resulting in substantial functional impairment.
The underlying etiopathogenesis of SSD is complex and multifactorial. The dominant theoretical framework—the biopsychosocial model—posits that SSD arises from a confluence of biological vulnerability, psychological predispositions, and social influences. These factors interweave to transform what might otherwise be transient somatic complaints into chronic, disabling syndromes. However, the boundaries between genuine somatic pathology and the psychological amplification of physical symptoms often blur, complicating both diagnosis and management.
The case presented by Horn and colleagues illustrates this complexity with striking clarity. Their patient initially presented with somatic symptoms severe enough to warrant extensive medical evaluation, eventually resulting in the diagnosis of pheochromocytoma, a rare catecholamine-secreting tumor. Surgical removal of the tumor, theoretically curative, should have alleviated the somatic manifestations and associated distress. Curiously, following surgery, the patient’s physical symptoms and psychological distress persisted with little abatement.
This incongruity between the resolution of the underlying medical condition and the ongoing symptomatology underscores a key clinical challenge: distinguishing SSD as a primary disorder from symptoms solely attributable to organic pathology. The persistence of symptoms despite adequate treatment of the physical disease suggests the presence of a somatic symptom disorder that has become independent, possibly entrenched by prior medical encounters and diagnostic labeling.
The authors propose that prolonged medical scrutiny and intervention themselves may serve as precipitating and maintaining factors in the evolution of somatic symptom disorder—a hypothesis with profound implications. This iatrogenic perspective draws attention to the potential unintended consequences of well-meaning medical care, wherein extensive diagnostic testing, repeated consultations, or ambiguous communication can exacerbate or even initiate maladaptive health preoccupations.
Such a view compels a reevaluation of clinical approaches, shifting the paradigm from one of exclusion—where SSD is diagnosed only after the dismissal of physical causes—to one of early identification and integrated treatment. Recognizing excessive health-related thoughts and behaviors at the outset of care might mitigate the reinforcement of somatic symptom disorder and improve patient outcomes.
This shift aligns with emerging predictive models of SSD, which advocate for interventions that address both psychological and somatic dimensions concurrently, rather than sequentially or competitively. By integrating psychosomatic assessments early in the diagnostic pathway, clinicians can tailor management plans that encompass both mind and body, potentially forestalling the chronicity of symptoms.
The case also highlights the complex relationship between somatic symptom reporting and the medical system. Multiple investigations and treatments can inadvertently validate patients’ concerns in ways that solidify symptom focus, inadvertently fostering persistent distress even after the original pathology has been addressed. Thus, a nuanced understanding of the patient’s narrative and symptom experience is essential.
Furthermore, the report illuminates the importance of communication strategies in mitigating maladaptive beliefs and behaviors. Clinicians must balance thorough investigation with judicious reassurance, avoiding unnecessarily pathologizing or dismissing patient reports. This delicate equilibrium requires training, time, and a biopsychosocial mindset.
From a research perspective, this case supports the urgent need for longitudinal studies examining the trajectories of SSD development following medical interventions. Exploring how iatrogenic factors contribute to the persistence or emergence of SSD could redefine clinical guidelines, promoting practices that reduce harm while enhancing diagnostic and therapeutic efficacy.
The proposition that SSD may be an iatrogenic disease challenges the traditional dichotomy between medical and psychiatric domains, reinforcing the necessity of collaborative care models. Psychiatrists, primary care providers, and specialists must work synergistically to identify at-risk individuals early and implement comprehensive care plans.
This collaborative approach dovetails with a growing emphasis on patient-centered care, where understanding patients’ experiences, fears, and contexts takes precedence. Tailoring interventions to individual needs, rather than adhering rigidly to diagnostic categories, may reduce the burden and stigma associated with SSD.
Ultimately, the insights gleaned from this case report articulate a profound truth about modern medicine. In its efforts to diagnose and cure, the healthcare system must remain vigilant about the psychosocial aftershocks that medical investigations and treatments can unleash. Recognizing somatic symptom disorder as potentially iatrogenic invites humility and caution, urging clinicians to refine practices in ways that heal without inadvertent harm.
The conversation ignited by this study prompts a wider societal reflection on health anxiety, the cultural meanings of illness, and the physician’s role in navigating uncertainty. As medical technology advances and patient expectations evolve, the integration of psychological understanding into somatic care becomes ever more crucial.
In conclusion, while somatic symptom disorder has traditionally been considered a diagnosis of exclusion, emerging evidence suggests that medical care itself may contribute to its development and persistence. Early recognition and treatment of SSD, alongside thorough investigation of physical symptoms, represent complementary strategies. This integrative approach not only promises better patient outcomes but may also recalibrate how health systems address the complex interplay of mind and body.
Subject of Research: Somatic Symptom Disorder and its potential iatrogenic origins.
Article Title: Can somatic symptom disorder be an iatrogenic disease?
Article References:
Horn, M., Fovet, T., Sobanski, V. et al. Can somatic symptom disorder be an iatrogenic disease?. BMC Psychiatry 25, 550 (2025). https://doi.org/10.1186/s12888-025-06918-w
Image Credits: AI Generated
