Psychological Burden in Patients With Distressing GI Complaints and Somatic Symptom Disorder

A man experiencing stomach pain
Researchers investigated which patients with distressing and chronic GI complaints also fulfilled criteria for a somatic symptom disorder.

Patients with distressing and chronic gastrointestinal (GI) complaints who fulfilled the criteria for somatic symptom disorder (SSD) exhibited higher psychological burden compared with patients who did not have SSD. These findings, from a cross-sectional study, were published in the Journal of Clinical Gastroenterology.

Patients (N=1198) with GI symptoms were recruited in 2017 from multiple centers affiliated with Heidelberg University Hospital in Germany. Individuals were assessed for sociodemographic and clinical characteristics, SSD, psychological distress, and psychological risk factors.

A total of 199 patients had distressing and chronic GI complaints and 7.7% (n=92) fulfilled the criteria for SSD. The GI complaints were for abdominal pain (92.7%), feeling full (80.1%), bloating or flatulence (82.8%), epigastric pain or burning (76.5%), diarrhea (72.4%), early satiety (52.6%), and obstipation (37.9%). In addition to their GI symptoms, these patients fulfilled symptom cutoffs for depression (54.3%), anxiety (38.2%), and panic syndrome (11.6%).

In total, the proportion of the SSD and non-SSD populations who had disorders of gut-brain interaction were 46.7% and 47.6%, respectively. However, stratified by SSD status, patients with SSD had higher rates of depression, anxiety, or panic (82.6% vs 40.2%; P <.001). Rates for comorbid inflammatory bowel diseases were also higher among the SSD group (30.4% vs 15.0%; P =.009).

SSD was associated with illness anxiety (d, 1.5; P <.001), anxiety (d, 1.1; P <.001), depression (d, 0.9; P <.001), somatization (d, 0.6; P <.001), mentalizing deficits (d, 0.5; P =.001), and personality functioning deficits (d, 0.5; P =.001).

This study was limited by its cross-sectional design. It remains unclear which aspects of the relationship between SSD, psychological burden, and GI symptoms are causative. Additional studies are needed to assess the biological relationship between these components.

The study authors concluded that among patients with GI symptoms, the individuals who fulfilled the criteria for distressing and chronic GI complaints and SSD were associated with more increased psychological burden then their non-SSD counterparts.


Berens S, Schaefert R, Ehrenthal JC, et al. The validity of somatic symptom disorder in patients with gastrointestinal complaints. J Clin Gastroenterol. 2021;55(8):e66-e76. doi:10.1097/MCG.0000000000001505