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Applying the functional somatic disorder classification to somatic symptom disorder: Findings from the SOMA.SSD study
Abigail Smakowski1, Bernd Löwe1, Franz Pauls2
1Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
Journal of Psychosomatic Research
|July 2, 2026
Summary
The Functional Somatic Disorders (FSD) classification helps characterize Somatic Symptom Disorder (SSD) presentations. Most SSD patients had multi-system FSD, linked to higher psychological burden and transdiagnostic factors like health anxiety.
Area of Science:
- Psychiatry and Psychology
- Medical Diagnostics
Background:
- Functional somatic disorders (FSD) present diagnostic challenges due to fragmentation across specialties.
- The FSD classification categorizes symptom presentations into multi-system, single-system, and single-symptom subcategories.
- This study examines the utility of the FSD classification in patients diagnosed with Somatic Symptom Disorder (SSD).
Purpose of the Study:
- To evaluate the applicability and clinical utility of the FSD classification in a clinical population with SSD.
- To assess how the FSD classification differentiates symptom presentations within SSD.
- To identify factors associated with different FSD subcategories in SSD patients.
Main Methods:
- Observational, cross-sectional analysis of baseline data from the SOMA.SSD cohort (N=239).
- SSD diagnosis confirmed using the Structured Clinical Interview for DSM-5-TR (SCID-5).
- FSD subcategories operationalized using the Bodily Distress Syndrome Checklist; statistical analyses included chi-square, Mann-Whitney U, and logistic regression.
Main Results:
- The majority of SSD patients (86.6%) met criteria for multi-system FSD.
- Multi-system FSD was significantly associated with greater psychological and behavioral burden (somatosensory amplification, perceived stress, health anxiety, negative affect).
- Single-system FSD showed poor alignment with established diagnoses; comorbid conditions were common but often mismatched with symptom systems.
Conclusions:
- The FSD classification effectively captures variation within SSD, serving as a valuable tool for characterization and differentiation.
- Transdiagnostic factors like health anxiety, somatosensory amplification, and negative affectivity appear crucial in multi-system FSD presentations.
- Further research is recommended to explore the FSD classification's utility in longitudinal studies and treatment settings.
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