Disentangling Somatic Symptoms of Depression and Anxiety

Primary care physicians are trained to recognize a client’s physical symptoms and determine the physiological or biological cause of those symptoms. But too often, clients visit their primary care physicians with physical symptoms that are psychological in origin. Depression and anxiety, two of the most frequently occurring mental health problems, have symptoms that can overlap, such as negative affect and internalizing behaviors. To better identify which specific mental health problems may be causing physical symptoms, L.J. Simms of the University at Buffalo of the State University of New York analyzed specific models that are used to identify somatic symptoms of depression and anxiety. Some experts believe that all mood disorders, including generalized anxiety, major depression, obsessive-compulsive disorder, posttraumatic stress, and social phobias, should be lumped together in one classification of “emotional disorders” in the upcoming revised DSM-V. However, others believe there is a clear distinction between the somatic symptoms of each of these illnesses.

To clarify how these symptoms vary, Simms examined data from 5,438 clients who were part of the World Health Organization’s Collaborative Study of Psychological Problems in General Health Care. The participants included clients from 14 countries and were assessed using the Primary Care Version of the Composite International Diagnostic Interview (CIDI-PC). The results revealed that the participants with depression exhibited unique symptoms that were different than those evident in participants with anxiety. Although negative affect was present in most of the participants with depression and anxiety, those with somatic symptoms had the highest levels of internalizing, followed closely by those with depression. These findings suggest that there is a difference in how physical symptoms manifest in each of these illnesses. Simms said, “In addition, diagnostic methods are needed (e.g. computerized scoring and/or administration of measures) that permit efficient parsing of such common and unique elements in clinical settings.” But until those measures are designed, Simms believes that primary care physicians who treat individuals presenting with physical symptoms and generalized negative affect should rely on existing models to determine whether or not there are underlying psychological causes.

Simms, L. J., Prisciandaro, J. J., Kreuger, R. F., Goldberg, D. P. The Structure of Depression, Anxiety and Somatic Symptoms in Primary Care. Psychological Medicine 42.1 (2012): 15-28. Print.

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  • Danny d

    February 10th, 2012 at 6:02 PM

    So there are indeed some patients where it rings true that the stuff going on with them is all in their head?

  • lissa

    February 11th, 2012 at 6:31 AM

    I do not mean to demean anyone and their health issues that they may have. . . but I know for a fact that there are simply some people who have to be sick, they have to have something going on in their lives either physically or mentally so that someone will pay attention to them. And that has to be hard for some doctors to distinguish. You don’t want to dismiss them outright because what if something really is going on? You deny care and you get sued. But then again what if you treat them for something that is not really there. Can’t that be just as bad?

  • traci Roberts

    February 12th, 2012 at 5:57 AM

    This is a whole lot of responsibility to place on the shoulders of the primary care physician.
    They have to be trained to recognize a lot of different physical ailments but are they then expected to be able to recognize mental health issues too?
    That just seems like a lot for any man or woman to be responsible for.
    And the bad thing is that these are the doctors who are expected to know a little about a lot and yet they are the doctors who are paid the least.

  • Blackcat

    February 13th, 2012 at 5:49 AM

    Some of the responsibility lies with the person going to visit the doctor – recognizing you have a new problem, book a longer appointment so that you can discuss both the problem and what’s happening in your life so the doctor has a chance to put two and two together. If you are able, also do a little homework on your symptoms. Don’t pretend you know the answer but suggesting something can be the starting point. I have this symptom/s. Could it be X problem?
    Having said all that, I know my own body pretty well and when I get SAD (stressed, anxious or depressed) there are telltale signs which tell me to slow down and take time out of my busy week to review the situation. This practice, if you can manage it, is cheaper than seeing a health professional. Be your own therapist!

  • yolanda

    February 13th, 2012 at 4:09 PM

    And some people are gonna be attention seekers no matter what!

  • chris j

    February 15th, 2012 at 9:30 AM

    how could a general physician possibly identify all that? do they receive any training in this regard or is it their experience at work?

  • Joey

    September 1st, 2012 at 5:48 AM

    People who are described in these posts as having to be sick or are “attention seekers” are indeed suffering from mental illness. But this is not the topic for which I am writing.

    I suffer from a host of symptoms that most people would not assume as depressive symptoms. I ache all over, daily tasks are overwhelming, I have interests but no energy to engage, I want to be alone but not to feel lonely, I want to sleep but cannot, eating is comforting in the act and causes emotional misery afterward, I feel numb yet very fragile and reactive, I am NOT lazy. I am educated and work hard despite how very difficult it is to function. I was once very active; in and of the world. Now I am a shred of that person despite the help of doctors, therapies, and medication. Unless you’ve lived in this world, you must not underestimate the misery and the realness of this misery. Please be sensitive. You do not have to understand; just believe it is real. Like any accepted physical illness, this, too, is real illness. I would give anything to find a way out of this hell. We depend on doctors and other professionals to help us. This is their chosen field and they are compensated for their work. These professionals have the responsibility of never giving up and always looking for new and better ways to help their patients. We need professionals committed to helping us, for when they do, everyone wins. If they were investment brokers responsile for your money, you sure wouldn’t make excuses for their making bad investments. This is about people, their lives, and the quality of life. Unless you’ve been where we are, you do not have the ability to understand how real this is. Rather than judge, take the time to learn more or simply stay out of it. The last thing people with mental illness need is to be told it’s not real.

  • Lottie

    October 25th, 2012 at 2:27 PM

    You are all incredibly ignorant (apart from Joey). You have no idea how it feels to be depressed to the point of paralysis. To the point that somebody else has to dress you and take you to the toilet. It is incredibly degrading to be completely dependent upon a carer at the age of 26.
    When I was a child, way before the problems really started, I assumed I would be a successful career person. Now I can barely leave the house.
    When I do, I frequently collapse and have to be carried home. I cannot do anything.
    I have lost most of my friends. Most of my relationships have ended due to my problems with depression.
    I’ve had to quit university twice. I wasnted to do a phd. I am poor because I cannot work.

    I am basically just sitting around waiting to die and my body will not allow me to live a normal life.


  • Damien

    October 25th, 2012 at 11:37 PM

    Lottie Thank you, you are a god send. I have wanted to say this to my family and my friends for a long long time. I have just copied and pasted this into my FB giving you credit but saying this is how I feel. THANK YOU.

    I suffer from IBS, GERD, FIbromyalgia, ADHD,Bi-polar, and Severe Anxiety. These symptoms over the last few years have my made my life a living hell. IT is nice to know that someone else feels the same way!

  • Christine

    August 27th, 2013 at 7:54 AM

    Great Article! This write up will really help people who are in need of medications and advice.

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