When and How Can Functional Somatic Disorders Be Treated?

Functional somatic disorders (FSDs) are characterized by persistent physical symptoms that cannot be fully explained by identifiable organic abnormalities. They account for 30%-40% of consultations across medical specialties and can substantially disrupt patients’ lives. During the 2026 National Days of General Medicine (JNMG), held on September 24-25 in Paris, France, Brigitte Ranque, MD, PhD, professor and head, Department of Internal Medicine, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP); medical lead, CASPER Unit, Hôtel-Dieu, AP-HP; and professor, Université Paris Cité, Paris, France, discussed how to recognize and manage these disorders.“What is a FSDs? It refers to physical symptoms — ‘soma’ means ‘body’ in Greek — that cannot be fully explained by an identifiable organic abnormality. These symptoms are generally recurrent, long-lasting, and persistent, which is an essential part of their definition,” Ranque said.FSDs can coexist with other diagnosed medical conditions. Irritable bowel syndrome is a common FSD, affecting nearly 10% of Ranque’s patients. Other examples include hyperventilation and chronic fatigue syndrome.Very Common DisordersFSDs are common in the general population. Approximately three quarters of affected patients are women, except among those presenting with chest pain.The causes are multifactorial. “It is often said that a FSDs follows a major traumatic event, such as rape. This is not always the case. A traumatic or highly distressing experience can contribute to the onset of FSDs, but such experiences take many forms, including non-sexual physical abuse, psychological abuse, emotional neglect, and adverse life events that influence brain development. Bereavement, a loved one’s serious illness, or even the fear of losing someone important can create a predisposition,” Ranque explained.Patients with FSDs may also exhibit perfectionistic or obsessive personality traits. However, it remains unclear whether these traits contribute to the disorders or develop as a consequence of an FSD.Triggering Factors and the Cycle of SymptomsFSDs manifest after triggering events, with a median age of approximately 40 years. According to Ranque, an event can initiate a process known as operant conditioning.“Operant conditioning is a well-established phenomenon in mammals, including humans. A classic medical example is that of patients undergoing chemotherapy. After several sessions associated with nausea, some patients begin to experience nausea as soon as they arrive at the hospital, with the same intensity, even before treatment begins,” said Ranque.In FSDs, this conditioning can lead the brain to anticipate symptoms, even in the absence of corresponding sensory signals. This cognitive prediction can cause the brain to misinterpret information and enter a state of constant alertness even when no triggering factor is present.“This heightened state of alertness has physical repercussions. It activates the sympathetic nervous system, which can cause a range of symptoms, including sweating, chest tightness, throat tightness, tachycardia, shortness of breath, diarrhea, paresthesia, and even visual disturbances related to changes in the iris,” said Ranque.These symptoms can lead patients to adopt avoidance behaviors, including avoiding activities that might trigger symptoms, seeking repeated medical consultations to reduce uncertainty, and withdrawing from social situations. “After repeated experiences of rejection and misunderstanding, patients with FSDs may withdraw into themselves,” said Ranque.“These behaviors can take various forms and gradually contribute to the persistence or even worsening of symptoms. These are precisely the behaviors that we can address in the treatment. Although triggering factors and predispositions cannot be changed, the vicious cycles that perpetuate symptoms can be identified and reduced,” she added.TreatmentOnce the diagnosis is established, treatment can be initiated. The first priority is to restore sleep, followed by breaking the vicious cycles that sustain the symptoms, starting with bodily hypervigilance.“The goal is not to ask patients to stop thinking about their symptoms, which would be impossible, but to help them avoid deliberately maintaining their focus. I often recommend removing connected devices, such as smartwatches and pulse oximeters, that reinforce constant monitoring of the body,” said Ranque.Treatment should also address the avoidance of uncertainty by discouraging repeated consultations with multiple healthcare professionals, sometimes referred to as “medical nomadism.” To reduce symptom avoidance, she recommends helping patients gradually resume activities that they have stopped because of their symptoms.“The aim is to work with patients to identify the activities they have given up because of their symptoms and encourage them to resume these activities gradually. We use a technique called ‘micro choices’ to support this process,” she said.Cognitive-behavioral therapy can also support recovery. Medication may relieve specific symptoms, such as those associated with irritable bowel syndrome, but “when the disorder is severe, that is not enough.” Recovery can take several months or even years.This story was translated from Univadis France, part of the Medscape Professional Network.