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RESEARCH ARTICLE

Subtypes of somatic symptom disorder: A secondary analysis of a multicenter cross-sectional study

Ziyang Wang1† ,  Boheng Zhu1† ,  Kurt Fritzsche2 ,  Anne Christin Toussaint3 ,  Jinya Cao1 ,  Lan Zhang4 ,  Yaoyin Zhang5 ,  Hua Chen6 ,  Heng Wu7 ,  Xiquan Ma8 ,  Wentian Li9 ,  Jie Ren10 ,  Wei Lu11 ,  Wenqi Geng1 ,  Rainer Leonhart12 ,  Tao Li1* ,  Jing Wei1*
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1 Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing , China
2 Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Baden-Württemberg , Germany
3 Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg , Germany
4 Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan , China
5 Department of Psychosomatic Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan , China
6 Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, Shanghai , China
7 Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai , China
8 Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai , China
9 Department of Clinical Psychology, Wuhan Mental Health Centre, Wuhan, Hubei , China
10 Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd., Jincheng, Shanxi , China
11 Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing , China
12 Institute of Psychology, University of Freiburg, Freiburg, Baden-Württemberg , Germany
†These authors contributed equally to this work.
HPR, 026330200 https://doi.org/10.36922/HPR026330200
Received: 13 August 2026 | Revised: 21 October 2026 | Accepted: 22 October 2026 | Published online: 30 October 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Somatic symptom disorder (SSD) is common and has high heterogeneity.

Objective: This study aimed to identify subtypes of SSD based on a multicenter cross-sectional study in China.

Methods: We analyzed data from 235 patients diagnosed with SSD. Exploratory graph analysis (EGA) was used to identify dimensions of somatic symptoms. Latent profile analysis (LPA) was then applied to classify patients into subtypes based on their symptom profiles across these dimensions. Finally, Bayesian network analysis was employed to explore the distinct patterns of relationships among psychological characteristics within each subtype.

Results: EGA revealed a four-dimensional structure of somatic symptoms: gastrointestinal, musculoskeletal, cardiopulmonary, and neurological/general. LPA classified patients into two distinct subtypes: a generalized somatic symptom subtype (GSS-type), with symptoms spanning all four dimensions, and a localized somatic symptom subtype (LSS-type), with symptoms not covering all dimensions. Patients in the GSS-type group reported significantly higher levels of anxiety (t = 5.482, p < 0.001), depressive symptoms (t = 6.576, p < 0.001), health-related anxiety (t = 6.266, p < 0.001), and disability (t = 4.282, p < 0.001), alongside poorer physical (t = −4.766, p < 0.001) and mental quality of life (t = −3.646, p < 0.001) compared to the LSS-type. Bayesian network analysis indicated that in the LSS-type, somatic symptoms and their psychological characteristics were the potential origin of depressive symptoms and anxiety, whereas in the GSS-type, depressive symptoms were the potential central driver influencing both anxiety and somatic symptoms.

Conclusion: SSD patients can be categorized into clinically distinct subtypes based on their somatic symptom distribution. The differing psychopathological mechanisms between the GSS and LSS subtypes suggest the need for tailored treatment strategies. These findings warrant further validation in larger, prospective studies.

Keywords
Somatic symptom disorder
Subtyping
Exploratory graph analysis
Bayesian network analysis
Psychopathological mechanism
Funding
This study was supported by the STI2030-Major Projects (2021ZD0202001) and the Peking Union Medical College Hospital Talent Cultivation Program (Category D, UHB11735).
Conflict of interest
The authors declare they have no competing interests.
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