Somatic Symptom Disorder – B Criteria Scale

The Somatic Symptom Disorder – B Criteria Scale (SSD-12) is a validated, self-reported clinical instrument designed to measure the psychological burden…

Questions: 12
Duration: 3 min
Original title: Somatic Symptom Disorder – B Criteria Scale
Adaptation: Somatic Symptom Disorder – B Criteria Scale
Authors: Toussaint, A., Murray, A. M., Voigt, K., Herzog, A., Gierk, B., Kroenke, K., Rief, W., Henningsen, P., & Löwe, B.
Created: 2016

The Somatic Symptom Disorder – B Criteria Scale (SSD-12) is a validated, self-reported clinical instrument designed to measure the psychological burden associated with physical symptoms. Developed to align with the DSM-5 criteria for Somatic Symptom Disorder, this tool specifically quantifies the cognitive, affective, and behavioral responses that complicate a patient's medical presentation. Rather than assessing the physical symptoms themselves, the scale provides a clear metric of how heavily those sensations weigh on the patient's daily life.

For clinicians, the SSD-12 is an essential asset when evaluating patients who present with high somatic distress or persistent health concerns, helping to explore the full anxiety experience. It offers a structured way to separate the physiological reality of the symptom from the patient's psychological reaction to it, which is often the primary driver of impairment. Because it is brief and highly sensitive, the SSD-12 functions as an excellent repeatable measure. It establishes a reliable baseline during intake and allows the clinician to track shifts in symptom preoccupation and emotional distress over the course of treatment.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

21/ 48

The SSD-12 is a 12-item self-report questionnaire assessing the intensity of excessive thoughts, feelings, and behaviors associated with somatic symptoms, in accordance with DSM-5 Criterion B for somatic symptom disorder. It explores three psychological dimensions (cognitive, affective, and behavioral) and aids in screening, assessing the severity of the psychological component, and monitoring disorder progression in clinical practice and research.

048

For information

Cut-off≥ 26Probable somatic distress

Optimal diagnostic cutoff for the SSD-12 alone for the diagnosis of somatic symptom disorder.

Toussaint et al. (2020)View the study ↗

Cut-off≥ 23High psychological burden

Selected cutoff when the SSD-12 is combined with a measure of somatic symptom burden (PHQ-15 or SSS-8 ≥ 9).

Toussaint et al. (2020)View the study ↗

Scoring

Total sum and subscale sums, total score from 0 to 48, each item is scored on a 5-point scale (from 0 to 4).

Affective aspects (health-related anxiety)

7/ 16

High and persistent anxiety regarding health or physical symptoms.

items 2, 5, 8, 11

016

Cognitive aspects (disproportionate thoughts)

8/ 16

Disproportionate and persistent thoughts about the seriousness of physical symptoms.

items 1, 4, 7, 10

016

Behavioral aspects (time/energy devoted to symptoms)

6/ 16

Excessive time and energy devoted to physical symptoms and health concerns.

items 3, 6, 9, 12

016

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What the test measures

The SSD-12 measures the psychological features—specifically the "B criteria" of the DSM-5—that characterize Somatic Symptom Disorder. It evaluates the psychological footprint of physical symptoms across three dimensions:

Cognitive aspects: The presence of disproportionate and persistent thoughts about the seriousness of physical symptoms, often manifesting as catastrophizing appraisals.
Affective aspects: The level of health-related anxiety, capturing the intense emotional distress triggered by a fear of body sensations.
Behavioral aspects: The extent to which symptom preoccupation consumes time and energy, leading to significant disruption in daily functioning.

This instrument is intended for use with adults who are experiencing distressing somatic symptoms, helping to distinguish adaptive concern from pathological health anxiety.

When and why to use it

Clinicians typically administer the SSD-12 when a patient exhibits a high degree of distress regarding their physical health, whether the symptoms are medically explained or not. It is a valuable tool for clarifying the clinical picture and guiding treatment planning.

Intake baseline: To quantify the initial severity of symptom preoccupation before introducing interventions that target the body's stress response.
Differential support: To help distinguish primary somatic symptom disorder from related conditions when recognizing hypochondriasis or generalized anxiety.
Screening and cut-offs: To efficiently identify patients whose distress crosses the threshold into a clinically significant psychological burden requiring targeted care.
Monitoring change: To track the reduction of maladaptive responses over time as patients learn to modify their automatic behaviors and checking rituals.

By moving beyond a simple verbal report, a validated SSD-12 score provides an objective measure of functional impairment that enriches the clinician's diagnostic impression.

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The questions

The following questions relate to your thoughts and feelings associated with your physical symptoms and how you deal with them in everyday life. Please read all statements carefully and select the answer that best applies to you.
1. I think my physical symptoms are signs of a serious illness.
This item evaluates the presence of catastrophic cognitive appraisals regarding the nature of the patient's bodily sensations.
- Never
- Rarely
- Sometimes
- Often
- Very often
2. I am very worried about my health.
This probes the generalized affective burden of health anxiety and the intensity of the patient's emotional distress regarding their physical state.
- Never
- Rarely
- Sometimes
- Often
- Very often
3. My health problems get in the way of my daily life.
This assesses the behavioral impact of health-related worries on the patient's daily functioning and role fulfillment.
- Never
- Rarely
- Sometimes
- Often
- Very often
4. I am convinced that my symptoms are serious.
This evaluates the rigidity of the patient's cognitive belief in the severity of their physical condition.
- Never
- Rarely
- Sometimes
- Often
- Very often
5. My symptoms scare me.
This measures the direct fear response and affective distress triggered by experiencing somatic sensations.
- Never
- Rarely
- Sometimes
- Often
- Very often
6. My physical problems take up almost my whole day.
This captures the behavioral and attentional resources consumed by focusing on somatic symptoms throughout the day.
- Never
- Rarely
- Sometimes
- Often
- Very often
7. Other people tell me that my physical problems are not serious.
This examines the cognitive dissonance between the patient's internal symptom appraisal and the external reassurance they receive.
- Never
- Rarely
- Sometimes
- Often
- Very often
8. I'm afraid my physical problems will never go away.
This probes the affective chronicity of the patient's fears, specifically their anxiety about the persistence of symptoms.
- Never
- Rarely
- Sometimes
- Often
- Very often
9. My worries about my health take up all my energy.
This assesses the behavioral and energetic toll that health-related preoccupation extracts from the patient.
- Never
- Rarely
- Sometimes
- Often
- Very often
10. I think that doctors don't take my physical problems seriously.
This evaluates the patient's cognitive appraisal of their medical encounters and feelings of invalidation by healthcare providers.
- Never
- Rarely
- Sometimes
- Often
- Very often
11. I'm afraid my physical symptoms will continue in the future.
This captures the anticipatory anxiety and affective burden regarding the future trajectory of their physical health.
- Never
- Rarely
- Sometimes
- Often
- Very often
12. Because of my physical problems, I have little concentration for other things.
This measures the behavioral interference of somatic preoccupations on the patient's cognitive focus and task execution.
- Never
- Rarely
- Sometimes
- Often
- Very often