Overview
Somatic symptom disorder is a condition characterized by an intense focus on physical symptoms, such as pain or fatigue, that leads to significant emotional distress and difficulties in functioning. The symptoms may or may not be related to an underlying medical condition, but the individual's reaction to them is excessive and not typical. The excessive thoughts, feelings, and behaviors related to the symptoms cause significant problems, impair daily functioning, and can sometimes result in disability. These thoughts, feelings, and behaviors can include excessive worry about potential illness, viewing normal physical sensations as signs of severe illness, and fearing that symptoms are serious even when there is no evidence. Somatic symptom disorder can be associated with anxiety, depression, stressful life events, and a history of trauma. Treatment can help alleviate symptoms, improve coping, and enhance quality of life.
Understanding the disease
Symptoms
The symptoms of somatic symptom disorder may include specific sensations such as pain or shortness of breath, general symptoms like fatigue or weakness, and excessive thoughts, feelings, or behaviors related to those symptoms. These thoughts, feelings, and behaviors can involve constant worry about potential illness, viewing normal physical sensations as severe illness, fearing that symptoms are serious, and thinking that physical sensations are threatening or harmful. Other symptoms may include fearing that medical evaluation and treatment have not been adequate, fearing that physical activity may cause damage to the body, repeatedly checking the body for abnormalities, frequent health care visits that don't relieve concerns or make them worse, being unresponsive to medical treatment or unusually sensitive to medication side effects, and having a more severe impairment than expected from a medical condition.
Risk Factors
The risk factors for developing somatic symptom disorder include:
- Having anxiety or depression
- Having a medical condition or recovering from one
- Being at risk of developing a medical condition, such as having a strong family history of a disease
- Experiencing stressful life events, trauma or violence
- Having experienced past trauma, such as childhood sexual abuse
- Having a lower level of education and socio-economic status These factors may increase the likelihood of developing somatic symptom disorder. However, it's important to note that not everyone with these risk factors will develop the condition, and some without these risk factors may still develop it.
Development
Somatic symptom disorder develops when an individual has an extreme focus on physical symptoms, such as pain or fatigue, which causes significant emotional distress and problems in functioning. The disorder can be characterized by excessive thoughts, feelings, or behaviors related to these symptoms, which can lead to significant problems in daily life and can sometimes result in disability. Risk factors for somatic symptom disorder include having anxiety or depression, having a medical condition or recovering from one, experiencing stressful life events, trauma, or violence, and having a lower level of education and socio-economic status. Complications of somatic symptom disorder can include poor health, problems functioning in daily life, issues with relationships, problems at work or unemployment, and other mental health disorders such as anxiety, depression, and personality disorders.
Assessment and Diagnosis
Triage
You should see a doctor if you experience physical symptoms that are causing significant emotional distress and interfering with your daily functioning. If your primary care provider suspects that you may have somatic symptom disorder, they may refer you to a mental health professional for further evaluation and treatment. It's important to seek medical attention if you have concerns about your physical symptoms, especially if they are unrelated to any identified medical condition or are more severe than what would typically be expected for the condition.
Diagnosis
To diagnose somatic symptom disorder, your doctor or healthcare provider will likely conduct a physical exam and any necessary tests to determine if there are any underlying health conditions that need treatment. They may also refer you to a mental health professional who will conduct a psychological evaluation, have you fill out a self-assessment or questionnaire, and discuss your symptoms, stress levels, and family history. The diagnosis is based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which includes having one or more distressing somatic symptoms, excessive and persistent thoughts about the seriousness of those symptoms, and continued symptoms for more than six months despite variations. Treatment usually involves psychotherapy, such as cognitive behavioral therapy (CBT), to address the psychological distress and high level of health anxiety associated with somatic symptom disorder.
Management and Treatment
Complications
The potential complications of somatic symptom disorder include poor health, problems functioning in daily life, including physical disability, problems with relationships, problems at work or unemployment, increased suicide risk related to depression, and financial problems due to excessive healthcare visits.
Treatment
Treatment for somatic symptom disorder typically involves a combination of psychotherapy, medication, and education. Here are some of the common treatments:
- Cognitive-behavioral therapy (CBT): CBT is a form of talk therapy that helps individuals identify and change negative thought patterns and beliefs about their physical symptoms. It focuses on helping patients understand the connection between thoughts, emotions, and behaviors, and how these factors influence their perception of physical symptoms.
- Psychotherapy: Other forms of therapy, such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), can also be beneficial for individuals with somatic symptom disorder. These approaches help patients learn coping strategies to manage their thoughts and emotions related to their physical symptoms.
- Medications: Antidepressant and anti-anxiety medications may be prescribed to help manage the emotional distress associated with somatic symptom disorder. These medications can help alleviate symptoms like anxiety, depression, and obsessive-compulsive disorder (OCD) that are often comorbid with somatic symptom disorder.
- Education: Educating the patient about somatic symptom disorder, its causes, and the nature of the symptoms can help reduce anxiety and improve understanding. Providing information on the connection between thoughts, emotions, and physical sensations can help patients develop a more balanced perspective on their health concerns. It's important to note that treatment plans are individualized based on the patient's specific needs and preferences. A healthcare professional, such as a mental health provider, can help determine the most appropriate course of treatment for someone with somatic symptom disorder.
Preparing for medical consultation
To prepare for an appointment for somatic symptom disorder, you should make a list of your symptoms, including when they first occurred and how they impact your daily life. Additionally, gather key personal information, such as any traumatic events or major stressors in your life, as well as any medical information, including other physical or mental health conditions you have. Make a list of medications, vitamins, herbs, or other supplements you're taking, and the doses. Prepare a list of questions to ask your healthcare provider or mental health professional, such as what they think is causing your symptoms, what treatments they recommend, and any possible side effects of medications. It's also helpful to bring a family member or friend for support.