Somatic Symptom Disorder
What Is It?
A person with somatic symptom disorder has one or more "somatic" (physical) symptoms over a long period of time (usually half a year or more). Symptoms may or may not be explained fully by another medical diagnosis.
The person may be reacting to normal bodily sensations or a minor illness. He or she may have a strong tendency to worry about illness or feel more threatened than average by health concerns. But the person is not "faking." The symptoms cause authentic distress.
The person may:
Seek care from more than one physician at the same time.
Not feel reassured by the evaluation or treatment received.
Be unresponsive to medical treatment.
Be particularly sensitive to adverse effects of treatment.
People with somatic symptom disorder do get other serious medical illnesses. Therefore, doctors must be careful not to dismiss symptoms too easily.
A person with somatic symptom disorder also may have symptoms of anxiety and depression. He or she may begin to feel hopeless and attempt suicide, or may have trouble adapting to the stresses of life. The person may abuse alcohol or drugs, including prescription medications.
Spouses and other family members may become distressed because the person's symptoms continue for long periods of time and no medical treatment seems to help.
Symptoms of somatic symptom disorder vary by culture, sometimes depending on how illness or "sick roles" are viewed in a given culture. Cultural factors also affect the proportions of men and women with the disorder.
Scientists do not know the cause of the symptoms reported by people with somatic symptom disorder, but researchers have some theories. It is possible, for example, that people with this disorder perceive bodily sensations in an unusual way. Or they may describe feelings in physical (rather than mental or emotional) terms. Trauma or stress may cause a person's physical sensations to change.
In 2013, this diagnosis replaced other disorders that are no longer listed in the diagnostic manual for psychiatry. In other words, somatic symptom disorder replaces the following diagnoses:
- Somatization disorder
- Undifferentiated somatoform disorder
- Hypochondriasis
Symptoms
Symptoms usually occur over many years. The person may be distressed and function poorly at work and at home. Medical evaluation does not explain the symptoms, or the symptoms may exceed what would be expected in any medical illness that is found. Pain is the most common symptom. Symptoms can appear in almost any part of the body.
Diagnosis
There are no laboratory tests to determine whether a person has somatic symptom disorder. The doctor may suspect it when a person has persistent physical complaints that do not respond to usual medical evaluation and treatment. The doctor may do tests to check for diseases that can look like somatic symptom disorder, such as multiple sclerosis and systemic lupus erythematosus (lupus), or syndromes such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome.
Many people with somatic symptom disorder also have a problem with depression or anxiety, so doctors may consider these diagnoses. If the person is willing, it is helpful to consult with a mental health professional for further evaluation.
Expected Duration
Somatic symptom disorder is a chronic (long-lasting) problem. The disorder usually starts before the age of 25 or 30, although it can begin in adolescence. It can last for many years.
Prevention
Although there is no way to prevent this disorder, a correct diagnosis of somatic symptom disorder can help the person avoid excessive medical testing. This is a challenge both for the person with the disorder and the doctor, because new symptoms could be caused by a medical problem other than somatic symptom disorder.
Treatment
People with somatic symptom disorder may find it difficult to accept a referral to a mental health professional or to accept that medical evaluation and treatment cannot relieve the symptoms. They are particularly sensitive to the stigma associated with mental disorders. In addition, they sometimes are dismissed by a subset of physicians who do not see their symptoms as a legitimate cause for concern.
Ideally, if a primary care physician and mental health professional work together, the person's physical symptoms can be evaluated while he or she also gets help managing the frustration of not having a clear diagnosis or treatment plan.
But mental health treatment can sometimes reduce symptoms or improve quality of life.
Cognitive behavioral therapy (CBT) may help reduce symptoms or address any accompanying anxiety or depression. Sometimes, an antidepressant medication or other psychiatric medication can provide relief from the physical symptoms that stem from somatic symptom disorder (especially if the person also has an anxiety or mood disorder). Treatment is often aimed at managing conflict at home or coping with secondary problems, such as problems with work and social functioning.
Psychotherapy can help the person deal with or manage chronic physical discomfort. Stress management (for example, relaxation techniques) may be useful. Some cognitive behavior therapists teach patients to identify the thoughts and feelings that are associated with changes in physical symptoms. They may help an individual reduce the tendency toward "body scanning," or the constant monitoring of body sensations.
When To Call A Professional
The earlier a person with somatic symptom disorder can be evaluated by a mental health professional, the easier it will be to help the person deal with the consequences of the disorder, such as exposure to unnecessary tests and treatment, or difficulty with relationships and poor productivity at work. However, a person with this disorder may avoid treatment by a mental health professional.
Prognosis
Medications may provide some relief. Psychotherapy tends to proceed slowly, because the person probably has been living with the disorder for many years before starting treatment. It is difficult to give up long-standing patterns of behavior, but with persistence and support, progress is possible.
Additional Info
American Psychiatric Association
www.psychiatry.org
American Psychological Association
www.apa.org
Mental Health America
www.nmha.org
National Institute of Mental Health
www.nimh.nih.gov
About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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