Somatic Symptom Disorder

What is somatic symptom disorder?

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 are real and 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.

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 may 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 normal 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 of somatic symptom disorder

Symptoms usually persist 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. Other symptoms may include

numbness
weakness
fatigue
gastrointestinal distress (such as nausea or abdominal pain).

Symptoms can involve almost any part of the body.

Diagnosing somatic symptom disorder

There are no laboratory tests to determine whether a person has somatic symptom disorder.

The doctor may suspect somatic symptom disorder when a person has persistent physical complaints that do not respond to usual medical evaluation and treatment. The doctor may also consider diseases that can look like somatic symptom disorder, such as multiple sclerosis and systemic lupus erythematosus (lupus), or syndromes such as fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and irritable bowel syndrome.

Many people with somatic symptom disorder also have depression or generalized anxiety disorder; evaluation by a mental health professional is often helpful.

People with somatic symptom disorder can, of course, develop other medical illnesses. Therefore, doctors must be careful not to attribute symptoms to somatic symptom disorder too readily.

Expected duration of somatic symptom disorder

Somatic symptom disorder is generally 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.

Preventing somatic symptom disorder

Although there is no way to prevent this disorder, a correct diagnosis of somatic symptom disorder can help the person avoid excessive medical testing and ineffective (or potentially harmful) treatment. This is a challenge both for the person with the disorder and the doctor, because new symptoms could be caused by another condition rather than somatic symptom disorder.

Treating somatic symptom disorder

People with somatic symptom disorder may find it difficult to accept a referral to a mental health professional or to accept that no additional medical evaluation is waranted. They may be particularly sensitive to the stigma associated with mental health disorders. In addition, they sometimes are dismissed by a subset of physicians who do not see their symptoms as real or a legitimate cause for concern.

Ideally, people with somatic symptom disorderwork with their primary care physician and a mental health professional to create a plan for evaluation and treatmentof their symptoms, and to help deal with the frustration of not having a clear medical diagnosis.

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 (such as fluoxetine, duloxetine, or nortrypinline) or another type of 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 frequent 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.

Prognosis

Medications and psychotherapy are often helpful for somatic symptom disorder, though it may take a significant amount of time to see results. It is often challenging for people with somatic symptom disorder to give up longstanding patterns of behavior, but with persistence and support, progress is possible.