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Somatic Symptom and Related Disorders

What are Somatic Symptom and Related Disorders?

Somatic symptom disorder (SSD) is a mental health condition in which a person experiences significant distress related to real or perceived physical symptoms. A person with SSD develops abnormal thoughts, perceptions, and feelings about the physical symptoms, which causes significant distress and impairment in daily functioning. It can develop at any age, including in childhood, but it usually develops by age 30.

People with SSD often spend significant amounts of time in doctors’ offices trying to find answers and treat the physical symptoms. The symptoms and pain are real, but there is usually no medical condition or reason for it. On some occasions, there is a medical reason for the physical symptoms, but the person’s reactions and responses to the symptoms are disproportionate to the medical condition. 

Signs and Symptoms

The physical symptoms in SSD may be mild to severe, and a person may have one or multiple physical symptoms. The physical symptoms may be due to a medical condition or have no definitive cause. The somatic symptoms are distressing and result in significant disruptions in daily life.

  • Typically, the most debilitating symptoms are the thoughts, beliefs, perceptions, feelings, and behaviors in response to the physical symptoms.
  • Physical symptoms (pain, fatigue, weakness, or shortness of breath)
  • Exaggerated or disproportionate and persistent thoughts about the seriousness of one’s symptoms
  • High level of anxiety regarding physical or health symptoms
  • Excessive amounts of time and energy given to these symptoms and health concerns
  • The state of being symptomatic is usually more than 6 months 
  • Worry that symptoms are more serious than they really are
  • Perceives that their healthcare workers do not believe them or take them seriously
  • Seeks treatment (including testing, imaging, screenings, procedures, or surgeries) from multiple healthcare providers
  • Typically, do not believe the results, diagnosis, or prognosis that healthcare workers give
  • Often, are unusually sensitive to drug side effects
  • Grow increasingly dependent on others for help and emotional support, often becoming angry when their needs are not met
  • Difficulty functioning in their daily life, as the thoughts, feelings, and behaviors due to experienced physical symptoms are all-consuming
  • Anxiety or depression

Causes

There is no singular cause for SSD. Research has shown several factors that may contribute to the development of SSD. The factors include:

  • Psychological. A lack of emotional awareness or emotional development in childhood can contribute to the development of SSD. Additionally, parental neglect or lack of emotional closeness may also be a contributing factor. Hyper-fixation on bodily processes or possible signs of illness can also be contributing factors. Having a serious illness in childhood may also increase your risk of developing SSD.
  • Environmental. Childhood sexual, physical, or psychological abuse can contribute to the development of SSD. Learned behavior, such as receiving second-hand gains for having symptoms of SSD (being given attention, being taken care of, emotional support, etc.) may also increase the risk of developing SSD. 
  • Biological. Differences in brain chemistry or a sensitivity to pain may contribute to the development of SSD.

Risk Factors

There are several risk factors with SSD. Risk factors include:Having anxiety or depression

  • Hyper-fixation on bodily sensations
  • Family history of medical conditions or illness (being at a greater risk for a developing a medical condition)
  • Having an actual medical condition or recovering from one (having a severe illness in childhood)
  • Trauma history or ongoing traumatic experiences
  • Acute or chronic stress
  • Substance abuse
  • Having a lower socio-economic status or lower education level

Complications

If left untreated, SSD can be debilitating, making functioning in your daily life extremely challenging. There are several complications that can develop from having SSD.

  • Anxiety and depression
  • Difficulties maintaining close relationships with friends or family
  • Financial problems due to all the medical costs
  • Difficulties maintaining a job
  • Difficulties with school or academic requirements
  • Increased risk for suicidal ideations 
  • Poor health

Diagnosis

Your healthcare provider will want to perform a physical exam, take a thorough medical history, and may want to order labs, tests, or screenings to rule out any medical conditions. If all medical conditions are ruled out, your doctor may refer you to a mental health professional, depending on your presenting symptoms.

A mental health provider will conduct a thorough intake session, gathering information regarding presenting issues, symptoms, social engagement, family relationships, substance use, medical history, and mental health history. Additionally, your mental health provider may have you fill out some assessments and may recommend further testing. It usually takes 1-3 (or more) sessions to make an appropriate diagnosis. Mental health professionals use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition to determine if a patient meets criteria for diagnosis. 

Treatment

There are several forms of treatment that can be helpful in reducing symptoms of SSD. The most common forms of treatment are psychotherapy and medication. Some simple lifestyle changes, such as being more active, increasing social engagement, limiting alcohol consumption, and avoiding recreational drugs can also help reduce symptoms. Specific treatments include:

  • Psychotherapy. Cognitive behavioral therapy is the most common therapy used to treat SSD. Mental health professionals work to help clients identify distorted thoughts, beliefs, feelings, and behaviors and change them to more adaptive ones. 
  • Medications. Medications are sometimes prescribed to help with associated depression symptoms or pain management.