What is Somatic Symptom Disorder?
Somatic symptom disorder (SSD), as defined in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, is a condition where a person experiences one or more physical symptoms. These symptoms can cause significant stress or difficulty in daily life due to the excessive worry, emotion, or behavior related to these symptoms. It’s important to note that these symptoms might not always be linked to a medical condition.
The diagnosis criteria for SSD was recently updated. Previously, there had to be no medical explanation for the physical symptoms. However, this is no longer required. Now, the diagnosis depends on specific psychological and behavioral traits being present. The updated guidelines also removed certain disorders – such as somatization disorder, hypochondriasis, and pain disorder – from the previous definitions, making SSD more relevant and easier to identify in primary care settings.
What Causes Somatic Symptom Disorder?
Somatic symptom disorder, or SSD, is a condition where a person is extremely aware of their body sensations and often interprets these sensations as signs of a medical illness. Although the exact cause of SSD is not well-understood, researchers believe that things like neglect or sexual abuse during childhood, a disorganized lifestyle, and a past of alcohol or drug misuses may increase the risk of developing this condition.
Moreover, those who have serious issues with somatization, which means experiencing and being worried about physical symptoms related to stress, have been found to often have certain personality disorders. These may include avoidant personality disorder (fear of rejection and criticism), paranoid personality disorder (feeling distrust and suspicion of others), self-defeating personality disorder (displaying self-destructive behaviors), and obsessive-compulsive disorder (having uncontrollable thoughts or behaviors).
Factors such as unemployment or difficulty in performing job tasks have also been linked to this disorder. Therefore, it’s important to have a healthy mindset and lifestyle to prevent or manage this condition.
Risk Factors and Frequency for Somatic Symptom Disorder
Somatic symptom disorder, also known as SSD, occurs in about 5% to 7% of all people. It’s more common in females, happening about ten times as often as in males. SSD can show up at any stage in life, such as during childhood, the teenage years, or adulthood. This disorder is even more widespread in certain types of patients. For example, people with functional disorders like constant fatigue, fibromyalgia, or an irritable bowel syndrome, are more likely to have SSD. In fact, the disorder affects approximately 17% of those seeking primary health care.
Signs and Symptoms of Somatic Symptom Disorder
Somatic Syndrome Disorders (SSDs), according to the American Psychiatric Association’s 2013 DSM-5, are diagnosed when three specific conditions are met:
- Physical symptoms are present that cause significant distress or disruption in daily life.
- There are one or more persistent, excessive thoughts, feelings, or behaviors related to the physical symptoms. These can lead to high anxiety and an overinvestment of time and energy.
- The symptoms have lasted for more than 6 months.
SSDs may be recognizable by a unclear and often changing summary of the current illness, symptoms that don’t improve with medical treatment, the patient’s tendency to interpret normal sensations as signs of illness, avoidance of physical activity, strong reactions to medication side effects, and seeking medical care from different providers for the same issues.
In addition to taking a detailed patient history and reviewing all health systems (not just those related to the major symptom), a complete physical examination is necessary to investigate physical causes of the complaints. Because people with SSDs often have concurrent mental health conditions, a mental status exam should be conducted, observing aspects like appearance, mood, attention, memory, concentration, orientation, and signs of hallucinations, delusions, or harmful thoughts. The physical examination can be used as a reference for future check-ups, reassure patients that their complaints are taken seriously, and confirm for the healthcare provider that the patient doesn’t have a physical illness. If a physical illness is identified, the exam might provide information about how severe it is.
Testing for Somatic Symptom Disorder
For a condition known as somatic syndrome disorder (SSD), doctors often don’t recommend multiple lab tests. This is because patients with SSD usually have undergone detailed examinations before. Too many tests might lead to results that indicate a problem that isn’t actually there, known as false positives. This could lead to unnecessary extra procedures, increased risks, and more expenses.
Some doctors might think that doing these tests will help patients feel assured. However, research shows that additional diagnostic tests don’t necessarily help to reduce the symptoms of SSD. In fact, one study showed that there was an equal decrease in symptoms and health concern in groups of patients that had undergone tests and those that didn’t. There was only a small reduction in the number of follow-up doctor visits in the group that had additional testing.
However, in certain cases where a doctor wants to confirm that the symptoms aren’t due to another medical condition, a few specific tests might be needed. These can include thyroid function tests, drug tests, blood tests for alcohol levels, and some forms of imaging tests, but these would be kept to a minimum.
Treatment Options for Somatic Symptom Disorder
The main goal is to help the patient manage their physical symptoms, which can often be aggravated by health-related worries and unhealthy behaviors. The aim is not to completely get rid of the symptoms, but to help the patient manage them effectively. Doctors should be sensitive when explaining to patients that their physical health may be influenced by their mental health, as this can sometimes be a difficult concept to accept.
Regular check-ups with their primary care doctor can reassure patients that their symptoms are not indications of a serious or debilitating illness. It’s generally not recommended to perform invasive procedures or surgeries just to investigate these symptoms. It’s also not advisable to prescribe sedative medicines, including anxiety-relieving drugs and strong painkillers.
Working with mental health professionals early on can be very beneficial. Studies have shown that cognitive-behavioral therapy, a type of therapy that helps you understand and change thought patterns that lead to harmful behaviors, can significantly improve a patient’s ability to function and can decrease physical symptoms. This approach can also reduce healthcare costs and lessen symptoms of depression.
While medication should not be the first line of treatment, antidepressants can sometimes be used to treat other mental health conditions that can occur in conjunction with these physical symptoms, such as anxiety, depression, and obsessive-compulsive disorder. Some types of medication known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to improve patient’s outcomes compared to placebo treatment. However, when medication is necessary, it’s usually best to start at the lowest dose and gradually increase, because people with these physical symptoms may more readily perceive side effects, which may cause additional worry or concern.
What else can Somatic Symptom Disorder be?
Diagnosing the somatic syndrome disorder (SSD) can be challenging, as its vague and widespread symptoms can resemble those of many other medical conditions. It’s a tricky disorder to pin down and treat. SSD can often be confused with adjustment disorder, body dysmorphic disorder, obsessive-compulsive disorder, and illness anxiety disorder, all of which can have extreme emotional and behavioral reactions.
However, some conditions, like fibromyalgia, and irritable bowel syndrome, despite being difficult to explain in terms of their cause, usually don’t involve such strong thoughts, feelings, or detrimental behaviors.
What to expect with Somatic Symptom Disorder
Research over time has shown that somatic syndrome disorder (SSD), a condition where a person has physical symptoms that can’t be explained by any underlying medical condition, tends to be quite persistent. In fact, up to 90% of cases continue for more than 5 years. Reviews and studies also indicate that current treatments typically have only a mild-to-moderate effect on the condition.
In many cases, SSD leads to long-lasting limitations on general functioning and notable psychological issues. As such, those suffering from SSD often experience a lower quality of life.
Possible Complications When Diagnosed with Somatic Symptom Disorder
Alcohol and drug misuse are commonly seen. Sometimes, individuals resort to these substances to achieve relief from their symptoms, which can potentially lead to an addiction. If the doctor opts for invasive examinations or surgery, there could be complications resulting from medical intervention.
Potential Risks:
- Alcohol and drug misuse
- Potential substance addiction
- Complications arising from medical examinations or surgeries
Preventing Somatic Symptom Disorder
Healthcare providers should be understanding of your physical discomforts by acknowledging your symptoms and suffering. They should schedule regular check-ups to monitor your condition. It’s important to talk about any physical symptoms you’re experiencing with your main healthcare provider. They have the knowledge and skills to decide if you need an extra evaluation by a specialist.
Treating mental health conditions promptly and addressing stress in your life can help manage these physical symptoms. It might also be necessary for your family members to be educated about your condition. Spending quality time with you, especially when you’re not showing any symptoms, is important. This can help prevent any misconceptions that your symptoms are a way of seeking special attention.