Somatic Symptom Disorder

My Mystery Pain: Somatic Symptom Disorder

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Have you ever had a physical ailment, such as pain or fatigue, that seemed to really upset you? Perhaps you struggled to think about anything else, aside from that symptom? Perhaps this emotional reaction even impaired your daily functioning at work or at home?  While physical symptoms can be distressing, when the reaction towards them is too intense or long-lasting, that reaction could be cause for concern. It may be that you are suffering from somatic symptom disorder, a mental health condition that requires psychological treatment to ease the mental health symptoms and improve your functioning.

Somatic Symptom Disorder (Formerly Somatoform Disorder): What Does It Mean?

Individuals who have somatic symptom disorder, or what is formerly known as somatoform disorder, will experience excessive focus on physical symptoms, emotional distress about those physical symptoms, and some impairment in their daily functioning. There may or may not be any actual diagnosable medical condition that is causing those physical symptoms.

Somatic Definition

The term somatic refers to anything relating to the body. Psychologists define the somatoform disorders as those involving physical symptoms that are not entirely consistent with any diagnosed medical condition or actual physical ailment exhibited by the person. There are several related mental health conditions, and somatic symptom disorder is characterized by a focus on physical symptoms and a distressed response to those physical symptoms

Stats: How Many Suffer from This Disorder?

Due to the similarity between somatic symptom disorder and related conditions, along with the changes in diagnostic criteria, statistics on the prevalence of this disorder can be difficult to identify. Research has indicated prevalence rates as low as 0.1% and as high as 21.9%. Generally, this condition is not considered very common and it is not seen very often in mental health treatments settings. When it occurs, it usually onsets before age 30. Research suggests it occurs more often in women than in men.

What Causes Somatic Symptom Disorder?

There is no one known cause for somatic symptom disorder. Several factors may work together to play a role in causing this disorder. Biology, especially one’s genetics may play a role. It is thought that this is due to inheriting an increase in one’s sensitivity to pain. Family may play a role even outside of biological inheritance. The attention and modeling that someone receives from their parents about how to react to pain may be a factor in later developing somatic symptom disorder. For some people, a difficulty in dealing with and processing their emotions may be the cause. Instead, they may channel mental and emotional distress into the physical symptoms and feel more comfortable discussing those symptoms.

Signs and Symptoms of SSD

As noted, individuals with somatic symptom disorder have an excessive focus on physical symptoms. The symptoms and their focus on the symptoms cause emotional distress. Ultimately, the person will usually have decreased functioning in their daily life, because their mind is consumed by distress.

What are the Common Behaviors/Characteristics?

An individual with somatic symptom disorder will be frequently focused on their physical symptoms. When they experience a symptom, they are likely to think of the worst-case scenarios for what that symptom may mean. They are likely to seek medical care to find some explanation. As they spend time thinking about and attending to their health concerns (which in some cases may not even be real) it will affect their relationships with others, ability to function at home, and performance at work. The whole scenario is likely to cause a great deal of distress for the person, which may need to be addressed through therapy.

Testing: What are the Diagnostic Criteria Per the DSM-5

To diagnose somatic symptom disorder, you need a complete physical examination and appropriate diagnostic tests to identify any medical conditions and ultimately, to rule out a physical cause for the symptoms. Assuming there is no medical cause, or any existing medical conditions do not account for the emotional reaction, then a psychological evaluation will be required to diagnose somatic symptom disorder. To do this, mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents these criteria to define somatic symptom disorder:

  • One or more somatic symptoms that cause distress and disrupt daily life.
  • Excessive thoughts, feelings, and/or behaviors related to the somatic symptoms. Shown through:
    • Disproportionate and persistent thoughts about one’s symptoms.
    • A persistently high level of anxiety about health and physical symptoms.
    • Devotion of excessive time and energy to health-related symptoms and concerns.
  • Symptoms may vary but must be persistent for at least six months.

If a patient meets the necessary criteria, then the diagnosis of somatic symptom disorder may be assigned. Mental health professionals can also indicate whether a person has a specific type of somatic symptom disorder. Some individuals may present with predominant pain where the somatic symptoms primarily involve pain. Other individuals may present with a persistent course of the disorder, in which the symptoms are more severe, markedly impair functioning, and have an excessively long duration. Beyond this, the disorder can be designated as being mild, moderate, or severe.

Somatic Symptom Disorder and Other Conditions

When making diagnoses, mental health professionals seek to rule out other similar conditions. In the case of somatic symptom disorder, similar conditions might include the following:

Somatic Symptom Disorder vs Hypochondria

Hypochondriasis is an outdated term and today this condition is referred to as illness anxiety disorder. The major distinction between illness anxiety disorder and somatic symptom disorder is that in the former, people’s distress is a response to the anxiety they feel, while in the latter, the distress is in response to the perceived physical concern. The two disorders may look similar to the untrained eye. However, a psychologist can differentiate them for proper diagnosis.

Somatic Symptom Disorder vs Somatization or Somatoform Disorder

Somatic Symptom Disorder may be confused with Somatization and Somatoform Disorder; however, the latter two are outdated terms. With the publishing of the DSM-5, this classification of disorders was re-organized and, in some cases, re-named. These changes were intended to clarify diagnostic criteria and to reduce stigma associated with those outdated terms.

Related Conditions

Other disorders in the Somatic Symptom and Related Disorders category of the DSM-5 may appear similar to somatic symptom disorder. One of these is conversion disorder, which is diagnosed when someone has symptoms of altered motor or sensory function with no clear medical cause. Another is factitious disorder, in which a person falsely presents symptoms in themselves or causes symptoms in another person, usually to gain attention or money.

Somatic Symptom Disorder in Adults/Children

Both adults and children can experience symptoms of somatic symptom disorder, and the disorder usually emerges before age 30. Symptoms may vary with age and other life factors.

Example Case of Somatic Symptom Disorder

Consider this Somatic Symptom Disorder example to see if it reminds you of yourself or a loved one:

Like anyone, Julie experiences various physical symptoms from time to time. When she has a prolonged symptom or illness, she becomes very upset. She tends to think about it endlessly, considering all the worst-case scenarios for what could happen if she does not recover quickly. Sometimes she is so lost in her emotional state that she neglects her home and work duties.

Somatic Symptom Disorder

How to Deal/Coping with Somatic Symptom Disorder

Individuals with somatic symptom will often first visit medical providers because they are concerned about physical symptoms. Once it is determined that there is no medical cause for the symptoms, they may be recommended to visit a mental health provider. Along with receiving mental health therapy, there are steps any individual can take to manage and reduce your psychological/emotional symptoms.

Look Out for These Complications/Risk Factors

Due to the complex causal factors for somatic symptom disorder, it may not be possible to entirely prevent the disorder. Once it is present, certain factors can also prolong and exacerbate it. Actual poor health, including physical disability, may contribute to the disorder. Unsatisfactory relationships or problems at work and home may make the symptoms worse. Having another mental health condition can also increase risk and complicate the disorder.

Somatic Symptom Disorder Treatment

If you choose to visit a therapist or counselor for treatment of your somatic symptom disorder, there are different approaches they may choose to use. Typical treatment options include medications and therapy. You can also learn self-care approaches to help manage the disorder outside of therapy. Many mental health providers will use a Cognitive-Behavior Therapy approach, which is shown to be effective.

Possible Medications for Somatic Symptom Disorder

If your provider recommends medication, a psychiatrist or medical doctor would likely prescribe an anti-depressant. This class of medication, known as a Selective Serotonin Reuptake Inhibitors (SSRIs), is also frequently used to treat other mental health conditions aside from depression.

Home Remedies to Help Somatic Symptom Disorder

Outside of therapy and medication, you should also use home remedies to manage your somatic symptom disorder. A key approach would be stress management and relaxation techniques, which will help to settle your mind and help you to achieve a state of calm. Getting physically active and involved with activities can also be helpful to your mental health, as these improve physical functioning and will distract your mind. Avoid the use of substances, such as drugs and alcohol, that might make you more vulnerable to overwhelming emotions.

Living with Somatic Symptom Disorder

Having somatic symptom disorder can bring unique life challenges. However, by seeking professional help from a mental health provider and then integrating self-care approaches into your daily life, you can manage the condition to live a full life.

Insurance Coverage for Somatic Symptom Disorder

Mental health and medical providers consider somatic symptom disorder to be a diagnosable mental health condition. If you suspect you have this condition and receive a formal diagnosis, it is likely that your health insurance will cover your counseling or therapy. You can call your insurance company to ask about this. Your provider’s office may also be able to assist with that.

How to Find a Therapist

With today’s online resources, it can be relatively easy to find the right mental health provider for you. Start by searching online for therapists in your area. You can research the potential providers online and even read reviews to ensure your prospective therapist is the right fit.

What Should I be Looking for in an LMHP?

When seeking out a mental health provider such as a counselor, therapist, or psychologist, you want to make sure that they are trained and licensed in their respective field. Ideally, you will also want to work with someone who has experience addressing somatic symptom disorder.

Questions to ask a Potential Therapist

When meeting with a potential therapist, you should ask about their training and previous experiences working with therapy clients. It can be helpful to ask specifically about their expertise in treating somatic symptom disorder. You may also want to ask about their approach to therapy. Finally, it can be helpful to ask how long your sessions may last and how this potential therapist intends to measure your progress through the course of therapy.

Somatic Symptom Disorder Resources and Support Helpline

There are resources online that may be helpful to anyone dealing with somatic symptom disorder:

  • Psychology Today is a searchable website to locate mental health providers.
  • SAMSHA also has a provider locator where you can find low-cost treatment options.
  • The Anxiety and Depression Association of America (ADAA) has information on the anxiety disorders, depression, and many related conditions.

If you want immediate support or have questions about your mental health, you can consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If your symptoms are causing or include suicidal thoughts, you can use the Suicide Prevention Lifeline.

Although the condition of Somatic Symptom Disorder can be distressing, it is helpful to remind yourself that this is a genuine condition. Knowing that it is real and that others struggle with the same symptoms can help you feel less alone. Seeking resources and treatment can help you feel better.

About the Author Depression Alliance Staff

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