Somatic symptom disorder

The symptoms that occur in SSD are genuine and not controllable. These symptoms may be related to another medical condition, but are much more marked than would be expected of that condition. For example, a person may experience severe symptoms following a mild heart attack, even though there was not enough damage to the heart to warrant those symptoms.

The prevalence of SSD is not known. However, estimates in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) suggest around 5-7% of adults may be affected. Women are more likely to experience somatic symptoms and the disorder usually begins before 30 years of age.

Causes

The cause of SSD is not well understood. It may be that people with SSD experience pain or symptoms in a heightened way. Worry and concern about the symptoms may make this worse.

Signs and symptoms

A wide range of symptoms can be associated with SSD. Some of the more common ones can include:

• Heart-related symptoms, such as chest pain, palpitations and shortness of breath;
• Digestive system symptoms, including nausea and vomiting, diarrhoea and abdominal pain;
• Muscle and joint pain;
• Nervous system symptoms, such as headaches, problems with vision, problems with memory, muscle weakness or paralysis, and;
• Reproductive system and genital symptoms including problems with menstruation, pain with urination and erectile dysfunction.

Methods for diagnosis

Your doctor may ask you questions about your symptoms and your medical history. A physical examination is important to determine if other medical conditions may be contributing to your symptoms.

Criteria for diagnosis

The Diagnostic and Statistical Manual of Mental Disorders outlines a list of criteria for the diagnosis of SSD:

• Symptoms must be distressing and cause significant disruption to daily life, for example, work or personal relationships;
• A person with somatic symptom disorder will tend to think about their symptoms or health a lot and be highly anxious about them. They may spend a great deal of time and energy dealing with their symptoms or health and frequently visit the doctor or other healthcare professionals, and;
• Though the symptoms may change, a person with somatic symptom disorder will tend to persistently have symptoms of one type or another.

Types of treatment

Regular reviews

Regular review appointments with a healthcare professional that you know and trust are an important part of managing SSD. When your doctor knows your medical history well, they are better able to assess your symptoms and help you to keep them under control. This can reduce the number of unnecessary visits to the emergency department, and the number of unnecessary tests and procedures that can lead to discomfort and complications.

Treatment of other medical conditions

Appropriate treatment of any co-existing medical conditions is an important part of staying as healthy as possible.

Strategies to cope with persistent symptoms

Where symptoms are not easily treatable, a range of lifestyle measures can help you to manage and minimise their impact on your daily life and wellbeing.

Strategies that can help include:

• Regular physical activity;
• Relaxation techniques such as meditation, yoga or other activities that you enjoy and help you to relax, and;
• Reducing stress.

Mental health assessment and treatment

SSD often occurs alongside mental health issues such as depression and anxiety.

Your doctor may recommend referral for assessment by a psychiatrist, or psychological therapies such as cognitive behaviour therapy. Psychological therapy is sometimes referred to as 'talking therapy' and describes the process of treating a mental illness by helping people to understand their condition and manage their symptoms.

 

Antidepressant medications

Tricyclic antidepressant medications such as amitriptyline or selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine may be helpful in reducing symptoms and treating depression and anxiety.

Potential complications

Tests and procedures

Because the causes of symptoms in SSD are not easily identified, people with SSD may go through a large number of tests and medical procedures. While it is important that symptoms are appropriately investigated, tests and medical procedures often carry risks of side effects and complications. For this reason, it is safest that tests and medical procedures only be carried out when necessary.

Severe depression or distress

Dealing with symptoms over a long period of time can be challenging. If you are in distress or have thoughts of self-harm, it is important to seek help. Your doctor or mental healthcare professional can provide assistance. Helplines are also available to provide support (see below).

Prognosis

SSD can often be a long-term condition. Treatment can help to manage symptoms and maximise your quality of life.

Prevention

The good management of symptoms in SSD can help to improve your quality of life.

Support services

If you or someone you know needs help, please call or visit:

Lifeline. Website: http://www.lifeline.org.au/ Tel: 13 11 14.

Beyond Blue. Website: http://www.beyondblue.org.au/ Tel: 1300 22 4636.