Somatic symptom disorder
Fast facts
- Somatic symptom disorder (SSD) is when a person displays symptoms that cannot be explained by another medical condition.
- A person with SSD is not 'faking' their symptoms, and cannot control them; the symptoms are genuine.
- The cause of SSD is not well understood. Because of this, people with SSD may undergo a large number of tests and medical procedures before being diagnosed with SSD.
- Treatment for SSD can include regular reviews of your health condition, psychological therapies and coping strategies, and lifestyle changes.
What is somatic symptom disorder?
Somatic symptom disorder (SSD) is a condition in which a person experiences persistent and distressing physical symptoms that cannot be easily explained by another medical condition. People with SSD are generally very concerned and anxious about their health.
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 [1] . Women are more likely to experience somatic symptoms and the disorder usually begins before 30 years of age.
X
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5: 9780890425558: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. Accessed November 11, 2014.
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.
Risk factors
Factors that may increase the risk of somatic symptom disorder include:
- Having other family members with somatic symptom disorder or similar mental disorders;
- Childhood sexual abuse;
- Recent sexual or physical abuse or other stressful life events;
- Other mental health disorders such as anxiety, depression and panic disorder, and;
- Medical conditions such as chronic pain and irritable bowel syndrome.
X
Anxiety
A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.
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, diarrhea 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.
X
Menstruation
The periodic shedding of the lining of a woman's uterus. Typically occurring about every four weeks between puberty and menopause (except during pregnancy). The menstrual period varies between individuals, but typically lasts 3-5 days.
X
Nausea
A sensation of sickness and unease, typically felt in the stomach, often accompanied by the urge to vomit. Nausea is a common symptom with many possible causes.
X
Nervous system
The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.
X
Paralysis
An inability to move or feel; a loss of muscle function or sensation.
X
Abdominal
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
X
Reproductive system
The parts of the body involved in sexuality and fertility. In females it includes the vagina, womb (uterus) and ovaries, and in males it includes the penis and testicles.
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 minimize 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 behavior 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.
X
Anxiety
A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.
X
Cognitive behavior therapy
A psychological or 'talking' therapy that focuses on changing unhelpful thoughts and behaviors that are causing a person distress.
X
Psychiatrist
A medical doctor specializing in the diagnosis and treatment of mental disorders.
X
SSRIs
A type of antidepressant medication.
X
Stress
The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.
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 maximize 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:
National Suicide Prevention Lifeline Lifeline Call 1-800-273-8255 - The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
References
- Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5: 9780890425558: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. Accessed November 11, 2014.
- “Diagnostic and Statistical Manual of Mental Disorders 5th Edition: DSM-5: 9780890425558: Medicine & Health Science Books @ Amazon.com.” Accessed November 11 2014.
- “Somatic Symptom Disorder | Doctor | Patient.co.uk.” Accessed October 27 2014. link here
- “Somatization Disorder: MedlinePlus Medical Encyclopedia.” Accessed October 27 2014. link here
- “Somatization: Epidemiology Pathogenesis Clinical Features Medical Evaluation and Diagnosis.” Accessed October 27 2014. link here
- “Somatization: Treatment and Prognosis.” Accessed October 27 2014. link here
10 Most frequently asked questions (FAQs)
What is somatic symptom disorder? Somatic symptom disorder is a condition in which a person experiences persistent and distressing physical symptoms that cannot be easily explained by another medical condition. People with somatic symptom disorder are generally highly concerned and anxious about their health. What are the symptoms of somatic symptom disorder? A very wide range of symptoms can occur in somatic symptom disorder. Pain, digestive problems such as vomiting and diarrhea, muscle weakness or paralysis, palpitations and shortness of breath are some of the more common examples. What causes somatic symptom disorder? The cause of somatic symptom disorder is not well understood. It may be that people with somatic symptom disorder experience pain or symptoms in a heightened way. Worry and concern about the symptoms may make this worse. How is somatic symptom disorder diagnosed? As part of the diagnosis of somatic symptom disorder, it is important that other potential causes of symptoms are ruled out. If this is the case, and the symptoms are persistent and distressing, a diagnosis may be made. A referral for psychiatric assessment may be recommended as part of the diagnosis. How is somatic symptom disorder treated? Somatic symptom disorder is managed through regular reviews with a healthcare professional who is familiar with your medical history. Treatments and strategies to help manage symptoms and improve quality of life may be recommended and may include antidepressant medications, psychological therapies and lifestyle changes. Is somatic symptom disorder serious? Somatic symptom disorder can have a very serious impact on quality of life. People with the disorder are often also affected by mental health issues, such as depression and anxiety. It is important that the disorder is managed appropriately. What can make somatic symptom disorder worse? Because it is difficult to identify the cause of symptoms, people with somatic symptom disorder may undergo many tests, procedures and treatments that may not be helpful in controlling the symptoms and may also lead to complications.
Related topics
Conversion disorder is a mental health condition in which a person experiences physical symptoms that have no physical cause. In the past, this condition has been known as hysteria. Paranoid personality disorder
Paranoid personality disorder is a mental health disorder in which a person experiences a persistent and deep distrust of friends, strangers, family and authority figures. It is usually diagnosed in adulthood. Schizophrenia is a complex disorder of the mind that results in having mixed-up thoughts and feelings. The main symptoms include delusions and hallucinations. People with schizophrenia may also become withdrawn, confused and agitated and may behave strangely. However, there are treatments available to help manage these symptoms.