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Get Help With Somatic Symptom Disorder

Curated and updated for the community by APA

Somatic symptom disorder involves a person having a significant focus on physical symptoms, such as pain, weakness or shortness of breath, that results in major distress and/or problems functioning. The individual has excessive thoughts, feelings and behaviors relating to the physical symptoms. The physical symptoms may or may not be associated with a diagnosed medical condition, but the person is experiencing symptoms and believes they are sick (that is, not faking the illness).

See definition, symptoms, & treatment

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Pain and Therapeutic Movement: Is a Paradigm Shift Required?
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How can family members best support and help someone with somatic symptom disorder?

Somatic symptom disorder is a complex illness that calls for consistent and reassuring relationships with confident and supportive healthcare providers. Often at the center is uncertainty and lack of trust in one’s own ability to tell the difference between normal bodily sensations and those that signal harm. It can be very challenging for individuals, family members and healthcare professionals alike to tell if new symptoms relate to a major illness or routine feelings of discomfort.

Further complicating the picture is the fact that often people with the disorder have ongoing chronic illnesses which can change and worsen over time. The art of managing somatic symptom disorders is therefore balancing the need for a prudent medical evaluation with over-diagnosis and over-treatment. This balance can only be achieved through a trusting relationship with a knowledgeable clinician, usually a primary care provider or primary care team.

Family members can assist an individual with somatic symptom disorders with ongoing support and understanding, and encouragement of stable and consistent healthcare relationships. Additionally, family members can help to follow treatment plans that aim to avoid urgent and emergent medical care settings in favor of outpatient appointments with a consistent provider. Family can also assist the person suffering to track and record symptom information for later discussion with his/her provider. Family members can also play a valuable role in reassurance and communication with the person’s healthcare team. Read More

My wife has been diagnosed with somatic symptom disorder. She continues to get angry with doctors and can’t accept that they can’t find anything physically wrong. She doesn’t want to consider that “it’s all in her head.” What can I do to get her to accept help?

As mentioned above, the name of the game is balancing prudent medical investigations and treatments with over-diagnosis and treatment. The ultimate shared fear of patients and healthcare providers dealing with somatic symptom disorders is that we’ve all gotten it wrong – that we’ve missed a rare disease and caused undue suffering and/or death as a result. Put another way – that we’ve identified something as being “all in their head” when, in fact, they weren’t “making it up”. Experienced clinicians reassure their patients that, though the tests run so far have been normal, it doesn’t necessarily mean that what the patient is experiencing isn’t happening. I frame normal lab tests as reassurance that nothing catastrophic is going on, highlight the number of diagnoses that we’ve “ruled out” as a result and pledge support to continue to work with the patient to improve functionality and monitor symptoms for any change in quality or quantity warranting further investigation.

It’s important to also acknowledge the toll these symptoms can take in loss of functioning, and to express empathy with the shared fear and confusion that inevitably occur with these disorders. Spouses and family members can take the same approach. Avoid direct confrontation about the truthfulness of the symptoms and help the person identify creative and practical solutions and coping strategies that can minimize the problems caused by the symptoms. Recognizing the emotional toll of feeling isolated through this process and encouraging attention to mental health concerns that could be framed as “side effects” of these symptoms may be a segue into more formal mental health treatments. Furthermore, spouses can help through the profession of unconditional love and support. Read More

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About the Expert:

Erik Vanderlip, M.D., M.P.H.
Assistant Professor, Departments of Psychiatry, Medical Informatics
University of Oklahoma School of Community Medicine

Martin’s Story

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Martin is a 31-year-old married male who has been seen by Dr. Smith, a primary care physician who practices near Martin’s work. Martin began to see Dr. Smith three months ago after abdominal pain he had been experiencing for about a year was becoming progressively worse. Martin noticed that the abdominal pain would come on intermittently, was located everywhere in his abdomen and was not consistently related to food intake. Read More

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As our understanding of diseases continues to expand, George Merrin explains what psychosomatic illnesses and injuries are and why there is so much mystery around them. Somatoform Symptom Disorder (SSD) is a mental illness which causes bodily symptoms such as pain. The difference between psychosomatic and somatoform disorders is that in the latter no physical damage is done.