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Help With Somatic Symptom Disorder

Curated and updated for the community by APA

Somatic symptom disorder is diagnosed when a person has a significant focus on physical symptoms, such as pain, weakness or dizziness, to a level that results in major distress and/or problems with daily activities. The individual has excessive worries, feelings and behaviors relating to the physical (somatic) symptoms.Sometimes people experience the symptoms even though they do not have a diagnosed medical condition. Other times people experience more concern about symptoms than would be expected with their diagnosed medical condition. Even though they do not have a diagnosed medical condition or experience the symptoms out of proportion to their diagnosed condition, they truly experience the symptoms (that is, not faking the illness).

A person is not diagnosed with somatic symptom disorder solely because a medical cause can’t be identified for a physical symptom. The emphasis is on the extent to which the thoughts, feelings and behaviors related to the illness are excessive or out of proportion.

Diagnosis 

  • One or more physical symptoms that are distressing or cause disruption in daily life
  • Excessive thoughts, feelings or behaviors related to the physical symptoms or health concerns with at least one of the following:
    • Ongoing thoughts that are out of proportion with the seriousness of symptoms
    • Ongoing high level of anxiety about health or symptoms
    • Excessive time and energy spent on the symptoms or health concerns
  • At least one symptom is constantly present, although there may be different symptoms and symptoms may come and go

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See definition, symptoms, & treatment

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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

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MAR 2, 2021
What it's like to deal with 'relentless' health anxiety: 'I think I’m going to die’
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This hyper-focus on health concerns is something that people with health anxiety can struggle with daily, said Melissa Dowd, a therapist at PlushCare, a virtual mental health and primary care company. Many may be more familiar with the former term hypochondria (or more technically hypochondriasis), which was replaced in the Diagnostic and Statistical Manual of Mental Disorders in 2013 by two updated concepts: somatic symptom disorder and illness anxiety disorder.

JAN 20 2021
Somatic Symptom Disorder Confuses Physical  Symptoms With Danger 
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Somatic symptom disorder is a condition where a person somaticizes or “feels their emotional pain.” For example, you may feel joint pain or numbness and tingling in your body and then be confused as to the source. You automatically assume that there is danger afoot. The pain you’re feeling in your body is due to anxiety, but it feels so “real.” Living with somatic symptom disorder can be frustrating when you go to see a doctor. Medical professionals aren’t sure whether the patient is experiencing a mental health condition, a physical problem, or both. It’s challenging to evaluate them. Here’s how somatic symptoms disorder impacts a person’s life.

JAN 5, 2021
New Best Practices for Treating Youth With Somatic Symptom and Related Disorders
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Somatic symptom and related disorders (SSRDs) are a set of psychiatric conditions characterized by physical symptoms that are inconsistent with physical disease and influenced by psychological factors. Across all ages, SSRDs account for nearly 20% of health care spending annually. Despite the impact of SSRDs on pediatric health care, there is a high level of clinician and patient/familial frustration associated with the evaluation and management of these conditions. 

Physician Reviewed

Philip R. Muskin, M.D., M.A.
 August 2021