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Somatic Symptom Disorder

Kathryn Patricelli, MA

What is Somatic Symptom Disorder?

Somatic Symptom Disorder is diagnosed when the following symptoms are ongoing and typically last more than 6 months:

  • A - One or more bodily/physical symptoms are causing stress or significant disruption of daily activities. These symptoms are either:
    • not caused by any other medical condition
    • are caused by a medical condition but symptoms are much worse than would normally happen with that condition
  • B - Excessive thoughts, feelings, or behaviors are related to the physical symptoms and include one of the following:
    • Excessive, unreasonable and ongoing thoughts about how serious the symptoms are
    • Ongoing high levels of anxiety about personal health or symptoms
    • Excessive time and energy spent focusing on health and symptoms

This condition can be diagnosed as "Somatic Symptom Disorder with predominant pain". This was previously known as pain disorder and this description is used when the physical symptoms are primarily involving pain in the body.

There are 3 severity levels that can be assigned to Somatic Symptom Disorder including:

  • Mild - only one of the symptoms listed in B is present.
  • Moderate - two or more of the symptoms in B are present.
  • Severe - two or more of the symptoms in B are present, plus there are multiple bodily symptoms (or one symptom that is very severe).

As described in the introduction of this center, these symptoms are real symptoms that are causing real pain and distress. They are not symptoms that are in the person's head. They are truly suffering and unable to function on a daily basis. The symptoms may or may not have a medical cause, but in either case, are causing significant worry to the person about his or her health. These individuals tend to have very high levels of worry about illness and often think that their bodily symptoms are very threatening or harmful. They always expect the worst when it comes to their personal health. They may spend hours reading about medical conditions and become convinced that their situation falls into the worst case scenario. They may or may not admit to feeling distress separate from the physical symptoms, but distressful thoughts, feelings or behaviors are definitely present.

How common is Somatic Symptom Disorder?

The exact prevalence rate is not known. It is estimated that 5-7% of adults may have it. Females are likely to report physical symptoms and seek assistance from a doctor. Because of this, the disorder is more commonly diagnosed in females than in males.

It is also common in the elderly. They may be more elderly with the condition that are not diagnosed. Elderly and their doctors can view some of the physical symptoms as just being a part of the natural aging process. An excessive amount of worrying about the state of their health can also be seen as more normal in the elderly.

When this disorder is seen in children, there is typically a single main bodily symptom that the child is complaining about. This is usually pain, a headache, being very tired and having low energy, or an upset stomach.

What are the risk factors for Somatic Symptom Disorder?

One of the highest risk factors is if the person has high levels of worry, anxiety, loneliness, or depression about life and the world around them. It also happens more frequently in those with less formal education and who are low income. People that have been through recently stressful situations can also be at risk. Other risk factors include having a history of sexual abuse or other childhood traumas, having another long-term medical or mental health condition, the person's sensitivity to pain level, and a having a focus on symptoms in the body.

What other disorders or conditions often occur with Somatic Symptom Disorder?

This condition commonly happens with depression or anxiety. It can also happen with medical conditions that may be related to the symptoms, but aren't enough to cause how severe the symptoms being reported are.

How is Somatic Symptom Disorder treated?

Having a doctor that the person trusts and can communicate with is very important for treatment. The goal will be to improve daily living and functioning, not necessarily about managing the physical symptoms.

The process will generally start with a full physical examination. This is done to make sure there are no medical conditions that are causing or affecting the symptoms.

Another treatment is psychotherapy, especially cognitive behavioral therapy (CBT). The therapist can help the person look at and change thoughts that may be causing some of the problems. This change in thoughts will also help reduce the worry and anxiety that the person feels. Family therapy can also be used to help family members deal with their thoughts and feelings about the person's condition and to teach them ways to support and help the patient as they work to change their thoughts and behavior.

Medication can be used to treat symptoms such as anxiety and depression, or sleeplessness, but does not cure the overall condition. Stress management techniques can be used to help deal with the worry and stress that is felt. Staying active and doing activities with other people can also be helpful.