Somatic Symptom Disorder in Adults

Overview

What is somatic symptom disorder?

Somatic symptom disorder is a disorder in which individuals feel excessively distressed about their health and also have abnormal thoughts, feelings, and behaviors in response to their symptoms. There are different subtypes of the disorder based on the patient’s complaint. The disorder causes a disruption in the patient’s normal functioning and quality of life.

Although a person with somatic symptom disorder reports symptoms, the symptoms may have no medical explanation. Even when there is a medical cause, the person’s worry is out of proportion to the symptom. The distress causes the patient to visit multiple healthcare providers and to have many medical tests and unnecessary procedures.

How common is somatic symptom disorder?

Somatic symptom disorder occurs in about 5 to 7 percent of the adult population.

Who is affected by somatic symptom disorder?

Women are ten times more likely to report somatic symptoms than men. This is explained by the fact that the disorder is often related to childhood abuse and trauma to which women are more often exposed then men. Somatic symptom disorder can appear in any age group.

Symptoms and Causes

What causes somatic symptom disorder?

Researchers believe there are many factors including biological susceptibility (it’s more common in women), exposure to emotional stress in childhood, and psychological factors such as learned ways of thinking in the context of a person’s social environment. The main factors include:

  • Childhood physical and sexual abuse.
  • Poor awareness of emotions/emotional development during childhood. This can be the result of such things as parental neglect or lack of emotional closeness.
  • Excessive anxiety and attention to bodily processes and possible signs of illness; low pain threshold.

What are the symptoms of somatic symptom disorder?

Somatic symptom disorder symptoms include:

  • Pain. This is the most commonly reported symptom. Areas of reported pain can include chest, arms, legs, joints, back, abdomen, and other areas.
  • Neurological symptoms such as headaches, movement disorders, weakness, dizziness, fainting
  • Digestive symptoms such as abdominal pain or bowel problems, diarrhea, incontinence, and constipation
  • Sexual symptoms such as pain during sexual activity or painful periods

Usually, patients report experiencing more than one symptom. Symptoms can range from mild to severe. Approximately 30 to 60 percent of patients with somatic symptom disorder also have anxiety and/or depression.

Who is at risk of developing somatic symptom disorder?

Studies have found certain risk factors associated with somatic symptom disorder. These risk factors include a history of:

  • Substance abuse
  • Alcohol abuse
  • Neglect during childhood
  • Physical and sexual abuse
  • Chaotic lifestyle/trauma
  • Chronic illness during childhood
  • Presence of other psychiatric disorders, especially anxiety or depression
  • A heightened attention to bodily sensations

Diagnosis and Tests

How is somatic symptom disorder diagnosed?

Your doctor will do a physical exam and probably order some laboratory tests to rule out diseases based on your symptoms. He or she will also ask you about your health history. If test results do not show the presence of an illness and you have the risk factors for the disorder, your doctor may refer you to a mental health provider for assessment.

A mental health specialist confirms a diagnosis of somatic symptom disorder using specific criteria. To be diagnosed, a patient:

  • Must have one or more symptoms that cause distress or disrupt daily life.
  • Must have excessive thoughts, feelings, or behaviors in response to the symptoms that meet at least one of the following criteria:
    • Overly excessive and long-lasting thoughts about the seriousness of the symptoms
    • Continuously high levels of anxiety about health or symptoms
    • Extreme amount of time and energy focused on symptoms and health concerns
  • One or more symptoms must be persistent (typically present for more than 6 months)

Management and Treatment

How is somatic symptom disorder treated?

The goal of treating somatic symptom disorder is to manage symptoms using both behavioral therapy and sometimes medications that treat the underlying anxiety and depression. Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps patients learn ways to change their patterns of thinking or behavior in order to change the way they feel. CBT helps patients better cope with anxiety and stress and respond to situations more effectively. If medication is prescribed, antidepressants are a common choice. Antidepressants in addition to helping mood, have been reported to help ease such symptoms as pain, fatigue, pain in joints, and sleep problems.

Prevention

Can somatic symptom disorder be prevented?

Somatic symptom disorder cannot be prevented but can be treated.

Outlook / Prognosis

What is the outlook for patients who have somatic symptom disorder?

Patients with somatic symptom disorder have symptoms that come and go for many years. The good news is that with treatment, most patients can experience an improvement in their symptoms.

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