Somatic symptom disorder
Somatic symptom disorder is a long-term (chronic) condition in which a person has physical symptoms that involve more than one part of the body, but no physical cause can be found.
The pain and other symptoms people with this disorder feel are real, and are not created or faked on purpose.
Somatic symptom and related disorders; Somatization disorder; Somatiform disorders; Briquet syndrome; Illness anxiety disorder
Somatic symptom disorder (SSD) usually begins after age 30. SSD occurs more often in women than in men. In the past, this disorder was thought to be related to emotional stress. The pain was dismissed as being "all in the person's head."
But patients who have SSD seem to experience pain or other symptoms in a way that increases the level of pain. Pain and worry create a cycle that is hard to break.
People who have a history of physical or sexual abuse are more likely to have this disorder. But not every person with SSD has a history of abuse.
As researchers study the connections between the brain and body, there is more evidence that emotional well-being affects the way people perceive pain and other symptoms.
Somatic symptom disorder is different from illness anxiety disorder. With illness anxiety disorder, persons are overly focused on their health. They worry that physical symptoms or signs of normal body function mean they have a medical problem, but the medical cause is not found.
People with SSD have many physical complaints that last for years. Most often, the complaints involve chronic pain and problems with the digestive system, nervous system, and reproductive system.
The symptoms often interfere with work and relationships, and lead to many visits to different health care providers.
Stress often worsens the symptoms.
Some of the many symptoms that can occur with somatization disorder include:
- Abdominal pain
- Back pain
- Chest pain
- Difficulty swallowing
- Joint pain
- Nausea and sometimes vomiting
- Pain during intercourse
- Pain during urination
- Painful menstruation
- Pain in the legs or arms
- Paralysis or muscle weakness
- Shortness of breath
- Vision changes
Exams and Tests
A thorough physical examination and diagnostic tests are performed to identify physical causes. The types of tests that are done depend on what symptoms you have.
A psychological evaluation is performed to identify related disorders.
After you have a thorough evaluation, if no physical cause is found to explain the symptoms, SSD may be diagnosed.
The goal of treatment is to help you learn to control your symptoms.
Having a supportive relationship with a health care provider is the most important part of treatment.
- You should have only one primary care provider, to avoid having too many tests and procedures.
- Schedule regular appointments to review your symptoms and how you are coping. The health care provider should explain any test results.
- Talk to your provider about any medicines you take for your pain or other symptoms. Ask if you should keep taking these medicines, or try other symptom-relief methods.
Finding a mental health provider who has experience treating SSD with talk therapy (psychotherapy) can be helpful. Cognitive behavioral therapy (CBT), a kind of talk therapy, can help you deal with your pain or other symptoms. During therapy, you will learn:
- To recognize what seems to make the pain or other symptoms worse
- To develop methods of coping with the pain or other symptoms
- To keep yourself more active, even if you still have pain or other symptoms
If you have depression or an anxiety disorder, it may respond to antidepressant medications.
You should not be told that your symptoms are imaginary. Many health care providers now recognize that real physical symptoms can result from emotional stress.
You can become dependent on pain relievers or sedatives.
When to Contact a Medical Professional
Having a good relationship with your primary health care provider is helpful. Call for an appointment if you notice a major change in your symptoms.
Counseling may help people who are prone to SSD learn other ways of dealing with stress. This may help reduce the intensity of symptoms.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
Feinstein RE, deGruy FV. Difficult patients: personality disorders and somatoform complaints. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 46.
Greenberg DB, Braun IM, Cassem NH. Functional somatic symptoms and somatoform disorders. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008:chap 24.
Reviewed By: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.