Somatic Symptom Disorder
Somatic symptom disorder is a condition in which a person feels extreme anxiety about physical sensations, such as pain or fatigue. This preoccupation with physical symptoms causes significant distress and disrupts the individual’s daily life. The physical symptoms may or may not be related to a diagnosable medical condition, but the extreme reaction to the physical symptoms is what characterizes somatic symptom disorder.
The prevalence of somatic symptom disorder is unknown, but it is estimated that 5 to 7 percent of the general population may have this condition. Females tend to report more physical symptoms than males, and it is therefore likely that the prevalence of somatic symptom disorder is higher in females. This condition is related to hypochondriasis, or illness anxiety disorder.
People with somatic symptom disorder have multiple physical symptoms that cause significant distress. These symptoms can be specific, pain in a specific area, or more general, fatigue; and they may be normal bodily sensations or be the result of a medical condition. Somatic symptom disorder is characterized by the way people feel and behave in response to their physical sensations, not the sensations alone.
People with somatic symptom disorder spend a great deal of time and energy experiencing high levels of worry about illness. They assume physical sensations in their bodies are threatening or harmful, and they often think the worst about their symptoms, regardless of any evidence to the contrary. For example, a person may have a surgical procedure with no complications, but their concern over physical sensations following the surgery could leave them impaired or disabled.
Health concerns may become so extreme that they are a central feature of a person’s identity and dominate their relationships with others. Individuals with somatic symptom disorder access medical care at high rates, however such medical care rarely improves their distress. Whether or not the physical complaints can be medically explained, their suffering is real and interferes with daily functioning.
Symptoms of somatic symptom disorder as cataloged by the DSM-5:
- One or more somatic symptoms that are distressing or result in significant disruption of day-to-day living.
- Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associ­ated health concerns as manifested by at least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
- Persistently high level of anxiety about health or symptoms.
- Excessive time and energy are devoted to these symptoms or health concerns.
- Although any somatic symptom may not be continuously present, the state of being symptomatic in some manner is persistent (typically more than six months).
Do people with somatic symptom disorder avoid physical activity?
In some cases, yes. Any physical sensation is deemed a potential sign of serious and harmful illness. This foreboding can lead to the avoidance of any physical activity, the individual does not want to exacerbate the illness or damage their body in any way. The possibility of such illness is a chronic concern.
What is the difference between somatic symptom disorder and illness anxiety disorder?
In somatic symptom disorder, a person feels physical symptoms such as pain or sensations. This is not the case in illness anxiety disorder; a person with the latter disorder does not experience specific physical problems, but they are convinced that they have developed or will develop a medical condition.
What is the difference between somatic symptom disorder and conversion disorder?
Conversion disorder, also known as functional neurological symptom disorder, is a condition in which a person develops physical symptoms that are not under voluntary control and are not explained by a neurological disease or another medical condition. The cause may not be clear, however, stress may be a factor.
There are multiple factors that may contribute to the development of somatic symptom disorder. Major life stress might precede the development of symptoms in some cases. People who have a negative outlook or personality are more prone to developing the condition, as well as those who have a family history of somatic symptom disorder. This condition is also more commonly seen in people who have a high sensitivity to pain or have a history of alcohol and substance abuse. If a general practitioner suspects somatic symptom disorder, the individual should be referred to a mental health professional immediately.
Does genetics play a role?
If an individual has family members who have suffered from somatic disorders or from anxiety, the risk of developing such a somatic condition may be higher.
Why is somatic symptom disorder controversial?
Somatic symptom disorder was added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, in its 2013 fifth edition. Critics of somatic symptom disorder note that with this addition, any physical symptom may be erroneously deemed a mental illness; people who actually have cancer might well be diagnosed with somatic symptom disorder. Other experts contend that this disorder links the mind and the body more firmly, which will help people who experience poorly understood physical conditions.
Treatment of somatic symptom disorder is multifaceted and should be tailored to the needs of each patient, keeping in mind cultural factors that influence their physical symptoms. Establishing a strong relationship with a provider and legitimizing symptoms are important aspects of treatment. Treatment strategies include medications such as antidepressants to address any underlying anxiety or depression; SSRIs or selective serotonin reuptake inhibitors have been known to be effective. Other effective treatment options also include cognitive behavioral therapy and mindfulness-based therapy. Somatic symptom disorder is generally a chronic condition, but research has shown that people can recover and learn strategies to minimize their distress.
Can somatic symptom disorder lead to physical disability?
Somatic symptom disorder can indeed lead to physical disability. If the person is afraid to be physically active, a cycle of poor function is perpetuated. The person may need care and support from loved ones, which can be exhausting and stressful. Again, attention from a mental health professional is paramount.