What to know about somatic symptom disorder

Somatic symptom disorder (SSD) is a condition in which a person has excessive physical symptom-related thoughts and feelings. Anxiety and negative emotions can trigger SSD.

Read on to find out more about SSD, including the causes, signs, treatment, and diagnosis. We also describe when to talk to a doctor.

SSD definition

A lady having mental illness

SSD is a type of mental illness that causes excessive emotions , thoughts, or behaviors based on at least one somatic (physical) symptom, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). People may refer to SSD as a disorder of anxiety disorder or hypochondria.

Negative thoughts and emotions must last for at least 6 months for a diagnosis of SSD and cause one or more of the following symptoms:

  • exaggerated or persistent thoughts concerning the severity of symptoms
  • spending excessive time and energy on treating or handling symptoms or potential health concerns
  • persistently high anxiety concerning health or symptoms
  • physical symptoms that last for at least 6 months or more, significantly disrupt daily life, and cause distress
  • taking excessive actions to reduce the risk of perceived danger or harm

In the DSM-V, SSD replaced other mental health conditions, including:

  • somatization disorder
  • hypochondriasis
  • pain disorder
  • undifferentiated somatoform disorder

One key difference between SSD and the former DSM-IV conditions above is that there is no need for people with SSD to experience unexplained symptoms.

Another distinction from the former cases is that at least one persistent physical symptom is triggered by SSD. In addition , excessive, persistent negative emotions, ideas , and feelings are followed by this.

Causes

The cause of SSD is presently unclear. Study, however, indicates that individuals with SSD may have an improved understanding of bodily signs and sensations. They can also experience symptoms in a particular way or physically describe emotions.

Furthermore, these people may tend to interpret these symptoms negatively or as a sign of medical illness.

SSD is related to diagnosed medical conditions in some cases. To have the disorder, however, someone must also develop persistent, pervasive negative feelings , thoughts, or acts that are related.

SSD is related to an undiagnosed medical condition in some cases, but this doesn’t make it any less real.

Risk factors

Nobody knows why SSD actually occurs, but studies indicate that risk factors can include:

  • sexual, emotional, or physical abuse
  • childhood neglect
  • a chaotic lifestyle
  • a history of substance and alcohol abuse
  • having an axis II personality disorder, such as obsessive-compulsive disorder
  • psychosocial stressors, such as reduced occupational functioning and unemployment
  • genetic factors

Symptoms

In relation to at least one chronic, disabling, or distressing physical symptom, individuals with SSD experience extreme anxiety and persistent negative thoughts, feelings , and behaviors. Some typical SSD-related physical symptoms include:

  • increased heart rate
  • gastrointestinal problems
  • muscle tension, stiffness, and cramps
  • pain
  • trouble breathing or shortness of breath
  • weakness

Diagnosis

A doctor will ask the person about all of their symptoms, take their medical history, and conduct a physical exam in order to diagnose SSD.

In order to better rule out any possible causes of the symptoms, the doctor will usually then perform a series of diagnostic blood, imaging, and other laboratory tests.

If no other tests explain their symptoms, physicians can diagnose someone with SSD and they have:

  • at least one chronic symptom, though there may be multiple symptoms that can come and go
  • at least one physical symptom that disrupts daily life
  • persistent excessive thoughts, emotions, or behaviors that relate to physical symptoms or health concerns and involve at least one of the following:
    • ongoing high level of anxiety focused on symptoms or health
    • excessive ongoing thoughts
    • spending excessive energy, time, or money on health concerns or symptom relief

In order to determine the following factors, a doctor can also want to conduct a mental status examination in which they will observe the person and ask them questions:

  • appearance and affect
  • attention, memory, and concentration
  • mood
  • orientation
  • presence of hallucinations or delusions
  • suicidal or homicidal thoughts or imaginings

People develop SSD by the age of 30 years in most cases. Usually, the diagnosis would be made by a family doctor or medical doctor, not a psychiatrist.

Treatment

Treatment plans help to control the symptoms and improve coping for people with SSD. Treatment options for SSD include:

  • regular visits with one trusted doctor or a network of connected doctors to avoid excessive testing or treatments
  • antidepressant and anti-anxiety medications
  • talk therapy or cognitive behavioral therapy (CBT), to change behavior and thinking patterns to help cope with physical symptoms and stress
  • occupational therapy, to learn how to cope with day-to-day functioning
  • physical therapy, to reduce physical symptoms and improve functioning
  • St. John’s wort supplements
  • electroconvulsive therapy
  • mindfulness therapy and relaxation training techniques

Complications

People with SSD can look for ways to deal with their symptoms, such as drug and alcohol abuse. Many people with SSD have depression and anxiety as well.

It may also be difficult to function because of physical and mental symptoms underlying or associated with SSD. These symptoms may become debilitating and decrease the quality of life in general.

SSD people can also develop something called alexithymia, which means they have trouble identifying and expressing emotions. Negative complications are often a possibility from invasive or distressing medical tests.

When to see a doctor

Anyone encountering unexplained, persistent, chronic symptoms should speak with a physician.

People should also talk to a doctor if they have:

  • distressing symptoms
  • symptoms that interfere with daily functioning
  • excessive, out-of-control thoughts or feelings
  • excessive behavioral patterns, such as going to extremes to avoid a perceived danger
  • thoughts or fantasies of hurting oneself or others
  • started to use negative coping mechanisms, such as drugs or alcohol, to handle symptoms

Summary

Excessive negative thinking, emotions, and behaviors related to physical symptoms develop in people with SSD.

Studies indicate that for 5 years or longer, up to 90 percent of people with SSD have symptoms. Although there are some treatment options, reviews and meta-analyses indicate that therapeutic SSD treatments usually have a beneficial impact that is small to moderate.

Any unexplained symptoms, especially those that are recurrent or debilitating or that interfere with day-to-day life, should be addressed with a doctor.

To prevent excessive testing and the related issues and costs, people may prefer to refrain from talking to several, unconnected healthcare professionals.

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