SOMATIC SYMPTOM DISORDER

Somatic symptom disorder happens when a person feels significantly distressed about physical symptoms and has abnormal feelings and behaviors in response to them. These responses interfere with their daily functioning. The physical symptoms may be due to a medical condition or have no clear cause.

Somatic symptom and related disorders is the name for a group of conditions in which the physical pain and symptoms a person feels are related to psychological factors. These symptoms can’t be traced to a specific physical cause. In people who have a somatic symptom and related disorders, medical test results are either normal or don’t explain the person’s symptoms.

People who have this disorder may have several medical evaluations and tests to be sure that they don’t have another illness. They often become very worried about their health because they don’t know what’s causing their health problems. Their symptoms are similar to the symptoms of other illnesses and may last for several years. People who have a somatoform disorder are not faking their symptoms. The pain that they feel is real.

For a diagnosis of SSD, the negative thoughts and emotions must last for at least 6 months 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 differentiation between SSD and the above former DSM-IV disorders is that people with SSD do not need to experience unexplainable symptoms.

Another difference from the former conditions is that SSD causes at least one chronic physical symptom. Additionally, it accompanies excessive, persistent negative feelings, thoughts, and emotions.

Difference between somatic symptom disorder and illness anxiety disorder

Illness anxiety disorder (formerly called Hypochondriasis) is a mental health condition in which a person is preoccupied and excessively worried about having an illness or getting an illness. Unlike somatic symptom disorder, a person with illness anxiety disorder usually doesn’t experience physical symptoms.

There are several types of somatic symptom and related disorders.

Somatization disorder usually involves pain and severe neurological symptoms (such as headache, fatigue). Other symptoms include:

· Digestive symptoms (such as nausea, vomiting, abdominal pain, constipation, and diarrhea).

· Sexual symptoms (such as pain during sexual activity, loss of sexual desire, and extremely painful periods in women).

Hypochondriasis occurs when a person believes that normal body functions (such as a grumbling stomach) or minor symptoms (such as a common headache) are symptoms of a very serious disorder. To a person who has hypochondriasis, a grumbling stomach may mean stomach cancer. A headache may mean a brain tumor.

Body dysmorphic disorder occurs when a person becomes obsessed with a flaw in his or her physical appearance. The flaw is either a minor flaw or a flaw that doesn’t exist. He or she constantly worries about the perceived flaw, which can be any part of the body. Common concerns for people who have body dysmorphic disorder include:

· wrinkles

· hair loss

· weight gain

· size and shape of feature like the eyes, nose, and breasts

Conversion disorder (also called Functional Neurological Symptom Disorder) is when physical symptoms that are similar to a neurological disorder develop even though no neurological disorder is actually present. Common symptoms include:

· paralysis of an arm or leg

· vision loss

· hearing loss

· seizure

Stress may make the symptoms worse.

Signs and symptoms of somatic symptom disorder

Physical symptoms that people with SSD may have include:

• Pain (the most commonly reported symptom).
• Fatigue or weakness.
• Shortness of breath (dyspnea).

The physical symptoms may be mild to severe, and there may be one or multiple symptoms. They may be due to a medical condition or have no clear cause.

How people think, feel and behave in response to these physical symptoms are the main signs of somatic symptom disorder. People with SSD may:

• Feel extreme anxiety about their physical symptoms.
• Feel concerned that mild physical symptoms are signs of serious conditions.
• See their healthcare provider for multiple diagnostic tests and exams but not believe the results.
• Feel that their healthcare provider doesn’t take their physical symptoms seriously enough.
• Go from one healthcare provider to another or seek treatment from multiple providers at once.
• Spend excessive amounts of time and energy dealing with health concerns.
• Frequently seem unusually sensitive to drug side effects.
• Become dependent on others, demanding help and emotional support, and become angry when they feel their needs aren’t met.
• Have trouble functioning day to day because of thoughts, feelings and behaviors about their physical symptoms.

Characteristics of Somatoform Disorders

Disorder	Essential characteristics
Somatization disorder	Unexplained physical symptoms manifested before age 30
	Symptoms last for several years
	Symptoms include two gastrointestinal, four pain, one pseudoneurologic, and one sexual
Undifferentiated somatoform disorder	≥ Six months' history
	One or more unexplained physical symptoms
Conversion disorder	Single unexplained symptom involving voluntary or sensory functioning
Pain disorder	Pain symptom is predominant focus
	Psychological factors play the primary role in the perception, onset, severity, exacerbation, or maintenance of pain
Hypochondriasis	Fixation on the fear of having a life-threatening medical condition
Body dysmorphic disorder	Preoccupation with a real or imagined physical defect
Somatoform disorder not otherwise specified	Misinterpretation or exaggeration of unexplained physical symptoms
	Patient does not meet full criteria for any of the other somatoform disorders

Causes

The exact cause of somatic symptom disorder isn't clear, but any of these factors may play a role:

· Genetic and biological factors, such as an increased sensitivity to pain

· Family influence, which may be genetic or environmental, or both

· Personality trait of negativity, which can impact how you identify and perceive illness and bodily symptoms

· Decreased awareness of or problems processing emotions, causing physical symptoms to become the focus rather than the emotional issues

· Learned behavior — for example, the attention or other benefits gained from having an illness; or "pain behaviors" in response to symptoms, such as excessive avoidance of activity, which can increase your level of disability