Dr Minhajzafar Nasirabadi, Professor and Head, Department of Psychiatry Deccan college of Medical Sciences, Hyderabad, Hon gen secretary Indian Psychiatric Society Telangana state branch
People with somatic symptom disorder obsess over physical senses and symptoms, such as pain, shortness of breath, or weakness. This condition has been previously called somatoform disorder or somatization disorder. It’s marked by the belief that you have a medical condition even if you haven’t been diagnosed with anything, and despite reassurances from your doctor that you have no health issue responsible for your symptoms. This can lead to major emotional stress when your doctor and those around you don’t believe that your symptoms are real.
Signs and Symptoms
The main symptom of somatic symptom disorder is the belief that you have a medical condition, which you may not actually have. These conditions range from mild to severe and general to very specific. Additional characteristics include:
Symptoms that aren’t related to any known medical condition
Symptoms that are related to a known medical condition, but are much more extreme than they should be
Constant or intense anxiety about a possible illness
Thinking that normal physical sensations are signs of illness
Worrying about the severity of mild symptoms, such as a runny nose
Believing your doctor hasn’t given you a proper examination or treatment
Worrying that physical activity will harm your body
Repeatedly examining your body for any physical signs of illness
Not responding to medical treatment or being very sensitive to medication side effects
Experiencing a disability more severe than what’s generally associated with a condition
Causes of Somatic Symptom Disorder
The exact cause of somatic symptom disorder is not well known. However, it seems to be associated with:
Genetic traits, such as pain sensitivity
Having negative affectivity, a personality trait that involves negative emotions and poor self-image
Difficulty dealing with stress
Decreased emotional awareness, which can make you focus more on physical issues than emotional ones
Learned behaviors, such as getting attention from having an illness or increasing immobility from pain behaviors
Over the years, some possible risk factors that might increase the risk of having somatic symptom disorder. These include:
Having anxiety or depression
Being diagnosed with or recovering from a medical condition
Having a high risk of developing a serious medical condition, due to family history, for example
Previous traumatic experiences
Diagnosis
Before diagnosing you with somatic symptom disorder, your doctor will start by giving you a thorough physical examination to check for any signs of a physical illness. If they don’t find any evidence of a medical condition, they’ll likely refer you to a mental health professional, who will start by asking questions about your:
Symptoms, including how long you’ve had them
Family history
Sources of stress
History of substance abuse
Treatment
People with somatic symptom disorder may find it difficult to accept a referral to a mental health professional or to accept that medical evaluation and treatment cannot relieve the symptoms. They are particularly sensitive to the stigma associated with mental disorders. In addition, they sometimes are dismissed by a subset of physicians who do not see their symptoms as a legitimate cause for concern. Ideally, if a primary care physician and mental health professional work together, the person's physical symptoms can be evaluated while he or she also gets help managing the frustration of not having a clear diagnosis or treatment plan. But mental health treatment can sometimes reduce symptoms or improve quality of life.
Cognitive behavioral therapy (CBT) may help reduce symptoms or address any accompanying anxiety or depression. Sometimes, an antidepressant medication or other psychiatric medication can provide relief from the physical symptoms that stem from somatic symptom disorder (especially if the person also has an anxiety or mood disorder). Treatment is often aimed at managing conflict at home or coping with secondary problems, such as problems with work and social functioning.
Psychotherapy can help the person deal with or manage chronic physical discomfort. Stress management (for example, relaxation techniques) may be useful. Some cognitive behavior therapists teach patients to identify the thoughts and feelings that are associated with changes in physical symptoms. They may help an individual reduce the tendency toward "body scanning," or the constant monitoring of body sensations.
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