Somatic Symptom Disorder: What It Is and How It’s Treated

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Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

Somatic Symptom Disorder (SSD) 

Somatic Symptom Disorder (SSD) represents a complex condition where individuals experience significant physical symptoms that have a psychological origin. This blog post aims to shed light on the nature, symptoms, and diagnostic criteria of SSD, while drawing parallels to related disorders, and discussing its prevalence, associated features, and potential therapeutic interventions.

young lady sitting on a couch talking to her psychiatrist about her illness

Signs and Symptoms of Somatic Symptom Disorder

Somatic Symptom Disorder (SSD) is defined by a profound preoccupation with physical symptoms — such as persistent pain, weakness, or difficulty breathing — that substantially disrupt daily life and cannot be fully accounted for by medical diagnoses or substance use. The distinguishing feature of SSD lies not in the feigning or deliberate production of symptoms but in the genuine distress and impairment they cause. Noteworthy characteristics include:

  • Widespread Physical Complaints: SSD manifests through a broad spectrum of physical symptoms that lack a definitive medical explanation. Affected individuals might experience an array of general symptoms like chronic fatigue and vertigo, as well as more specific and localized discomforts.

  • Heightened Concern Over Symptoms: Those with SSD tend to engage in excessive rumination about the severity of their symptoms. They might allocate an inordinate amount of time to health-related worries or exhibit exaggerated responses to physical sensations, indicative of a heightened state of health anxiety.

  • Continued Distress Despite Medical Reassurance: Individuals with SSD often find little solace in medical assessments that rule out serious medical conditions. This persistent health anxiety can lead to repeated medical consultations or investigations, as the individual seeks validation for their distress.

  • Significant Impact on Functioning: The intense focus on bodily symptoms and the resulting distress encroach upon and significantly impair social interactions, job responsibilities, and other critical aspects of daily life, markedly reducing the individual’s quality of life.

  • Emotional Recognition and Expression Difficulties: A unique aspect of SSD is the challenge some individuals face in acknowledging and articulating their emotions. For them, emotional turmoil might instead manifest through physical symptoms, reflecting a disconnection from their emotional state.

  • Link to Psychological Stress: Symptoms in SSD, while genuine and not deliberately produced, often have roots in psychological stress or conflict. This highlights the intricate connection between psychological states and physical health, underscoring the importance of addressing both aspects for effective treatment.

This refined understanding of SSD underscores the complexity of the disorder, emphasizing the critical need for a holistic approach to treatment that addresses the intricate web of physical symptoms, emotional distress, and psychological well-being.

DSM-5 Criteria for Diagnosing Somatic Symptom Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides specific criteria for diagnosing Somatic Symptom Disorder (SSD). To receive a diagnosis of SSD, an individual must meet the following 3 criteria:

  1. One or More Somatic Symptoms: The individual experiences one or more somatic symptoms that are distressing or result in significant disruption of daily life. These symptoms can vary widely in their nature but are typically persistent and perceived as distressing.

  2. Excessive Thoughts, Feelings, or Behaviors Related to the Somatic Symptoms: At least one of the following must be present:

    • Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
    • Persistently high level of anxiety about health or symptoms.
    • Excessive time and energy devoted to these symptoms or health concerns.
  3. Chronicity: Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than six months).

Most Common Somatic Symptoms

The most common somatic symptoms experienced by individuals with Somatic Symptom Disorder (SSD) can vary widely but often include:

  1. Pain: This pain may be localized (e.g., headaches, back pain, joint pain) or generalized.
  2. Fatigue: A pervasive sense of exhaustion that isn’t alleviated by rest.
  3. Digestive Symptoms: Including nausea, bloating, and bowel disturbances.
  4. Neurological Symptoms: Such as dizziness, sensations of tingling or numbness, and perceived weakness.
  5. Cardiovascular Symptoms: Like palpitations or sensations of chest pain.

What Are The 6 Somatic Symptom Disorders?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), categorizes several related disorders under Somatic Symptom and Related Disorders, which include:

  1. Somatic Symptom Disorder (SSD): Characterized by significant focus on physical symptoms, such as pain or fatigue, that cause major distress or functional impairment.
  2. Illness Anxiety Disorder: Previously known as hypochondriasis, where the person is preoccupied with having or acquiring a serious illness, often with minimal or no somatic symptoms.
  3. Conversion Disorder (Functional Neurological Symptom Disorder): Involves neurological symptoms incompatible with medical conditions, like paralysis or non-epileptic seizures.
  4. Psychological Factors Affecting Other Medical Conditions: A diagnosis that indicates psychological or behavioral factors that exacerbate a medical condition.
  5. Factitious Disorder: Characterized by falsifying illness or injury or inducing injury or illness without external rewards for such behaviors.
  6. Other Specified Somatic Symptom and Related Disorder: This includes conditions that cause distress or impairment but do not meet the full criteria for any of the disorders above.

Four Characteristics of Somatic Symptom Disorder

  1. Disproportionate Thoughts, Feelings, or Behaviors Related to the Symptoms: Excessive anxiety about health, disproportionate concern about the medical seriousness of symptoms, or excessive time and energy devoted to these symptoms or health concerns.
  2. High Level of Health-Related Anxiety: Persistent worries about the implication of symptoms despite medical reassurance.
  3. Persistent Symptoms: Though the specific symptom may change over time, the state of being symptomatic is persistent, typically for more than six months.
  4. Significant Distress or Functional Impairment: The symptoms lead to significant distress in the individual’s life or impairment in social, occupational, or other important areas of functioning.

Somatic Symptom Disorder Overlap With Other Disorders

A person with Somatic Symptom Disorder (SSD) may also experience various other psychological disorders, which are important to be aware of:

  • Depression often coexists with SSD, where the physical symptoms and the emotional distress of depression mutually exacerbate each other. Addressing both can be pivotal for improvement.
  • Anxiety disorders, including generalized anxiety, share a reciprocal relationship with SSD, where anxiety amplifies somatic symptoms and vice versa, necessitating integrated treatment approaches.
  • Illness Anxiety Disorder shares similarities with SSD in health-related preoccupations but differs in the absence of significant physical symptoms in the former, making differential diagnosis crucial.
  • Delusional Disorder, Somatic Type, involves unfounded beliefs of having a physical illness, distinct from SSD’s real physical symptoms influenced by psychological factors.

Treatment for Somatic Symptom Disorder

Treatment for SSD is often multidisciplinary and tailored to the individual, including things like therapy, medications, and psychoeducation:

  • Psychodynamic Therapy: This therapeutic approach can be particularly effective for individuals with SSD by exploring the underlying emotional and psychological factors contributing to their somatic symptoms. Psychodynamic therapy delves into past experiences and unresolved conflicts, aiming to uncover the root causes of the emotional distress manifesting as physical symptoms. By gaining insight into these underlying issues, patients can begin to understand the connections between their emotions and physical sensations, leading to more integrated and effective coping strategies.
  • Cognitive Behavioral Therapy (CBT): Helps patients identify and challenge negative thought patterns related to their symptoms and develop healthier coping mechanisms.
  • Regular Scheduled Health Care Visits: Establishing a consistent, non-urgent medical follow-up to reduce excessive medical shopping and to foster a trusting patient-provider relationship.
  • Medication: Antidepressants may be used to treat underlying depression or anxiety contributing to the somatic symptoms.
  • Stress Management Techniques: Such as relaxation training, mindfulness, and meditation, can help reduce overall symptom severity.
  • Psychoeducation: Teaching patients about the disorder can help reduce anxiety and improve coping strategies.

Effective management often requires a combination of these treatments, emphasizing a holistic approach that addresses both the psychological and physical aspects of the disorder.

Looking For A Psychiatrist In Orlando Florida?

Dr. Sidawi is happy to be a part of your journey towards mental health, or at least point you in the right direction. Please either fill out the contact form below, call or email and we will get back to you as soon as possible. We are now scheduling adults age 18 and up residing in Florida for initial appointments. Unfortunately, due to laws around cash pay we cannot see patients who have Medicare or Medicaid.

Phone: 407-900-9656