Somatic symptom disorder is characterized by an extreme focus on physical symptoms, such as pain or fatigue, that causes major emotional distress and problems in normal functioning. You may or may not have another diagnosed medical condition associated with these symptoms, but your reactions to the symptoms is not normal.
What this means is that you often end up thinking the worst about your symptoms and frequently seek, medical care, continuing to search for answers even when other serious medical conditions have been excluded.
Health concerns then end becoming such a central focus in your life that you are unable to function normally and this ends up becoming a liability and disability.
While we haven’t been able to completely understand the causes of somatoform disorders, contributory factors include depression and anxiety. These can also manifest as an obsession with interpretations of somatic symptoms as evidence of a disease, excessive concern with physical illness and a tendency to seek medical care for everything. A family history of a particular condition may have shaped the patient’s beliefs. Doctors also sometimes inadvertently contribute towards the symptoms by either dismissing the patient’s complaints or by over-emphasizing and investigating the possibility of a disease.
Somatoform disease can present itself in several different ways:
Somatoform Autonomic Dysfunction
This refers to somatic symptoms referable to bodily organs that are largely under the control of the autonomic nervous system. The most common examples involve the cardiovascular system (cardiac neurosis – heart complaints for which no organic cause can be found), respiratory system (psychogenic hyperventilation – respiratory disorder, where you are breathing either too deeply or too rapidly), gut complaints (psychogenic vomiting, irritable bowel syndrome)
Somatoform Pain disorder
This describes severe, persistent pain that cannot be adequately explained by a medical condition. The pain causes clinically significant distress, impairment, in social, academic and or occupational areas of functioning. The pain is not intentionally produced or accounted for by a mood disorder.
Chronic Fatigue Syndrome
It is characterized by excessive fatigue after minimal physical or mental exertion, poor concentration, dizziness, muscular aches and sleep disturbance. This pattern of symptoms may follow a viral infection and symptoms often overlap with those of depression and anxiety.
Dissociative Conversion Disorder
Dissociative conversion disorders are characterized by a loss or distortion of neurological functioning that is not fully explained by an organic disease. These may be psychological functions such as memory (dissociative amnesia – when a person cannot remember important people, events from their life), sensory functions such as vision (dissociative blindness –a person has selective paralysis or blindness). The causes are unknown but there is an association with recent stress and adverse childhood experiences, including physical and sexual abuse.
This is defined as the occurrence of multiple medically unexplained physical symptoms affecting several bodily systems. It is also known as Briquet’s syndrome after the physician who first described the presentation. The symptoms start often early in childhood but can also present itself after a bout of physical illness. The disorder is much more common in women. They are characterized by recurring, multiple and current, clinically significant complaints about somatic symptoms.
Patients with this condition have a strong fear or belief that they have a serious, often fatal disease (such as cancer) and that fear persists even after repeated medical assurances and tests done. They are typically highly anxious and seek many medical opinions and investigations in futile but repeated attempts to relieve their fears. These often resemble OCD, but in a small proportion of cases, the disease reaches delusional intensity.
Body Dysmorphic Disorder
This is defined as a preoccupation with bodily shape or appearance with the belief that one is disfigured in some way (previously known as dysmorphophobia). People with this condition often make inappropriate requests for cosmetic surgery.
Management of Disease
The general principles to medically manage such symptoms are by:
- By taking a full sympathetic history
- Excluding disease but avoiding unnecessary investigations and referral
- Seeking specific treatable psychiatric symptoms
- Demonstrating to the patient that you understand their complaint
- Establishing a collaborative relationship
- Giving a positive explanation for the symptoms but not over emphasizing psychological factors
- Encouraging them to return to normal functioning
Patients should be reassured and effort should be put in to find out more about their condition. It isn’t wise to categorically state that they don’t suffer from any disease. However, it may be emphasized that the probability of them having this disease is low.
Patients need a positive explanation for their symptoms. It is unhelpful to say the symptoms are psychological in nature or it is all in their head. When possible, it is useful to describe a plausible physiological mechanism that is linked to psychological factors such as stress and imply that the symptoms are reversible.
Antidepressant drugs are often helpful, even if the patient is not depressed.
A mix of talk therapy and cognitive behavior therapy can be employed. Behavioral therapy can be used to modify dysfunctional behavior. CBT has shown reduction in anxiety, depression and improved physical functioning.
2. Davidson’s Principles and Practices of Medicine, Medical Psychiatry