From the Guidelines
The management of Somatic Symptom Disorder (SSD) should prioritize a multidisciplinary approach, focusing on cognitive behavioral therapy (CBT) as the first-line treatment, alongside a strong therapeutic alliance with the patient. This approach is crucial in addressing the psychological factors that maintain symptoms and helping patients develop more adaptive ways of interpreting and responding to bodily sensations. According to the most recent and highest quality study available, which emphasizes the importance of addressing psychosocial predisposing and perpetuating factors 1, treatment should involve identifying and challenging maladaptive thoughts about physical symptoms, reducing symptom-focused behaviors, and developing coping strategies.
Key components of the management plan include:
- Cognitive behavioral therapy (CBT) as the primary treatment, typically involving 10-16 weekly sessions
- Medications, such as selective serotonin reuptake inhibitors (SSRIs) or low-dose tricyclic antidepressants, may be used to target specific symptoms like comorbid depression, anxiety, or pain, but are not the first-line treatment
- Regular appointments with a consistent primary care provider to avoid unnecessary testing, validate the patient's distress, and focus on improving function rather than eliminating symptoms
- Setting realistic treatment goals and providing education about the mind-body connection
- Complementary therapies such as physical therapy, occupational therapy, and mindfulness-based stress reduction can be beneficial in addressing the patient's overall well-being
It is essential to recognize that somatic symptom and related disorders can be challenging to manage, particularly in settings like the emergency department, where diagnostic uncertainty can lead to extensive and potentially harmful testing 1. Therefore, a comprehensive and multidisciplinary approach, prioritizing psychological interventions and a strong therapeutic alliance, is critical in managing SSD and improving patient outcomes.
From the Research
Management of Somatic Symptom Disorder
The management of Somatic Symptom Disorder (SSD) involves a combination of psychological and pharmacological interventions.
- Cognitive-behavioral therapy (CBT) is a proven treatment for SSD, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache 2, 3, 4.
- Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, are also effective in treating SSD 2, 3, 4.
- A stepped care approach, which consists of three phases, may be useful in the care of patients with somatic symptoms 2, 5.
- Early psychological interventions, such as CBT and mindfulness therapy, may be beneficial in preventing and treating SSD, especially in individuals at risk or with recent onset of symptoms 6.
- A biopsychosocial model, which integrates somatic and psychosocial determinants of distress and therapeutic factors, is recommended for managing SSD 5.
Treatment Approaches
- Psychological treatments, such as CBT and mindfulness therapy, aim to address the psychological and emotional factors contributing to SSD 3, 6.
- Pharmacological treatments, such as antidepressants, aim to reduce symptoms of depression and anxiety, as well as alleviate somatic symptoms 2, 3, 4.
- A multidisciplinary approach, involving primary care, somatic specialists, and mental health care professionals, is essential for effective management of SSD 5.