What is Somatic Symptom Disorder?

From the Guidelines

Somatic Symptom Disorder should be treated with a combination of cognitive behavioral therapy (CBT) and sometimes medication, prioritizing a multidisciplinary approach to improve patient outcomes and reduce morbidity, mortality, and enhance quality of life. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of early intervention and a comprehensive treatment plan 1.

Key Considerations

• Somatic Symptom Disorder is characterized by excessive thoughts, feelings, or behaviors related to physical symptoms that cause significant distress and impairment.
• Treatment typically involves a combination of CBT and sometimes medication, such as antidepressants like sertraline (50-200 mg daily) or duloxetine (30-60 mg daily) if depression or anxiety coexist.
• A multidisciplinary approach is essential, involving primary care physicians, psychiatrists, and psychologists working together to manage symptoms and improve patient outcomes.
• Physical therapy and relaxation techniques, such as progressive muscle relaxation practiced 15-20 minutes daily, can help manage symptoms and reduce distress.
• Patient education is crucial, as understanding that symptoms are real but amplified by psychological factors improves outcomes and reduces morbidity, mortality, and enhances quality of life.

Diagnostic Criteria

• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition recognizes 7 distinct somatic symptom and related disorders, including somatic symptom disorder, illness anxiety disorder, conversion disorder (functional neurologic symptom disorder), psychological factors affecting other medical conditions, factitious disorder, other specified somatic symptom and related disorder, and unspecified somatic symptom and related disorder.
• Each disorder has specific diagnostic criteria, which apply to both adults and children and which are not adjusted for children.
• Symptoms that are intentionally created are classified as factitious disorders; those that result in material gain are categorized as malingering.

Treatment Outcomes

• Early intervention leads to better outcomes, with many patients showing significant improvement within 3-6 months of consistent treatment.
• Accurate diagnosis and appropriate referrals for these patients may be important, as studies have found that on follow-up, a significant percentage of patients' symptoms had resolved after psychiatric treatment 1.
• A multidisciplinary approach and patient education are essential to improve treatment outcomes and reduce morbidity, mortality, and enhance quality of life.

From the Research

Definition and Diagnosis of Somatic Symptom Disorder

• Somatic Symptom Disorder (SSD) is characterized by a patient's concern with physical symptoms that they attribute to a nonpsychiatric disease 2.
• The diagnosis of SSD can be challenging due to the co-occurrence of physical and mental disorders, making it difficult to determine which symptoms are the cause and which are the effect 3.
• Screening instruments are useful in determining the presence of SSD, and primary care physicians play a crucial role in diagnosing and managing the disorder 2.

Treatment of Somatic Symptom Disorder

• Cognitive Behavioral Therapy (CBT) is a proven treatment for SSD, and it can be effective in reducing physical symptoms, psychological distress, and disability 4, 5.
• Mindfulness-based therapy and pharmacotherapy, such as selective serotonin reuptake inhibitors or tricyclic antidepressants, can also be effective in alleviating symptoms 2.
• Early psychological interventions, including CBT, can improve outcomes for individuals with SSD, particularly when targeted at an early stage 6.
• Group-based CBT interventions can be beneficial for individuals with SSD, and they can be effective in reducing psychiatric symptomatology 5.

Challenges and Future Directions

• The treatment of SSD can be challenging due to the complexity of the disorder and the need for a comprehensive approach that addresses both physical and mental health concerns 3.
• Further research is needed to evaluate the efficacy of different treatments for SSD, including CBT, and to develop more effective interventions for individuals with the disorder 6, 5.
• The development of readily accessible interventions that address transsymptomatic processes of SSD development and consolidation is highly needed 6.