Somatic Symptom Disorder (SDD) is a mental disorder characterized by clinically significant recurrent, multiple and continuous complaints of somatic symptoms. Formerly known as somatization disorder or psychosomatic illness, SJS causes so much anxiety and worry that it interferes with daily life.
People with SSD may perceive routine medical conditions or procedures as life threatening. The feelings and behaviors associated with illness anxiety do not decrease with normal test results. Treatment for SJS includes cognitive behavioral therapy and certain antidepressants.
Symptoms of the physical symptom of the disorder.
A Somatic Symptom Disorder is a psychiatric diagnosis characterized by somatic (physical) symptoms that cause severe anxiety or a significant impairment in the ability to function normally .
Symptoms generally include pain , fatigue, weakness, and shortness of breath. The degree of symptoms is not relevant to the diagnosis of SSD. In some people, the symptoms may be associated with another medical condition, although a physical cause is often not found .
A key characteristic of SSDs are the excessive and disproportionate thoughts, feelings, and behaviors associated with symptoms or general health conditions. To be diagnosed with SSD, you must have persistent symptoms that last at least six months .
As with most mental illnesses, there is no clear cause for the physical symptom disorder. However, several factors have been found that predispose a person to developing SSD :
- Age: People who develop SSD are generally under the age of 30 when the condition develops.
- Gender: more common in women than in men.
- Genetics: A family history of SJS or anxiety disorders has been associated with the development of this condition.
- Personality: The disorder is more common in people who are very sensitive to physical or emotional pain, or in people with a negative outlook.
- Personal history: People who have suffered physical or sexual abuse may have a higher risk of developing SJS.
A diagnosis of a somatic symptom disorder is usually not made until the person has experienced a flood of unexplained physical symptoms, medical tests, and treatments. However, the physical symptoms do not need a medical explanation to diagnose SSD.
If your PCP suspects that you have STS, he or she may refer you to a psychiatrist who will ask you questions and perform additional tests to determine if you meet the criteria set forth in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Number 5 (DSM – 5).
Many medical conditions are idiopathic (that is, of unknown origin). Although the symptoms are very real and occur in certain groups with a common pattern, the actual mechanisms of these diseases have not yet been established. An example is chronic fatigue syndrome , which in the past was considered psychosomatic by many, especially in women.
Features that differentiate SSD from idiopathic diseases include:
- Symptoms of SJS most commonly include pain in various parts of the body (including the back, joints, head, or chest), organ dysfunction (gastrointestinal tract, respiratory system, etc.), fatigue , and exhaustion.
- People with SJS often have a variety of physical symptoms and associated mental and psychosocial problems that make symptoms worse or worse. For example, work-related stress can cause respiratory symptoms without any organic or chemical causes.
- People with STS tend to have trouble regulating emotions – the ability to respond to situations in a socially acceptable and proportionate way. It is not uncommon for people with SSD to be overly active or unable to shake off emotional distress.
- People with STS often jump to see doctor after doctor for a diagnosis or treatment, without informing everyone that they have received the same tests or treatment from another doctor.
Many of the emotional characteristics of SJS – worrying about symptoms or worsening symptoms due to emotional triggers – can occur in anyone with a chronic or chronic medical condition.
What distinguishes SSDs is that excessive thoughts, feelings, or behaviors manifest themselves in at least one of three distinctive ways:
- The thoughts are persistent and disproportionate to the severity of the symptoms.
- Consistently high levels of anxiety about your health or symptoms.
- These symptoms or health problems take too much time and energy.
If one or all of these emotional traits affect your ability to function normally, SSD is a possible cause.
Changes in diagnostic criteria in DSM-5
Somatic Symptom Disorder was introduced into the DSM-5 in 2013 and the following diagnoses were removed from the DSM-IV:
People who have been previously diagnosed with these conditions are very likely to meet the current criteria for SSD.
Other changes to DSM-5 include:
Psychiatric conditions associated with physical symptom disorder include:
- Anxiety disorder disease (IAS) , formerly known as hypochondria, is a concern for the presence or development of a serious medical condition. People with SAI may or may not have a diagnosed medical condition, but in most cases they will not have a serious medical condition. A person with NOS may believe, for example, that a cough is a sign of lung cancer or that a bruise is a sign of AIDS.
- Conversion disorder (CD) , also known as functional neurological symptom disorder, is characterized by the appearance of neurological symptoms (such as paralysis, seizures, blindness, or deafness) without any organic or biochemical cause. In times past, these phenomena used to be called "hysterical blindness" or "hysterical paralysis."
- Psychological Factors Affecting Other Illnesses (PFAOMC) is a DSM-5 classification in which a psychological or behavioral problem negatively affects overall health. This may include lack of adherence to a treatment regimen or behavior that prolongs the disease, aggravates symptoms, or consciously compromises health.
- A pseudo disorder (PD) is diagnosed when a person acts when they have an illness by pretending, exaggerating, or causing symptoms, often to induce someone to help them. People with FD often seek medical tests, describe challenging but pressing medical conditions, and often end up in the hospital .
- Other Specific Somatic Symptom and Related Disorder (OSSSRD) is a category in which symptoms do not meet the diagnostic criteria for SDD but still cause significant distress. With OSSSRD, symptoms appear for less than six months. An example is pseudocyesis, in which a woman mistakenly believes that she is pregnant, due to perceived changes in breast size or fetal movement in her abdomen .
Treatment for SDD varies from person to person. If a person is aware that concern about symptoms is affecting their quality of life, cognitive behavioral therapy (CBT) can help identify and correct distorted thoughts, unfounded beliefs, and behaviors that cause health problems.
CBT is often used in conjunction with mindfulness therapy, including meditation, to eliminate self-criticism, reflection, and negative moods or thoughts .
A more serious problem arises when a person with SSD clings to the belief that their symptoms have a physical cause despite a lack of evidence or extensive medical examination. Often these people are brought in by a spouse or family member who has also been negatively affected by the abnormal thoughts and behavior of their loved one.
Selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants may be prescribed as needed, and both have been shown to be effective in relieving SJS symptoms .
Other antidepressants, such as monoamine oxidase inhibitors (MAOIs) and Wellbutrin (bupropion), are ineffective in treating SJS and should be avoided. The same applies to anticonvulsants and antipsychotics commonly used in the treatment of mood and anxiety disorders .
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A diagnosis of SJS can be disconcerting, but with the right counseling and therapy, you can begin the process of regaining your quality of life and your ability to function normally without fear taking over. Don't expect things to change overnight; persistence is the key to success. If you are still unsure of your diagnosis, don't be afraid to seek the advice of a board certified psychiatrist .