Somatic Symptom Disorder

Somatic Symptom Disorder, as outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), represents a significant shift in how mental health professionals understand and approach somatic symptoms. Somatic Symptoms refer to physical symptoms that are either significantly distressing or result in notable disruption of daily life, but lack a fully explanatory medical or neurological basis. These symptoms are not feigned or intentionally produced, and they are often linked to psychological distress. Somatic Symptom Disorder is characterised by an excessive focus on these physical symptoms, such as pain or fatigue, which cause significant emotional distress and problems functioning. The individual has excessive thoughts, feelings, or behaviours related to the somatic symptoms.

Key aspects of the psychological analysis of Somatic Symptom Disorder include:

1. Symptom Perception and Interpretation: Individuals with this disorder often have heightened awareness of their bodily sensations and interpret them as indicative of a serious illness, despite medical reassurance to the contrary.
2. Cognitive Distortions: There is often a presence of catastrophic thinking, where the individual assumes the worst about their symptoms. This can lead to heightened anxiety and preoccupation with health concerns.
3. Emotional Distress: The disorder is often accompanied by significant distress and impairment in social, occupational, or other important areas of functioning, not merely the direct physiological effects of the symptoms themselves.
4. Health-Related Behaviours: This might include excessive health-related behaviours (e.g., repeatedly checking the body for signs of illness) or maladaptive avoidance (e.g., avoiding doctor visits and hospitals).
5. Duration: For a diagnosis, the somatic symptoms must be persistently present, typically for more than six months.
6. Not Deliberately Produced Symptoms: Unlike Factitious Disorder or Malingering, the symptoms in Somatic Symptom Disorder are not intentionally produced or feigned.
7. Relationship with Medical Conditions: The disorder can occur with or without a coexisting medical condition. The key is not the presence or absence of a medical condition but how the individual reacts to and interprets the symptoms.
8. Cultural and Social Influences: Cultural factors can influence how symptoms are experienced and expressed. The expression of somatic symptoms can be a culturally acceptable way of expressing psychological distress.

The treatment for Somatic Symptom Disorder often involves a multidisciplinary approach, including cognitive-behavioural therapy (CBT), which helps in restructuring maladaptive beliefs about symptoms, and mindfulness-based therapies to help manage distress. It’s also essential for healthcare providers to establish a supportive and non-confrontational relationship with the patient, avoiding implying that the symptoms are “all in their head”. Regular, scheduled visits rather than symptom-based visits are often recommended to avoid reinforcing the illness behaviour.

NOTE: Somatic Symptom Disorder and Functional Neurological Symptom Disorder (FNSD) have some similarities but they are fundamentally different diagnosis.