What are the somatic symptoms and related disorders?

Somatic symptom disorder (SSD formerly known as "somatization disorder" or "somatoform disorder") is a form of mental illness that causes one or more bodily symptoms, including pain. The symptoms may or may not be traceable to a physical cause including general medical conditions, other mental illnesses, or substance abuse. But regardless, they cause excessive and disproportionate levels of distress. The symptoms can involve one or more different organs and body systems, such as:

• Pain
• Neurologic problems
• Gastrointestinal complaints
• Sexual symptoms

Many people who have SSD will also have an anxiety disorder.

People with SSD are not faking their symptoms. The distress they experience from pain and other problems they experience are real, regardless of whether or not a physical explanation can be found. And the distress from symptoms significantly affects daily functioning.

Doctors need to perform many tests to rule out other possible causes before diagnosing SSD.

The diagnosis of SSD can create a lot of stress and frustration for patients. They may feel unsatisfied if there's no better physical explanation for their symptoms or if they are told their level of distress about a physical illness is excessive. Stress often leads patients to become more worried about their health, and this creates a vicious cycle that can persist for years.

Disorders Related to Somatic Symptom Disorder

Several conditions related to SSD are now described in psychiatry. These include:

• Illness Anxiety Disorder (formerly called Hypochondriasis). People with this type are preoccupied with a concern they have a serious disease. They may believe that minor complaints are signs of very serious medical problems. For example, they may believe that a common headache is a sign of a brain tumor.

• Conversion disorder (also called Functional Neurological Symptom Disorder). This condition is diagnosed when people have neurological symptoms that can't be traced back to a medical cause. For example, patients may have symptoms such as:
  • Weakness or paralysis
  • Abnormal movements (such as tremor, unsteady gait, or seizures)
  • Blindness
  • Hearing loss
  • Loss of sensation or numbness
  • Seizures (called nonepileptic seizures and pseudoseizures) 

Stress usually makes symptoms of conversion disorder worse.

• Other Specific Somatic Symptom and Related Disorders. This category describes situations in which somatic symptoms occur for less than six months or may involve a specific condition called pseudocyesis, which is a false belief women have that they are pregnant along with other outward signs of pregnancy, including an expanding abdomen; feeling labor pains, nausea, fetal movement; breast changes; and cessation of the menstrual period.

Treatment of Somatic Symptom Disorders

Patients who experience SSD may cling to the belief that their symptoms have an underlying physical cause despite a lack of evidence for a physical explanation. Or if there is a medical condition causing their symptoms, they may not recognize that the amount of distress they are experiencing or displaying is excessive. Patients may also dismiss any suggestion that psychiatric factors are playing a role in their symptoms.

A strong doctor-patient relationship is key to getting help with SSD. Seeing a single health care provider with experience managing SSD can help cut down on unnecessary tests and treatments.

The focus of treatment is on improving daily functioning, not on managing symptoms. Stress reduction is often an important part of getting better. Counseling for family and friends may also be useful.

Cognitive behavioral therapy may help relieve symptoms associated with SSD. The therapy focuses on correcting:

• Distorted thoughts
• Unrealistic beliefs
• Behaviors that feed the anxiety