What would be most helpful to a person with somatic symptom disorder that involves pain?
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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: 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. Several conditions related to SSD are now described in psychiatry.
These include: Stress usually makes symptoms of conversion disorder worse. 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: Somatic symptom disorder is characterized by multiple persistent physical complaints that are associated with excessive and maladaptive thoughts, feelings, and behaviors related to those symptoms. The symptoms are not intentionally produced or feigned and may or may not accompany known medical illness. Diagnosis is based on history
from the patient and occasionally from family members. Treatment focuses on establishing a consistent, supportive physician-patient relationship that avoids exposing the patient to unnecessary diagnostic testing and therapies. The symptoms may or may not be associated with another medical problem; symptoms no longer have to be medically unexplained but are characterized by the patient having disproportionately excessive thoughts, feelings and concerns about them. Sometimes the
symptoms are normal body sensations or discomfort that do not signify a serious disorder. Patients are commonly unaware of their underlying psychiatric issue and believe that they have physical ailments, so they typically continue to pressure physicians for additional or repeated tests and treatments even after results of a thorough evaluation have been negative. Recurring physical complaints usually begin before age 30; most patients have multiple somatic symptoms, but some have only one severe symptom, typically pain. Severity may fluctuate, but symptoms persist and rarely remit for any extended period. The symptoms themselves or excessive worry about them is distressing or disrupts daily life.
Some patients become overtly depressed. When somatic symptom disorder accompanies another medical disorder, patients overrespond to the implications of the medical disorder; for example, patients who have had complete physical recovery from an uncomplicated myocardial infarction (MI) may continue to behave as invalids or constantly worry about having another MI. Whether or not symptoms are related to another medical disorder, patients worry excessively about the symptoms and their
possible catastrophic consequences and are very difficult to reassure. Attempts at reassurance are often interpreted as the physician not taking their symptoms seriously. Health concerns often assume a central and sometimes all-consuming role in a patient's life. Patients are very anxious about their health and frequently seem unusually sensitive to adverse drug effects. Any body part may be affected, and specific symptoms and their frequency vary among cultures. Whatever the
manifestations, the essence of somatic symptom disorder is the patient's excessive or maladaptive thoughts, feelings, or behaviors in response to the symptoms. Patients may become dependent on others, demanding help and emotional support and becoming angry when they feel their needs are not met. They may also threaten or attempt suicide. Often dissatisfied with their medical care, they typically go from one physician to another or seek treatment from several physicians concurrently. The
intensity and persistence of symptoms may reflect a strong desire to be cared for. Symptoms may help patients avoid responsibilities but may also prevent pleasure and act as punishment, suggesting underlying feelings of unworthiness and guilt. Usually clinical criteria Symptoms must be distressing or disruptive of daily life for > 6 months and be associated with at least one of the following:
At first presentation, physicians take an extensive history (sometimes conferring with family members) and do a thorough examination and often testing to determine whether a physical disorder is the cause. Because patients with somatic symptom disorder may subsequently develop physical disorders, appropriate examinations and tests should also be done when symptoms change significantly or when objective signs develop. However, once a medical disorder has clearly been excluded or a mild disorder has been identified and treated, physicians should avoid repeating tests; patients are rarely reassured by negative test results and may interpret continued testing as confirmation that the physician is uncertain the diagnosis is benign. Pearls & Pitfalls
Patients, even those who have a satisfactory relationship with a primary physician, are commonly referred to a psychiatrist. Pharmacologic treatment of concurrent mental disorders (eg, depression) may help; however, the primary intervention is psychotherapy, particularly cognitive-behavioral therapy. Patients also benefit from having a supportive relationship with a primary care physician, who coordinates all of their health care, offers symptomatic relief, sees them regularly, and protects them from unnecessary tests and procedures. Click here for Patient Education Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.  What is the best treatment for somatic symptom disorder?Cognitive behavior therapy and mindfulness-based therapy are effective for the treatment of somatic symptom disorder.
How is somatic pain treated?Doctors will often use drugs to treat somatic pain. Over-the-counter medications you can take include: NSAIDs, such as aspirin, naproxen (Aleve), and ibuprofen (Advil) acetaminophen (Tylenol). baclofen.. cyclobenzaprine (Flexeril). metaxalone.. opioids, including hydrocodone and oxycodone.. What would be most helpful to a person with pain disorder?Medical treatments, including medication, surgery, rehabilitation and physical therapy, may be helpful for treating chronic pain. Psychological treatments are also an important part of pain management.
Which interventions are used to care for clients with somatic symptom disorders?Various forms of psychotherapy have been recommended for somatoform disorder. Evidence supports the role of cognitive behavior therapy (CBT), mindfulness-based interventions, acceptance and commitment therapy, and relaxation therapy in the management of individual subtypes of somatoform disorders [Table 7].
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