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Somatic Symptom Disorder

Somatic Symptom Disorder is characterized by persistent somatic (bodily) symptoms that cause significant distress or disruption in daily life. These symptoms are accompanied by excessive thoughts, feelings, or behaviors related to the symptoms or one’s or general health. Symptoms are generally unrelated to any serious medical condition; however, they may be related at times. The presence of “unexplained” medical symptoms are not by themselves sufficient for a diagnosis; rather, the individual’s thoughts, feelings, and behaviors surrounding these symptoms are a major factor. Whether the somatic complaints are medically explained or not, it is important to remember that the individual’s suffering is real.

Criteria

  1. One or multiple somatic complaints that cause distress or disruption in daily life.
  2. Excessive thoughts, feelings, and behaviors related to these symptoms or one’s overall health. At least one of the following is present:
  3. Persistent and disproportionate thoughts about the seriousness of these symptoms.
  4. Continuous high levels of anxiety about these symptoms or overall health.
  5. Excessive time and energy is allocated towards these symptoms or other health concerns.
  6. The individual continuously feels symptomatic, despite whether any one specific somatic symptom is present.

Some other associated features and behaviors:

  • Despite evidence to the contrary, the individual still perseverates on the severity of the somatic complaint.
  • The somatic symptoms may become part of that person’s identity and affect interpersonal relationships.
  • There is a high level of medical care utilization, or the patient consults multiple doctors for the same symptoms.
  • The individual may seem unresponsive to medical interventions or appear to feel worse afterwards.
  • Extreme sensitivity to the side effects of medication.
  • Perseverative attention allocated towards somatic complaints, inability to focus on other things or engage in tasks.
  • Hyperfocusing on somatic sensations or interpreting them as possibly catastrophic.
  • Co-occurring depression.

Prevalence

The prevalence of Somatic Symptom Disorder is still unknown, but estimated to be around 5%-7% in the adult population, more commonly occurring in females.

Etiology and Risk

Both biological and environmental factors can contribute to the development of Somatic Symptom Disorder. The personality trait “neuroticism” has been correlated with a higher number of somatic symptoms. Anxiety and depression may also co-occur, and could make symptoms worse. Stressful life events and low socioeconomic status predict these symptoms. Other demographics features commonly associated include: sex (female), a history of sexual abuse, social stress, and a co-occurring psychiatric disorder.

Culture

Because different cultures have different ways of expressing illness and suffering, the prevalence and form of this disorder will vary across cultural demographics. In some cultures, it is more acceptable to express physical pain rather than psychological. Thus, these symptoms may be an expression of psychological pain that has been confined due to stigmatization. Presentations may also take on different cultural “idioms,” depending on ways of expressing suffering in that culture. Across the world, there seems to be a connection between somatic complains and depressive symptoms.

Material summarized from:

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.

 

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