Somatic symptom disorder is a clinical term that refers to both a specific psychiatric condition and to other related disorders.
Somatic symptom disorders all include physical symptoms ranging from pain to paralysis. The origin of these symptoms is psychosomatic in some conditions and physical in others. What connects all of the somatic disorders is that the psychological reaction to these symptoms is excessive or disproportionate.
In other words, the somatic symptom disorder definition requires people to have somatic symptoms as well as maladaptive psychological reactions to them. People with this disorder spend a lot of time and energy worrying about their physical sensations and what they mean. They may take actions to address these symptoms that are unnecessary and excessive.
Somatic symptom disorder and related conditions sometimes worsen treatment outcomes for medical conditions or interfere with activities of daily living. Somatic symptom disorder treatment can help improve quality of life for people with these conditions.
Medications for Somatic Symptom Disorder
While medications are not the primary intervention for somatic disorders, they can be used to relieve the specific symptoms of these conditions. They are more commonly used when people have co-occurring mental health conditions like anxiety and depression.
Antipsychotic medications are sometimes used in the treatment of conversion disorder and somatic symptom disorder, but research does not generally support their efficacy in treating these conditions. They may be useful in extreme cases of conversion disorders when psychosomatic symptoms include significant motor disturbances.
In a clinical analysis of research data on somatic symptom disorder, Stuart Kurlansik and Mario Maffei report that antidepressants are an effective treatment for the condition. They conclude that tricyclic antidepressants are more effective than selective serotonin reuptake inhibitors (SSRIs), though fluoxetine (Prozac) works to a lesser degree. Both kinds of antidepressants reduced pain, improved global functioning and sleep and increased overall feelings of well-being in people with somatic symptom disorder.
Antidepressants have also been shown to be effective in the treatment of illness anxiety disorder and conversion disorder. They are not typically used to treat a factitious disorder or psychological factors affecting other medical conditions. These conditions are typically treated with therapy alone.
Therapy for Somatic Symptom Disorder
The primary intervention for somatic disorders is psychotherapy or any form of therapy in which a person meets with a therapist to discuss and work on psychological problems. People with somatic disorders experience the best outcomes when they coordinate psychotherapy with the work they are doing with their medical doctors to address their physical symptoms.
Research suggests that the treatment of somatic symptom disorder is more successful when the person receiving treatment has a strong relationship with their physician. Since people with somatic disorders typically believe that an underlying medical condition causes their symptoms, ongoing work with a doctor can build trust and facilitate symptom and pain management. This trust-based relationship can also illuminate when symptoms do have physiological causes. Doctors should be careful to limit medical tests and communicate clearly with patients about conditions that have been ruled out as causes of their symptoms.
Cognitive Behavioral Therapy
Cognitive behavior therapy (CBT) is the primary intervention for all somatic symptom disorders. While people with somatic symptom disorder, illness anxiety disorder or psychological factors affecting a medical condition may have symptoms that are not psychosomatic, they generally experience more distress from how they think about the symptoms than from the symptoms themselves.
Cognitive behavioral therapy was designed specifically to address the relationship between irrational thinking and emotional and behavioral distress. By helping people identify cognitive distortions, such as beliefs that their symptoms signal something much worse than they do, CBT therapists can help people with somatic disorders become more aware of these thoughts and start to change them. For example, someone with somatic symptom disorder can counter thoughts that they need to go to the doctor to get a new symptom checked by reminding themselves that their doctor has already ruled out the condition that they’re concerned about.
Thoughts become less powerful when people realize that they don’t have to believe them. Another therapeutic method that provides relief from anxious thinking is acceptance and commitment therapy (ACT). This intervention also targets distorted thoughts but does not task people with changing them. Instead, ACT techniques help people to learn how to let thoughts arise and fall without acting on them. Both CBT and ACT are effective treatments for somatic disorders.
Acceptance and commitment therapy is one type of mindfulness-based cognitive therapy that can be useful in the treatment of somatic disorders. There are many other mindfulness-based interventions with a similar approach. Dialectical behavior therapy (DBT) is another treatment that utilizes both mindfulness and CBT techniques to help people reduce anxiety and improve emotional regulation through calm awareness of the mind and body.
Stress reduction techniques may be especially important for people with somatic disorders. These include progressive relaxation, CBT exercises and mindfulness-based stress reduction. Mindfulness techniques draw from the practice of meditation and use techniques like breath and posture awareness that may help people shift their focus from anxious thoughts to the physical sensations that anchor them to the present moment. By encouraging a more refined awareness of physical sensations, these practices can help people with somatic disorders observe bodily phenomena with less anxiety.
Research shows that somatic symptoms are more common in people with high levels of stress-related exhaustion, especially pain and fatigue. Nausea and headaches also frequently arise as stress-related somatic symptoms. For some people, chronic stress may cause transient somatic symptoms that fade as soon as the stress does. For others, these stressors may lead to the development of chronic somatic symptom disorders.
Many research studies, including one by Carmody and Baer, have proven that mindfulness-based stress reduction programs are effective not only in reducing stress but also in improving stress-related somatic and psychological symptoms.
Treatment for Somatic Symptom Disorder and Co-Occurring Conditions
Somatic disorders can cause an overall increase in anxiety, and comorbid mental health conditions often increase somatic symptoms, especially pain and fatigue. People with these disorders are at increased risk of developing co-occurring substance use disorders, which can worsen the physical discomfort associated with somatic symptoms and lead to other complications.
It’s important for people with somatic disorders and co-occurring conditions to receive integrated treatment that addresses all of their symptoms. Fortunately, the most effective interventions for somatic disorders, especially CBT, also work well in the treatment of anxiety, depression and substance use disorders. An integrated program of group and individual CBT that coordinates care with a trusted physician will lead to the best outcomes for people with somatic disorders.
The Recovery Village operates rehab facilities across the United States that offer integrated treatment options for people with co-occurring substance use and mental health disorders. To learn more about how treatment can help you or someone you care about recover from these conditions and start feeling better, contact a representative from The Recovery Village today.