Some people have excessive and unrealistic worries about their health. They are very worried about getting a disease or are certain they have a disease, even after medical tests show they do not. And these people often misinterpret minor health problems or normal body functions as symptoms of a serious disease. An example is a person who is sure that their headaches are caused by a brain tumor. This condition used to be called hypochondria. Now it is called somatic symptom disorder. The symptoms associated with somatic symptom disorder are not under the person's voluntary control, and they can cause great distress and can interfere with a person's life.
Somatic symptom disorder can happen at any time of life, but most often begins in early adulthood. It affects men and women equally.
What Are the Features of Somatic Symptom Disorder?
People with somatic symptom disorder -- thought of as being hypochondriacs -- are worried about having a physical illness. The symptoms they describe can range from general complaints, such as pain or tiredness to concerns about normal body functions, such as breathing or stomach noises. People with somatic symptom disorder are not faking or lying about their symptoms; they truly believe they are sick. Or, if they do have an actual physical illness, their level of worry and distress is out of proportion to the condition.
Warning signs that a person might have somatic symptom disorder include:
- The person has a history of going to many doctors. They may even "shop around" for a doctor who will agree that they have a serious illness.
- The person recently experienced a loss or stressful event.
- The person is overly concerned about a specific organ or body system, such as the heart or the digestive system.
- The person's symptoms or area of concern might shift or change.
- A doctor's reassurance does not calm the person's fears; they believe the doctor is wrong or made a mistake.
- The person's concern about illness interferes with their work, family, and social life.
- The person may suffer from anxiety, nervousness, and/or depression.
What Causes Somatic Symptom Disorder?
The exact cause of somatic symptom disorder is not known. Factors that might be involved in the development of the disorder include:
- A history of physical or sexual abuse
- A history of having a serious illness as a child
- A poor ability to express emotions
- A parent or close relative with the disorder; children might learn this behavior if a parent is overly concerned about disease and/or overreacts to even minor illnesses
- An inherited susceptibility for the disorder
How Is Somatic Symptom Disorder Diagnosed?
Diagnosing somatic symptom disorder can be very difficult, because people with the disorder are convinced their symptoms and feelings of distress are explainable by a medical illness."
When symptoms appear, the doctor will begin their evaluation with a complete history and physical exam. If the doctor finds no physical reason for the symptoms, they might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on their assessment of the person's attitude and behavior, and the fact that physical illness has been ruled out as the cause of the symptoms. The psychiatrist or psychologist may administer a personality assessment to confirm the diagnosis of somatic symptom disorder.
How Is Somatic Symptom Disorder Treated?
A main goal of somatic symptom disorder treatment is to help patients live and function as normally as possible, even if they continue to have symptoms. Treatment also aims to alter the thinking and behavior that leads to the symptoms.
The disorder can be very difficult to treat. This is due, in part, to the fact that people who have it refuse to believe their symptoms and distress are the result of mental or emotional rather than physical causes.
Treatment for somatic symptom disorder most often includes a combination of the following options:
- Supportive care: In most cases, the best course of action is for the person to stay in regular contact with a trusted health care provider. Within this doctor-patient relationship, the doctor can monitor the symptoms and stay alert to any changes that might signal a real medical illness. The doctor's main approach is likely to focus on reassuring and supporting the person, and preventing unnecessary tests and treatments. It might be necessary, however, to treat some of the symptoms, such as severe pain.
- Medications: Antidepressant or anti-anxiety drugs are sometimes used if a person with somatic symptom disorder also has a mood disorder or anxiety disorder.
- Psychotherapy: Psychotherapy (a type of counseling), particularly cognitive therapy, can be helpful in changing the thinking and behavior that contribute to the symptoms. Therapy also can help the person learn better ways to deal with stress, and improve their social and work functioning. Unfortunately, most people with somatic symptom disorder deny there are any mental or emotional problems, making them fairly resistant to psychotherapy.
What Complications Are Associated With Somatic Symptom Disorder?
A person with somatic symptom disorder is at risk for repeated episodes of symptoms. They also might suffer from reactions or health problems related to multiple tests, procedures, and treatments. In addition to the pain and frustration this disorder often causes to the person and their family, repeated episodes also can lead to unnecessary and risky procedures, as well as high medical bills and trouble functioning in daily life. Further, genuine medical problems can be missed in a person with a long history of having tests with negative results, because doctors may assume the person's complaint is caused by a psychiatric problem, rather than a real physical illness.
What Is the Outlook for People With Somatic Symptom Disorder?
This disorder tends to be a chronic (long-term) condition that can last for years. In many cases, symptoms can recur. Only a small percentage of patients recover completely. For that reason, the focus of treatment is on learning to manage and control symptoms, and on minimizing functional problems associated with the disorder.
Can Somatic Symptom Disorder Be Prevented?
There is no known way to prevent somatic symptom disorder. However, providing the person with an understanding and supportive environment might help decrease the severity of the symptoms and help them better cope with the disorder.