What is somatic symptom disorder?
Somatic symptom disorder is characterized by multiple recurrent somatic symptoms that are distressing or causes a disruption in the individual's daily life. Pain is typically the most common symptom. The individual's suffering is authentic, whether or not it is medically explained. The prevalence of somatic symptom disorder is estimated to be 5-7%, and it is seem more in women than men.
Somatic symptom disorder is a new addition to the DSM-5 and it encompasses the previous diagnoses:
- Somatization disorder
- Hypochondriasis (75%)
- Pain disorder
- Undifferentiated somatoform disorder
What does somatic symptom disorder look like?
Risk Factors
- Low education level
- Low socioeconomic status
- Adverse childhood events
- Maternal insensitivity during infancy
- Recent stressful life events
Prognosis
- Affected individuals have poorer health status scores
- Comorbid anxiety or depression is common and may exacerbate symptoms and impairment
Differential Diagnosis
- Other medical conditions
- Panic disorder
- Generalized anxiety disorder
- Depressive disorders
- Illness anxiety disorder
- Conversion disorder
- Delusional disorder
- Body dysmorphic disorder
- Obsessive-compulsive disorder
How is somatic symptom disorder investigated?
How is somatic symptom disorder treated?
Goals of treatment
- Reduce anxiety and stress related to the somatic symptoms
- Avoid unnecessary medical investigations, treatments, and medications
- Selective serotonin reuptake inhibitors (SSRI) can help with affect instability, mood, and anxiety symptoms but do not improve somatic symptoms
Special Considerations
Children & Teenagers
The most common symptoms in children are:
- Recurrent abdominal pain
- Headache
- Fatigue
- Nausea
A single prominent symptom is more common in children than in adults. Pre-adolescent children may be less likely to worry about potential "illness". The way that their parents respond to the symptom(s) can determine the child's associated distress, as they role model how to interpret the symptoms that the child experiences.
Older Adults
Older adults may experience more functional decline.
Nursing Management
Causes & Behaviors:
- Verbalization of numerous physical complaints in the absence of any pathophysiological evidence
- Focus on the self and physical symptoms
Interventions:
- Acknowledge that the client is suffering
- Provide pain medication if indicated
- Encourage the use of CBT, relaxation, and mindfulness techniques
- Encourage the client to verbalize fears and anxieties
- Encourage the client to keep a journal of their symptoms and stressors so that they can monitor for trends and avoid triggers
References
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.
[3] Henningsen, P. (2018). Management of somatic symptom disorder. Dialogues in Clinical Neuroscience, 20(1), 23–31.(2020) Somatic and anxiety symptoms of depression are associated with disability in late life depression. Aging & Mental Health, 24(8), 1225-1228.
[5] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.