Somatic

Psychosomatic medicine is an interdisciplinary field that evaluates how psychological and biopsychosocial factors affect an individual's physiological well-being and vice versa. 

The term “somatic” is clinically used to describe somatic symptom disorders.² Initially classified as somatoform disorders in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), the classification of psychological disorders exhibiting somatic symptoms has been replaced in the newest edition (the DSM-V) as “somatic symptom and related disorders” due to changes in diagnostic criteria.   

According to the DSM-V, a diagnosis³ of somatic symptom disorder (SSD) requires one or more of the following psychological symptoms:

• Disproportionate preoccupation with the urgency of one's symptoms.
• Excessive anxiety about one's health or symptoms.
• Undue expenditure of time and energy on the symptoms or related health concerns.

Diagnosis depends on the physical systems' emergence, persistence, and severity. Individuals must display one or more of the following symptoms significantly interfering with daily functioning:

• A history of pain in the extremities, head, back, chest, abdomen, joints, and rectum. Persistent pain during urination, sexual intercourse, and menstruation are also included in this category. 
• A history of gastrointestinal issues other than or excluding pain or pregnancy-related symptoms. These symptoms include nausea, vomiting, bloating, diarrhea, and food intolerance. 
• A history of sexual or reproductive symptoms excluding pain, including erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, excessive vomiting throughout pregnancy, and sexual indifference.

There is also an extensive list of neurological symptoms or deficits associated with somatic symptom disorder that may or may not feature pain. The presence of such symptoms is sometimes called functional neurological symptom disorder or conversion disorder. 

These symptoms may include seizures, hallucinations,⁴ difficulty swallowing or a lump in the throat, loss of pain sensation or touch, blindness, double vision, deafness, impaired balance or coordination, localized weakness, urinary retention, amnesia, and loss of consciousness other than fainting.

When diagnosing SSD, psychologists note whether the physical symptoms primarily involve pain and are severe enough to impair daily functioning for six months or more. They may also document if the symptoms are classified as mild, moderate, or severe according to the fulfillment of DSM-V criteria.

The diagnosis of somatic disorders is a topic of debate among some in the medical community, and as such, can benefit from empathy and care in healthcare environments. Some medical professionals caution that SSD may not necessarily be the cause of somatic symptoms but is a co-occurrent condition of an existing medical condition and should be approached as such during diagnosis.

Somatic disorders have long brought attention to the debate over the mind-body relationship. The mind-body connection may be used by some professionals to explore the interplay between psychological experiences and physical sensations, facilitating the integration of bodily sensations and emotional processing.

Two psychological schools of thought (rooted within metaphysical philosophy) currently exist regarding how and if the mind and body are connected: dualism and monism.

Dualism

Dualism in psychology suggests that the human mind and body are separate and distinct interacting entities. According to Cartesian Dualism (named after René Descartes, a French philosopher and mathematician), the mind (or soul) is immaterial and possesses consciousness. At the same time, the body is material and operates according to the laws of physics. Descartes famously stated, "I think, therefore I am," emphasizing the importance of consciousness and self-awareness as evidence of the mind's existence.

Another school of dualism is property dualism, which acknowledges that mental and physical properties are distinct but doesn't necessarily assert the existence of two separate substances. It suggests that mental properties, like thoughts, emotions, and consciousness, cannot be reduced to or explained solely by physical properties, such as neural activity.

It's worth noting that dualism has been heavily criticized in modern philosophy and psychology for several reasons. However, while contemporary psychology tends to align more with physicalist or monist perspectives (largely due to advances in neuroscience and society’s understanding of the brain), the nature of consciousness and its connection with the physical world remains a complex and debated topic. 

Monism

Monism is a philosophical perspective in psychology that posits that only one fundamental substance, reality, or principle underlies all aspects of the universe, including mental and physical phenomena. Monism recognizes that emotions, thoughts, and psychological states can directly impact bodily sensations and health. There are several variations of monism, each emphasizing a different aspect of reality, but materialism (physicalism) and idealism are two regularly referenced within a psychological context. 

Materialism asserts that everything, including mental processes and consciousness, can be explained in terms of physical matter and the interactions of physical particles. This view contends that the mind is a product of the brain's neural activity and that mental phenomena can ultimately be reduced to biological processes.

Idealism proposes that the physical world derives from or depends on the mind or consciousness. In this view, reality is fundamentally mental in nature, and the external world is a product of subjective experience.

Somatic therapy

Somatic therapy,⁵ sometimes known as body-centric therapy, addresses the treatment of mental disorders with a focus on the bodily aspects of mental health. This type of therapy typically includes a variety of techniques focusing on both mind and body. Some somatic treatments include the following. 

Breathwork

Intentional, mindful breathing may promote body awareness by consciously focusing on the breath. This process may link the body and mind—cultivating an understanding of how thoughts and emotions can affect the nervous system. 

Brainspotting 

This type of therapy identifies locational points within a client’s field of vision (brain spots) associated with trauma. This trauma may exist at different levels of the conscious or subconscious mind, but regardless, can act as a potential cause of somatic symptoms. The purpose of brainspotting is to help clients disassociate these points from emotional events. 

Psychologists may identify a patient's brain spot(s) by watching the client and paying close attention to their gaze patterns. In some cases, an individual may already present a brain spot for the therapist to address and work with. When a brain spot emerges, the individual is directed to focus on that location while recreating or evoking a traumatic memory. The purpose is to effectively process the event within a safe, supportive environment by directing attention to the emotional connection with physical sensation. 

Eye-Movement Desensitization Reprocessing (EMDR)

Eye-movement desensitization and reprocessing therapy (EMDR) is a somatic therapy that uses physical stimulation of the left and right bodily hemispheres to diminish the intensity of a traumatic memory. During this treatment, the therapist may ask the client to evoke a traumatic memory while exposed to bilateral stimulation like eye movements, physical taps, or audio tones. This treatment aims to change how the memory is stored in the brain. During the process, the individual may be encouraged to become mindful of their bodily sensations and associated emotions.

Somatic therapists often include EMDR in treatment plans for patients with post-traumatic stress disorder (PTSD), anxiety, depression, and dissociative disorders.

Hakomi

Hakomi translates as "How do you stand concerning these many realms?" in the Hopi language. Therapists who use the Hakomi technique focus on body language, gestures, and posture while exploring traumatic memories with clients to uncover potential subconscious associations and memories. This type of therapy also requires the therapist to stay mindful of the link between the client's own conscious experiences and bodily sensations. 

Sensorimotor psychotherapy

Sensorimotor therapy allows a client to safely re-experience a past trauma and carry out unfinished actions from that event. This process may bring a client a sense of closure and completeness.

For those experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Lifestyle changes 

Some psychologists recommend cultivating a yoga or meditation practice to supplement somatic therapy. They may also combine somatic therapeutic methods with talk therapy, such as cognitive-behavioral therapy (CBT) and, in some cases, medication as a treatment for somatic symptoms.

Some forms of somatic therapy may not be suitable for specific individuals—for example, those who experience frequent dissociation, have severe medical conditions, or are pregnant. Somatic therapy is facilitated by a licensed mental health professional with experience in using these methods. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Current research on somatic symptom disorder yields some insight into the nature of the condition, its etiology, and treatment effectiveness. 

Some of this research explores how connectivity within the brain's systems may differ in people with SSD. A 2019 study from researchers at Chung-Ang University in the Republic of Korea assessed the brain activity of 18 individuals with SDD and 20 without using a form of MRI called functional magnetic resonance imaging (fMRI). The results indicated increased functional connectivity within a few networks, most notably the network involved in integrating emotional and sensory stimuli (the salience network). 

Research may also reveal potential alternatives to standard treatment methods such as somatic therapy and psychotherapy. For example, a case study and literature review published in Progress in Neurology and Psychiatry suggests that electroconvulsive therapy (ECT) may be a highly effective option for treatment-resistant SSD. Finding alternative approaches to treatment-resistant SSD can be a vital area of research, as some individuals with this type of SSD experience urgent physical deterioration.