Somatic Symptom Disorder (SSD)

Formerly referred to as somatization disorder, somatic symptom disorder is characterized by an individual's disproportionate emphasis on physical symptoms, which can cause significant emotional distress and affect their thoughts, feelings, and behaviors on an everyday basis. Medically unexplained physical symptoms (MUPS) are the main characteristic of SSD. These symptoms might not be connected to any diagnosed medical condition or could be more severe than expected from a physical illness. It's also possible for the symptoms to change or for new symptoms to develop. The individual often experiences high anxiety about the possibility of a serious medical condition.

Common physical symptoms associated with SSD include:

• Pain: Physical pain is one of the most frequent symptoms and can occur anywhere in the body. It might be chronic pain, like headaches, joint pain, back pain, or pain in multiple areas.
• Fatigue: A person may experience extreme tiredness that doesn't get better with rest.
• Weakness: This symptom might be a general physical weakness or a specific weakness in a particular area of the body.
• Shortness of breath or difficulty breathing: Respiratory symptoms can sometimes lead to panic attacks, where the individual has the sensation they can't catch their breath.

Other symptoms might include:

• Digestive symptoms: Nausea, bloating, diarrhea, or constipation
• Neurological symptoms: Dizziness or fainting spells
• Cardiac symptoms: Palpitations or chest pain
• Sexual symptoms: Sexual dysfunction or painful menstruation

Emotional and behavioral symptoms are also significant in SSD. These might include:

• Anxiety and excessive worry about physical symptoms
• Frequent doctor visits and medical tests
• Unresponsiveness to medical treatment or unusual sensitivity to medication side effects
• Frequently talking about the symptoms or searching for information about them online
• Avoiding physical activities out of fear of worsening the symptoms
• Having difficulty functioning in daily life due to the symptoms, like missing work or school

Additionally, the person might become highly preoccupied with their symptoms and constantly seek reassurance from healthcare providers or family and friends. However, even with reassurance, they might still have high anxiety about their health. They may become frustrated or believe they’re being misunderstood when medical tests don't reveal any underlying cause for their symptoms. This frustration can further contribute to distress and preoccupation with physical symptoms and medical care.

Somatic symptom disorder is a complex condition with causes that are not entirely understood. A combination of physical, psychological, and environmental factors may contribute to the development of this disorder.

Physical factors

Below are some potential physical causes of somatic symptom disorder: 

• Certain physical illnesses and conditions can make individuals more prone to experience somatic symptoms.
• Some individuals may have a heightened sensitivity to pain, making them more likely to perceive and report physical symptoms.
• Neurobiological factors might be involved, like differences in brain structure and function.

Psychological factors

Below are some of the psychological factors that may be behind this condition: 

• Some individuals may focus excessively on their physical health and bodily sensations.
• Certain personality disorders or traits like neuroticism (a tendency to experience negative emotions) might contribute to developing SSD.
• Past trauma or stress can play a role in the development of somatic symptoms .

Environmental factors

The following environmental factors may impact the development of somatic symptom disorder: 

• Growing up in a family where health concerns were a primary focus might increase the risk of developing SSD.
• Experiencing significant stress or major life changes can contribute to the onset or exacerbation of somatic symptoms.
• Cultural factors can also influence how individuals experience and express physical symptoms and health concerns.

SSD is not the result of deliberate fabrication of symptoms. The pain and other symptoms that individuals with SSD experience are real, even if medical tests can't find an underlying physical cause. In addition, individuals with SSD often have a higher-than-average number of medically unexplained symptoms. Having a medical condition does not preclude the possibility of also having SSD. Some individuals with SSD have a diagnosed or undiagnosed medical condition but could experience physical symptoms that are more severe than expected based on their medical condition alone.

Treating somatic symptom disorder often involves addressing the physical symptoms and underlying psychological factors contributing to the disorder. Treatment often aims to help individuals better understand their symptoms, manage associated distress, and improve their overall quality of life.

Medication

Below are some medication options people with SSD may explore with their medical professional: 

• Antidepressant medications: These medications may reduce physical symptoms, improve mood, and decrease anxiety associated with the symptoms.
• Analgesics: Pain relievers (analgesics) may be prescribed for individuals with SSD who experience chronic pain. However, they are often used as a last resort due to the risk of addiction.
• Anti-anxiety medications: Anti-anxiety medications may reduce anxiety contributing to physical symptoms.

Consult your primary care physician or another provider before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatment options

Other treatment options for SSD could include the following: 

• Biofeedback:³ The biofeedback technique involves learning to control physiological functions to improve physical health. Biofeedback can be helpful for individuals with SSD who have symptoms like chronic pain or tension.
• Physical therapy: Physical therapy may benefit individuals with SSD who have musculoskeletal symptoms.
• Occupational therapy: This type of therapy may help individuals with SSD develop strategies to manage their symptoms and improve daily functioning. 

Self-care

There are steps people with SSD can take at home to improve their condition, including self-care strategies like the following: 

• Stress management techniques: Learning to manage stress may reduce physical symptoms. Techniques might include deep breathing, meditation, and progressive muscle relaxation.
• Regular physical activity: Exercise may reduce symptoms like pain and fatigue by boosting endorphins and serotonin levels.
• Healthy diet: Eating a balanced diet may reduce physical symptoms and improve overall well-being.
• Quality sleep: Ensuring enough sleep may prevent fatigue and other physical symptoms from exacerbating. 
• Avoiding alcohol and recreational drugs: Substances can worsen physical symptoms and make it more challenging to manage distress. 

Individuals with SSD can work closely with their healthcare providers to establish a comprehensive treatment plan. Because the symptoms of SSD are real, it can be essential to address the disorder's physical and psychological aspects. Treatment may involve a combination of therapies, medications, and self-care strategies. The specific treatment plan may depend on the individual's symptoms, the severity of the disorder, and any co-occurring conditions.

Therapy can be essential to managing somatic symptom disorder, as it addresses physical symptoms and psychological factors contributing to the condition. Online therapy can be a convenient and accessible option, allowing individuals to work with a mental health care provider from their homes. Platforms like BetterHelp connect individuals with licensed professionals from home via phone, video, or live chat sessions. 

In addition to online therapy, there are various other resources available for those living with SSD, including the following: 

• National Institute of Mental Health (NIMH): The NIMH provides resources and information on SSD, including ongoing research and potential treatment options.
• American Psychiatric Association (APA): The APA offers a range of resources on mental health conditions, including SSD, and may help you locate a therapist in your area.
• Anxiety and Depression Association of America (ADAA): The ADAA offers information about anxiety and depression, which often co-occur with SSD, and resources for managing these conditions. 
• National Alliance on Mental Illness (NAMI): NAMI provides support, advocacy, and education for individuals with mental health conditions, including SSD.

Some may find it helpful to connect with others with similar experiences. You can ask your healthcare provider or therapist about local support groups or explore online forums and social media groups dedicated to SSD. 

SSD is a real and challenging condition, but support is available. Whether through online therapy, support groups, or other resources, there are options to help you manage your symptoms and live a life of balance and health. 

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). 

Please see our Get Help Now page for more immediate resources.

Recent research has illuminated the role of specific psychological factors in somatization, particularly in the context of depressive disorders. 

In a study examining the interplay between negative psychological factors and somatization, researchers found that the presence of depressive disorders could incite responses in the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, which in turn could influence the severity of somatic symptoms. This study highlights the importance of understanding the impact of negative psychological factors on somatization and underscores the need for targeted interventions that address these factors in the context of somatic symptom disorder.

Another study has explored the potential health benefits of music for alleviating somatic symptoms. This research suggests that music-induced changes in the central nervous system could reduce biological stress levels and promote states of relaxation. These changes may, in turn, mitigate the perceived intensity and impairment associated with somatic symptoms. This study highlights the potential for alternative and complementary treatments, such as music therapy, to play a role in managing somatic symptom disorder. 

The results of this study are promising and suggest that incorporating music into the treatment plan may benefit some individuals with this condition. However, more research may be beneficial to determine its efficacy in relieving somatic symptom disorder. 

Below are several statistics on somatic symptom disorder:

• An estimated 5% to 7% of people are affected by somatic symptom disorder.
• SSD prevalence is higher in the elderly population at 63.2%, compared to 45.3% in the non-elderly population.
• A recent study found that 25.6% of people with fibromyalgia also meet the criteria for somatic symptom disorder. Among those, a significant 95% also meet the criteria for anxiety or depressive disorders, highlighting a high co-morbidity rate between SSD and other mental health conditions. 
• After trying cognitive-behavioral therapy, 23% of people with SSD saw a 50% reduction in somatic symptoms, which rose to 27% at follow-up. Moreover, about 70% experienced clinically significant symptom improvement.

These statistics highlight the prevalence of SSD and the risk factors which may contribute to it. Through evidence-based treatments and support, individuals with SSD may better manage their physical and psychological symptoms.