Somatic Symptom Disorder describes the experience of a person who is extremely worried about some existing physical symptoms that doctors and other medical specialists cannot explain. These symptoms can be many:

• pain (muscles, bones, joints, etc.)

• fatigue (lack of energy, tiredness, etc.)

• problems with organs (commonly digestive organs like stomach or intestine, or sexual organs)

• skin problems

The name “Somatic Symptom Disorder” appeared in 2013 with the publication of the 5th version of the American classification of mental illnesses (DSM-5). It is similar to other conditions called “Illness Anxiety Disorder” and “Health Anxiety”, in which the person is worried of getting ill.

As always, these classifications need to be taken with a pinch of salt and there are a lot of things in common between the various conditions. For a long time, since 1952, Somatic Symptom Disorder, Illness Anxiety Disorder and Health Anxiety were called “Hypochondria” (see image below).

What is Somatic Symptom Disorder

It is a combination of different factors.

First of all, you have something physical about you that you are certain is not normal.

Many people complain of having pain in their body without a clear reason for it. One of the most common type of pain is back pain, but it could be a knee that hurts, or some skin pain.

This pain can be always in the same spot, or it can change from time to time. Sometimes it is a problem with your belly that is always there, or it could be something to do with your sexual organs.

No matter what the pain is, it is ALWAYS THERE, and IT DOES NOT MAKE SENSE

We talk about Somatic Symptom Disorder only when the symptom has been there (even if on and off) for a long time. You might ask how long? The length varies from person to person, but imagine what happens when you get a small paper cut. It hurts at the beginning, but it makes sense and you know you have to wait a couple of days before you forget you even got it.

But what if the paper cut does not heal? What if they pain stays there for a week? You will rightly start thinking that something wrong is going on because the pain is there for too long.

What makes Somatic Symptom Disorder difficult to treat

The treatment of Somatic Symptom Disorder is difficult because, at the moment, doctors only give this diagnosis when all other physical causes have been ruled out.

For example, if you have back pain and it is not going away after a long time, you go to the GP and ask for help. The GP will probably ask you to wait and see if the pain goes away, but it does not. In the meantime, you grow more and more worried of what is happening to you and why the symptoms are not going away.

You go back to the GP again, and insist that you get referred to a specialist, but which specialist do you go to?

You then start to consult with different doctors from various fields. Each of them will give you a different opinion and a different treatment plan, which either does not work, or, if it does, the pain comes back in some other form.

Bottom line, you spend months or years trying to figure out what is wrong with your body and trying to convince medical professionals that your pain is real.

The worst situation happens when the medical profession makes mistakes. For example, they fail to diagnose a condition that you really have, and you have to fight to make your voice heard. In this case, you might lose trust in the fact that any expert might help you heal.

What makes Somatic Symptom Disorder difficult to live with

There are various factors that make life difficult for people living with Somatic Symptom Disorder at a personal and social level

Personal problems when living with Somatic Symptom Disorder

• It is consuming to have constant pain.

  Even if the level of pain is low, it is the fact that it is always there that causes huge distress. Imagine having a little stone in your shoe while you walk, and not being able to remove it. The pain itself is not a lot, but, when it is always there, it becomes unbearable.

• You develop negative beliefs that you will never heal.

If something is painful for so long and does not have a reason to be there, you start believing that something is wrong with you, that you will never get better, and that there is no hope

• You start creating theories of what is wrong with you, and you suspect that you have rare conditions.

  Because you have lost trust in your own ability to heal and in the ability of others (experts, friends, family) to be help, you start thinking that there must be something seriously wrong with you

• You spend a lot of time researching the Internet.

  Because nothing seems to work on your symptom, you research constantly for a condition that describes what is happening to you in the hope for a cure

Social problems when living with Somatic Symptom Disorder

• People (including specialists) might not believe how serious this is.

People struggle to understand where you are coming from. They start suggesting quick fixes, or they minimise your issue

• Close friends and family feel powerless.

  While you do not necessarily talk to many people about your pain, your close friends and family might have heard you complain a lot about your condition. Because it takes professional training to offer emotional and personal support in these cases, family and friends might feel powerless and, despite their best intention to help, they might lose patience with you, or stop listening to you.

All of the above create a negative cycle that has got heavy consequences on life like

1. Loss of interest in the future (career, dreams, projects, etc.)

2. Giving up social activities

3. Isolation

4. Depression

5. Anxiety

Treatment of Somatic Symptom Disorder

Before treating Somatic Symptom Disorder, or any other mental health issues that have become chronic, it is important that you decide what you want to achieve once the treatment is complete.

If you are interested in short-term relief of the worries and behaviours that go with Somatic Symptom Disorder and you want some immediate strategies, evidence suggests that a course of CBT is the best option. If you prefer to follow a different route, you can consult with a psychiatrist to get drugs that can help you with the condition.

If you are interested in a long-term resolution of the worries and the behaviours that go with Somatic Symptom Disorder, then a longer course of psychotherapy is needed. It is important that, no matter what type of therapy you choose, your therapist helps you identify your issues in the present as well as the past experiences that led to the development of Somatic Symptom Disorder.

Somatic Symptom Disorder can be considered a type of OCD.

Somatic Symptom Disorder and OCD (Obsessive Compulsive Disorder)

Treating SSD as OCD helps identify the different parts at play, which you can see in the diagram below.

We have at least three parts at play

1. The physical symptom

2. The worry about the symptom

3. The checking and research for solution

Each part of the condition needs to be understood. First, physical symptoms needs to be acknowledged for being real, and not a creation of the person who feels them.

Second, some empathy and compassion needs to be provided to the person to honour the incredible level of suffering they have gone through. It is only when the person with SSD realises that they have developed an extreme worry about their symptoms and that this only gets worse by checking for solutions, that they might be able to open up changing they way they behave.

I make it clear to my clients that I cannot promise, as a psychotherapist, that I will be able to get to the medical and physiological causes of their physical symptom because I am not a doctor. Regardless of the symptom, though, someone with SSD has developed an entire structure of worries and checking mechanisms that need to be treated to help cope with the physical symptom and have a fulfilling life.

Dealing with worries and checking mechanisms requires that past traumas and negative beliefs are dealt with, and there is no way of telling how long this process will take.