The connection between the human body and mind is both profound and complex. Each can impact the other, shaping our overall health and well-being. Somatic symptoms exemplify this connection, highlighting conditions where physical symptoms, often distressing, emerge without a clear medical cause but are deeply rooted in psychological factors. These disorders challenge the conventional boundaries of physical and mental health, emphasizing the need for a comprehensive understanding and approach to patient care.
In this chapter, we will provide a detailed examination of these disorders, focusing on their diagnostic criteria, potential triggers, and recommended interventions. By understanding these disorders, healthcare professionals can better address the needs of patients, ensuring holistic care that recognizes the powerful interplay between the mind and body.
Somatic Symptom Disorder (SSD)
- Characterized by one or more somatic symptoms for 6 or more months that cause significant distress or functional impairment
- Brief somatic symptom disorder: Same symptoms of somatic symptom disorder but symptoms are less than 6 months in duration
- Patients experience excessive thoughts, feelings, or behaviors related to somatic symptoms or health concerns
- Another key phenomenon observed in SSD is somatosensory amplification, where patients have a tendency to experience normal bodily sensations as unusually intense, noxious, and disturbing
- This involves heightened sensitivity to bodily sensations coupled with a tendency to focus on and magnify weak or infrequent bodily signals
- Associated with elevated interleukin-6 (IL-6) levels, which is a non-specific marker of chronic psychological stress
- Onset is typically in adolescence or early adulthood
- Associated with increased healthcare utilization, frequent medical appointments and tests, and dissatisfaction with medical care
- Pseudocyesis is a variant of SSD where patients believe they are pregnant when testing reveals otherwise
- Also known as a false pregnancy
- Patients can have the physical signs of pregnancy, such as breast changes, abdominal swelling, feeling of fetal movement and labor pains
- Medical student syndrome is a variant of SSD that specifically affects medical students and healthcare professionals, where medical knowledge leads to misinterpretation of benign symptoms as serious illness
- Treatment:
- Cognitive-behavioral therapy (CBT)
- Acceptance and commitment therapy (ACT)
- Psychodynamic therapy
- Stress management
- The strongest predictor of treatment success is the quality of the therapeutic alliance. Specific techniques that strengthen alliance include:
- Validating physical symptoms as real
- Avoiding confrontation about symptom origin
- Regular, time-limited visits
- Clear communication about treatment goals
Note
It's critical to avoid scheduling appointments only when new symptoms arise or conducting extensive testing at each visit. Instead, scheduling regular follow-up appointments helps establish a structured approach to care, reduces anxiety, and prevents emergency department visits.
Illness Anxiety Disorder
- Previously known as hypochondriasis
- Presents with a preoccupation with having or acquiring a serious illness, despite a lack of somatic symptoms or only mild symptoms
- Brief illness anxiety disorder: Same symptoms of illness anxiety disorder but symptoms last less than 6 months.
- Patients have a high level of anxiety about health and excessive health-related behaviors or avoidance of healthcare
- Onset is typically in early adulthood
- Risk factors include: History of childhood abuse, neglect, or significant trauma and family history of somatic-related disorders
- Differential diagnosis: Somatic symptom disorder, generalized anxiety disorder, panic disorder, major depressive disorder, delusional disorder
- Treatment: CBT, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Schedule regular follow-up appointments to address concerns, provide reassurance, and monitor progress
- Avoid excessive medical testing or referrals, as they may reinforce health anxiety
High Yield
Somatic symptom disorder focuses on symptoms, while illness anxiety disorder focuses on fear of disease.
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