Somatic Symptom Disorder

What Causes Somatic Symptom Disorder?

The cause of SSD is not known. It is likely triggered by a combination of factors, including biology and external environmental events. Some factors seem to put a person at increased risk for SSD. Possible risk factors include:

• Childhood physical or sexual abuse
• Parental neglect
• Chaotic home life
• Traumatic experiences
• Chronic illness in childhood
• Low pain threshold
• Alcohol or substance abuse
• Mental conditions such as depression or anxiety
• Lower education level or socio-economic status

Is Somatic Symptom Disorder Hereditary?

There is no known inherited genetic cause of SSD. However, some of the risk factors for the disorder can have an inherited component. For example, people with a low pain tolerance are at increased risk for SSD, which sometimes runs in families. In addition, having a mental illness such as depression or anxiety increases SSD risk, and those illnesses are more common in people with a family history of them.

How Is Somatic Symptom Disorder Detected?

Early detection and treatment of SSD can be challenging because the disorder is sometimes associated with an actual medical condition, and co-existing medical conditions can develop during the course of SSD. Because of this, doctors must be careful to diagnose and treat existing illnesses while avoiding unnecessary tests and treatments.

How Is Somatic Symptom Disorder Diagnosed?

Diagnosis of SDD begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that SSD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment. Doctors are discouraged from conducting repeated tests because patients are typically not convinced by negative results and may use repeated tests as evidence of diagnostic uncertainty.

Diagnostic steps may include:

• A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for SSD. These criteria include:

• Persistent thoughts, worry, or anxiety about health issues.
• Excessive time or energy spent worrying about symptoms.
• Anxiety about symptoms causes significant impairment or distress.
• The impairment has lasted more than six months.
• The symptoms are not explained by any other mental or physical condition.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Somatic Symptom Disorder Treated?

There is no cure for SSD. Psychotherapy, usually cognitive-behavioral therapy, is the most common course of treatment. Medications may help symptoms of other co-existing disorders, such as depression or anxiety. In some cases, antidepressant medicines may help the physical complaints associated with SSD as well.

How Does Somatic Symptom Disorder Progress?

With treatment, most people with SSD experience improvement. Left untreated, however, SSD can linger for years, and symptoms may periodically resolve and then reappear later. The symptoms can cause impairments that produce severe complications. Long-term complications can include:

• Depression or other mental disorders
• Social isolation
• Lack of healthy interpersonal relationships
• Work difficulties or unemployment
• Financial difficulties
• Suicide attempts

How Is Somatic Symptom Disorder Prevented?

There is no known way to prevent SSD. However, due to the disorder’s common association with depression and anxiety, prompt treatment of these disorders when they occur may help decrease the risk of developing SSD.

Somatic Symptom Disorder Caregiver Tips

Many people with somatic symptom disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with SSD:

• More than half of people with SSD also suffer from depression.
• About a third of people with SSD have a co-existing anxiety disorder, such as generalized anxiety disorder or a phobia.
• People with SSD are at increased risk of suicide.

Somatic Symptom Disorder Brain Science

A recent study used functional magnetic resonance imaging (fMRI) to examine the brains of people with SSD and compare them to healthy brains. Specifically, the study examined the interaction between different parts of the brain and compared the interactions in the brains of SSD patients to those in healthy control subjects. The study made some important discoveries, including:

• SSD subjects had increased interaction between the part of the brain responsible for planning movement and the area responsible for integrating sensory and emotional information. The study’s authors suspect this atypical connection could make the subjects more sensitive to pain.
• SSD subjects also had increased connectivity between the brain’s movement-planning network and the part of the brain responsible for directing attention. The researchers theorized that this activity could lead to attention deficits and misinterpretation of specific stimuli.

Somatic Symptom Disorder Research

Title: Study of Dextromethorphan in OCD and Related Disorders

Stage: Not Yet Recruiting

Principal investigator: Peter J. van Roessel, MD PhD

Stanford University

Palo Alto, CA

The purpose of the study is to assess the tolerability and efficacy of dextromethorphan in combination with fluoxetine for symptom relief in OCD and related disorders.

Obsessive-compulsive disorder (OCD) and the related disorders body dysmorphic disorder (BDD), somatic symptom disorder (SSD), and illness anxiety disorder (IAD) are psychiatric conditions characterized by recurrent, intrusive thoughts, feelings or images (obsessions or preoccupations) and repetitive or ritualized behaviors or avoidance performed to relieve obsession or preoccupation-related anxiety. They are a significant cause of mental health-related disability and are inadequately served by available treatments.

This study tests whether an over-the-counter cough suppressant medicine, dextromethorphan, may offer symptom relief when combined with a low dose of fluoxetine, a standard prescription treatment for OCD and related disorders.

Title: Exposure Therapy vs. Standardized Education for Distress Related to Somatic Symptoms (SOMEX1)

Stage: Recruiting

Principal investigator: Erland Axelsson, PhD

Liljeholmen Academic Primary Care Clinic

Stockholm, Sweden 

The annual societal cost of medically unexplained symptoms in Sweden is approximately 40 billion SEK, i.e., similar to the annual cost of cancer. Prevalent chronic diseases like asthma and diabetes are also commonly associated with somatic symptoms that lead to significant distress and pervasive behavioral changes that result in functional impairment and place added strain on the health care system. Exposure-based treatment, where the patient willingly engages with stimuli that give rise to unwanted physical sensations or distress, has shown promise in reducing somatic symptom load and increasing quality of life in several conditions where patients commonly report substantial distress related to somatic symptoms, such as in asthma, musculoskeletal pain, and functional gastrointestinal syndromes. In routine care, however, access to such exposure-based treatment is limited. One reason for this is that there is no flexible exposure-based treatment protocol that can be easily tailored to suit a broad spectrum of patient groups who suffer from distress related to recurrent somatic symptoms. In a recent single group feasibility trial (N=33) at Karolinska Institutet, Sweden, the investigators found that such a tailored exposure-based treatment delivered in an online text-based format can be acceptable, with high treatment adherence, adequate treatment satisfaction, large and lasting within-group improvement, and no serious adverse events. This is a randomized controlled trial (N=160). The investigators aim to test if the same tailored internet-delivered exposure-based treatment is more efficacious than a standardized education control for adult patients with clinically significant distress related to somatic symptoms in a primary care setting. The primary outcome is change in self-rated somatic symptom burden as modeled using linear mixed models fitted on weekly Patient Health Questionnaire 15 sum scores over the treatment period. Long-term efficacy is assessed up to one year after treatment, and cost-effectiveness is investigated based on the incremental cost-effectiveness ratio.

Title: Reappraisal Of Medical Assurance (ROMA): An Experimental Study in Patients With Functional Somatic Symptoms (ROMA)

Stage: Recruiting

Principal Investigator: Tobias Kube, PhD

University of Koblenz-Landau

Landau, Germany 

It is known from research on functional somatic symptoms that patients continue to worry about having a serious illness despite receiving medical reassurance and normal medical test results. However, the psychological mechanisms underlying this maintenance of concern are largely unknown. The planned study will therefore apply knowledge from depression research to this question: In the field of depression, there is sound evidence that people with depressive symptoms maintain negative expectations despite positive experiences to the contrary, and in previous work, it was shown that this is due to a cognitive re-appraisal of expectation-disconfirming experiences, referred to as cognitive immunization. The planned study seeks to investigate whether cognitive immunization is also a mechanism underlying sustained concerns about having a serious disease despite medical reassurance in patients with functional somatic symptoms. For this purpose, participants are presented with a vignette in which gastrointestinal complaints are reported; participants are instructed to imagine suffering from these symptoms and to go to a doctor to have their symptoms examined. Subsequently, participants watch a videotaped doctor’s report in which a family doctor discusses the results of several medical tests that have been carried out to exclude the possibility of some serious diseases, such as colon cancer. In this report, the doctor states clearly that, based on the test results, a serious disease is very unlikely. Afterward, participants of some experimental groups receive additional information on the accuracy of medical diagnostics, aimed at differentially varying the appraisal of the medical reassurance received.

The experimental conditions described above apply only to the sample of patients with functional somatic symptoms (inclusion and exclusion criteria see below). In addition, we will also recruit a clinical (patients with depression, n=30) and healthy control group (n=30). These control groups will not undergo the cognitive immunization manipulation but will only pass through the basic procedure of the experimental paradigm, that is, the same procedure as the control group from the sample of patients with functional somatic symptoms. These two control groups (healthy and clinical) are recruited to replicate previous findings showing that patients with somatic symptoms report increased probabilities of suffering from a serious disease compared to patients with depression and healthy control participants. Below, we will only present the inclusion and exclusion criteria of the sample with functional somatic symptoms.