Somatic Symptom and Related Disorders

Somatic symptom and related disorders are mental health disorders characterised by an intense focus on physical (somatic) symptoms that causes significant distress and/or interferes with daily functioning.

Most mental health disorders are characterised by mental symptoms. That is, individuals have unusual or disturbing thoughts, moods, and/or behaviours.

However, in somatic symptom disorders, mental factors are expressed as physical symptoms – a process called somatisation – and the individual’s main concern is with physical (somatic – from soma, the Greek word for body) symptoms, such as pain, weakness, fatigue, nausea, or other bodily sensations.

The individual may or may not have a medical disorder that causes or contributes to the symptoms. However, when a medical disorder is present, an individual with somatic symptom or a related disorder responds to it excessively.

Everyone reacts on an emotional level when they have physical symptoms. However, individuals with a somatic symptom disorder have exceptionally intense thoughts, feelings, and behaviours in response to their symptoms.

To distinguish a disorder from a normal reaction to feeling ill, the responses must be intense enough to cause significant distress to the individual (and sometimes to others) and/or make it difficult for the individual to function in daily life.

The different responses individuals have define the specific disorder they have, as in the following:

• In conversion disorder, physical symptoms that resemble those of a nervous system disorder develop.
• In factitious disorder, individuals pretend to have symptoms for no apparent external reason (such as to get time off from work).
• In illness anxiety disorder, individuals are excessively preoccupied and worried about the possibility of having or getting a serious illness.
• Sometimes attitudes or behaviours can have a negative effect on a medical disorder that a person has – a disorder called psychological factors affecting other medical conditions.
• In somatic symptom disorder, an individual’s symptoms concern and preoccupy them, worry them constantly, and/or drive them to see medical professionals very frequently.

Because individuals with one of these disorders think they have physical symptoms, they tend to go to a medical professional rather than to a mental health care practitioner.

Somatic symptom or related disorders may also occur in children.

Treatment varies according to which disorder an individual has but usually involves psychotherapy.

Interaction of Mind and Body

How the mind and body interact to influence health has long been discussed.

Although we may speak casually about mind and body as though they were distinct, they are actually so interrelated that it is hard to separate their effects, as in the following cases:

• Social and mental stress can aggravate many physical disorders, including diabetes mellitus, coronary artery disease, and asthma.
• Stress and other mental processes can worsen or prolong physical symptoms.
  • For example, individuals who are depressed or anxious may suffer more if they become ill or injured than people who are in a better frame of mind.
• Stress sometimes can cause physical symptoms even when no physical disorder is present.
  • For example, children may develop abdominal pain or nausea because they are anxious about going to school, or adults may develop a headache when they are under emotional stress.
• Thoughts and ideas can influence how a disorder progresses.
  • For example, individuals with high blood pressure may deny that they have it or that it is serious.
  • Denial may help reduce their anxiety, but it may also prevent them from following their treatment plan.
  • For example, they may not take their prescribed drugs, thus worsening their disorder.
• A general physical disorder can influence or lead to a mental health problem.
  • For example, individuals with a life-threatening, recurring, or chronic physical disorder may become depressed.
  • The depression, in turn, may worsen the effects of the physical disorder.
• A physical disorder of the brain, such as Alzheimer disease, can affect an individual’s personality and/or ability to think clearly.

When physical symptoms result from stress or mental factors, medical professional may have difficulty identifying the cause.

Various diagnostic tests may be required to clarify the situation.