View of What Is Somatic Symptom Disorder?

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What Is Somatic Symptom Disorder?

Mobin Maghsoomi

Researcher Student, Farabi High School, Boukan, Iran (Corresponding author) [email protected]

Faryad Jafari

Physical therapy student, Karatekin University, Cankiri, Turkey [email protected]

Abstract

Somatic symptom disorder is a disease in which a patient presents with physical symptoms to a physician but no physical problem is seen on examination or laboratory testing. In this type of disease, the physician considers the cause of the patient’s problems not physical but mental. Somatic symptom disorder can affect the quality of life.This disorder has received a lot of attention from the physicians, psychiatrist and even medical services centers around the world. Recurrent visits of these cases in outpatient clinics or hospitals and the vicious cycle of unnecessary investigations that reinforce "sick role" and somatic complaints, cause many problems for the patients, as well as the physicians and health services. The aim of this study was to investigate the symptoms, epidemiology and etiology of somatic symptom disorder.

Key words: Somatic symptom, Medically unexplained symptoms, Psychosomatic disorders

Introduction

Somatic symptom disorders are a group of disorders, all of which fit the definition of physical symptoms similar to those observed in physical disease or injury for which there is no identifiable physical cause. As such, they are a diagnosis of exclusion [1]. A somatic symptom disorder, formerly known as a somatoform disorder, [1] is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder (e.g., panic disorder).[2] Somatization disorder was first described by Paul Briquet in 1859 and was subsequently known as Briquet's syndrome. He described patients who had been sickly most of their lives and complained of multiple symptoms from different organ systems. Symptoms persist despite multiple consultations, hospitalizations and investigations [3].Somatic symptom disorders, as a group, are included in a number of diagnostic schemes of mental illness, including the Diagnostic and Statistical Manual of Mental Disorders [4]. (Before DSM-5 this disorder was split into somatization disorder and undifferentiated somatoform disorder [5]).

In people who have been diagnosed with a somatic symptom disorder, medical test results are either normal or do not explain the person's symptoms, and history and physical examination do not indicate the presence of a known medical condition that could cause them, though the DSM-5 cautions that this alone is not sufficient for diagnosis [6].The patient must also be excessively worried about their symptoms, and this worry must be judged to be out of proportion to the severity of the physical complaints themselves [7]. A diagnosis of somatic symptom disorder requires that the

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958 subject have recurring somatic complaints for at least six months [8]. Somatic symptom disorders are a group of disorders, all of which fit the definition of physical symptoms similar to those observed in physical disease or injury for which there is no identifiable physical cause. As such, they are a diagnosis of exclusion [9].

Considering that the most of the studies conducted outside of Iran have comprehensively examined somatic symptom, there are a few papers in Iran that have specifically studied this disorder. The aim of this study was to review the symptoms, epidemiology and etiology of somatic symptom.

Symptoms

Symptoms of somatic symptom disorder may be (Column 1):

Column 1. Main symptoms of somatic symptom disorder

Pain is the most common symptom, but whatever your symptoms, you have excessive thoughts, feelings or behaviors related to those symptoms, which cause significant problems, make it difficult to function and sometimes can be disabling [10].

These thoughts feelings and behaviors can include (Column 2):

Prevalence and Epidemiology

Somatic symptom disorder is relatively common, affecting about 5-7% of the population of the United States [11]. It can affect children, teenagers and adults. Its prevalence is far higher in women

than in men, and the female to male ratio of patients is about 10:1 [12].

According to the American Psychiatric Association’s guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for somatic symptom disorder are (Column 3)

: Etiology

The exact cause of somatic symptom disorder isn’t clear, but any of these factors may play a role (Column 4).

Risk factors for somatic symptom disorder include (Column 5):

Symptoms:

Specific sensations, such as pain or shortness of breath, or more general symptoms , such as fatigue

or weakness

Unrelated to any medical cause that can be identifid, or related to a medical condition such as

cancer or heart disease, but more significiant than whats usually expected

A single symptom, multiple symptoms or varying symptoms

Mild, moderate or severe

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959 Somatic symptom disorder can be associated with (Column 6):

Thoughts, feelings and behaviors:

Constat worry about potential illnes

Viewing normal physical sensations as a sign of severe physical illness

Fearing that symptoms are serious, even when there is no evidence

Thinking that physical sensations are threating or harmful

Feeling that physical activity may cause damage to their body

Fearing that medical evalution and treatment have not been adequate

Repeatedly checking their body for abnormalities

Frequent health care visits that dont relieve their concerns or that make

them worse

Being unresponsive to medical treatment or unusually sensetive to

medication side effects

Having a more severe impairment than is usually expected from a medical

condition

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Column 3. diagnostic criteria for somatic symptom disorder

Column 4. Etiology of somatic symptom disorder

diagnostic criteria for somatic symptom disorder:

One or more somatic symptoms that are distressing or significantly disrupt daily

life

Excessive thoughts, feelings or behaviors related to somatic symptom

Specific symptoms may increase or decrease in severity, but at least one symptom is still present at any given time

Etiology of somatic symptom disorder:

Genetic and biological factors, such as an increased sensitivity to pain

Family influence, which may be genetic or environmental, or both

Personality trait of negativity, which can impact how you identify and perceive illness and bodily

symptoms

Decreased awareness of or problems processing emotions, causing physical symptoms to become

the focus rather than the emotional issues

Learned behavior - for example, the attention or other benefits gained from having an illness; or pain behaviors in response to symptoms, such as

excessive avoidence of activity, which can increase your level of disability

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Column 5. Risk factors for somatic symptom disorder

Conclusions:

This review study examined the symptoms, epidemiology and etiology of somatic symptom disorder.

According to research on somatic symptom disorder, this disorder impairs person’s mental function and also it can affect the quality of life. Due to the significant increase in the number of patients with somatic symptom in the community, the high cost of care and treatment of these patients, the training of applied methods of psychotherapy is necessary. Therefore, psychotherapists are advised to pay attention to the subtle diagnostic points in evaluating this disorder.

Risk factors for somatic symptom disorder:

Having anxiety or depression

Having a medical condition or recovering from one

Being at risk of developing a medical condition, such as having a strong

family history of a disease

Expreincing stressful life events, truama or violence

Having exprienced past trauma, such as childhood sexual abuse

Having a lower level of education and socio-econimic status

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Column 6. Complications of somatic symptom disorder

References

1.Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988;

145(11): 1358-68.

2. Verhaak PF, Tijhuis MA. Psychosocial problems in primary care: some results from the Dutch National Study of Morbidity and Interventions in General Practice. Soc Sci Med 1992; 35(2): 105- 10.

Complications:

Poor health

Problems functioning in daily life, including physical disability

Problems with relationships

Problems at work or unemployment

Other mental health disorders, such as anxiety, depression and personality

disorders

Increased suicide risk related to depression

Financial problems due to excessive health care visits

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963 3. Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994; 272(22): 1741-8.

4. Bridges KW, Goldberg DP. Somatic presentation of DSM III psychiatric disorders in primary care. J Psychosom Res 1985; 29(6): 563-9.

5.Gulbrandsen P, Fugelli P, Hjortdahl P. Psychosocial problems presented by patients with somatic reasons for encounter: tip of the iceberg? Fam Pract 1998; 15(1): 1-8.

6. Page LA, Wessely S. Medically unexplained symptoms: Exacerbating factors in the doctor-patient encounter. J R Soc Med 2003; 96(5): 223-7.

7. Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: A comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res 1997; 42(3): 245- 52.

8. Kawanishi Y. Somatization of Asians: An artifact of Western medicalization. Transcultural Psychiatry 1992; 29(1): 5.

9. Kroenke K, Rosmalen JG. Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 2006; 90(4): 603-26.

10.Simon G, Gater R, Kisely S, Piccinelli M. Somatic symptoms of distress: an international primary care study. Psychosom Med 1996; 58(5): 481-8.

11. Pennebaker W. Cultural similarities and differences regarding emotion disclosure. Emotion, disclosure, and health.New York: American Psychological Association; 1995. p. 293-309.

12. Mobarki GH, Ahmadzadeh GH, Shishehforonsh SH. Sommatization among Iranian psychiatric patients. Actas Espanola's de Psiquiatri 2001; 29(1): 125.