Somatic Symptom Disorder

What is a somatic symptom disorder?

Somatic Symptom Disorder (SSD) is a condition characterized by physical symptoms that lack a clear medical cause, even after thorough medical examinations. These symptoms can be varied and may include:

• Fatigue
• Abdominal pain
• Headache
• Muscle pain
• Joint pain
• Dizziness

Despite the absence of a clear medical explanation, the symptoms are real and can significantly impact daily functioning, often leading to frustration and anxiety. The uncertainty of having “unexplained” symptoms can make acceptance and coping more challenging.

Recognizing and understanding Somatic Symptom Disorder is crucial for managing symptoms effectively and improving the quality of daily life.

What are the symptoms?

Symptoms of somatic symptom disorder that are common:

• frequent fatigue
• back pain
• chest pain
• pain in your joints
• (chronic) headaches or migraines
• (chronic) abdominal pain or nausea
• dizziness
• failure symptoms
• Difficulty concentrating or memory problems
• palpitations, tightness of the chest or chest pain
• pain after an illness or injury

Psychological symptoms of somatic symptom disorder:

• Paying a lot of attention to physical complaints.
• Thinking that normal physical sensations are a dangerous disease.
• Worrying about illness.
• Being afraid that all forms of physical activity are harmful to your body.
• Regularly checking your body for abnormalities.
• Regularly seeking help and reassurance from doctors.
• Shunning physical activity.

Examples of symptoms considered unexplained 

• Chronic fatigue: prolonged, often intense fatigue that cannot be explained by a medical condition.
• Fibromyalgia: an unexplained condition that causes chronic pain, fatigue and stiffness in the muscles and joints.
• Irritable bowel syndrome (PDS): a condition that causes abdominal pain, bloating, constipation and/or diarrhea, with no apparent cause.

Diagnosis

Up to 40% of consultations with the family doctor involve unexplained symptoms. The causes of physical complaints are often explained by stress, anxiety or depression. About 2.5% of people experience severe symptoms. According to the DSM-5, the classification of mental disorders, the criteria for somatic symptom disorder are as follows:

• You have excessive thoughts or feelings about your symptoms. You worry about your health all the time, such as persistent worries about the effects of the symptoms, or you spend a lot of time and energy on the symptoms or health concerns. You suffer greatly from your symptoms and they get in the way of your daily life considerably.
• The somatic symptoms are prolonged, usually longer than six months.

The criteria for diagnosis are in the DSM-5. You can also find more information about it in the mental health standards. Here you can read more about the quality standards for the treatment of this disorder, created by patients, their loved ones and professionals. 

Causes

• Attention and sensitivity to symptoms.
  You are extra sensitive to your body’s signals. For example, you explain small changes in muscle tension as physical symptoms. This may be because you had severe or prolonged pain before.
• Thoughts and ideas about symptoms.
  What you think and expect to feel is happening. Because your body and mind react to each other.
• Unpleasant experiences from the past.
  Unprocessed emotions you store in your body. This makes it harder to tell the difference between feelings and physical symptoms.
• Violent events or overexertion.
  When something intense happens or you have a lot of daily worries, it causes stress. A lot of stress can make the disorder worse.

Why do symptoms stay?

There are several factors that cause symptoms to remain present. For example, avoiding situations that reduce symptoms. In addition, symptoms may worsen due to increased stress and tension. The following factors can contribute to the persistence of somatic symptom disorder:

• Health problems.
  Consider loss of stamina and chronic stress.
• Psychological factors.
  Such as fear, anxiety or feeling that others don’t take you seriously.
• Social factors.
  For example, lack of social contacts and/or no work.
• Thoughts, feelings and behaviors.
  Negative thoughts about your symptoms, cause negative feelings and behavior.

Wat can you do?

There are several things you can do to relieve symptoms.

• Talk and seek support.
  This often provides relief and makes you feel less sad or anxious.
• Keep a journal.
  For two weeks, write down what your symptoms are, what you do and how you feel. Also write down how people around you react. Maybe you’ve started exercising or working less. Or you go out less, eat less or perform fewer hobbies. Do you think your symptoms will never go away or are your own fault? See if that makes you feel more anxious and think more negatively about your symptoms.
• Look at anxiety in a different way.
  Having physical symptoms does not mean your body is damaged or getting damaged. It often helps to move more and do more activities. This is good for your stamina and self-confidence. And it makes you feel better. It provides distraction and helps you relax.
• Eat healthy and get a good night’s sleep.
  A healthy way of life and a good night’s sleep reduce your symptoms.
• Look at your symptoms from a different perspective.
  Try to look at what is going well and what you can do. For example, write down when you have fewer symptoms and what you are doing at that time. This will give you ideas for how to deal with your symptoms.
• Pay more attention to enjoyable activities.
  Try focusing your attention on activities outside of yourself that you find important. Like spending time with friends or family, enjoying nature or having a cup of tea. This gives pleasure and makes you pay less attention to your symptoms.

Tips for my partner or loved one (and me)

Can’t figure it out with your partner? The following advice will help you and your loved one with somatic symptom disorder:

• Communicate with understanding and patience.
  Give your partner time to tell you what is going on and listen without complements or judgment. Your partner will feel heard and supported this way.
• Don’t be overly critical and demanding.
  Your partner is not able to meet all your expectations right now. Adjust them and be patient.
• Help with good nutrition.
  A healthy way of life helps to have fewer symptoms.
• Be careful with advice.
  Don’t give advice that your partner already knows. For example, who already knows that exercising more is good, but doesn’t manage to do it. Show that you are there and show understanding. That helps more.