Somatic Symptom Disorder

Yes. The human body and the psyche do not work like two separate worlds. Stress, anxiety, anger, grief, shame, and prolonged tension can affect bodily systems. Headaches, stomach problems, muscle pain, palpitations, fatigue, shortness of breath, numbness, and fainting-like episodes can sometimes increase together with psychological burden.

The first point to keep in mind is that physical symptoms deserve to be taken seriously. The fact that a symptom may be related to psychological processes does not make medical evaluation unnecessary. Good clinical practice means first conducting an appropriate medical evaluation, then understanding psychological and physical processes together.

The same person can have both a genuine medical illness and somatic symptom anxiety that goes beyond that illness. For example, a person with epilepsy may also have fainting-like episodes arising from psychological causes. For this reason, sharp either-or distinctions between physical and psychological are often inadequate.

Somatic symptom disorder does not mean the person is making their symptoms up. The distress being experienced is real. But sometimes, to understand the source and persistence of symptoms, the mind, emotions, stress, and relationships must be evaluated alongside the body.

In what we call psychosomatic conditions, there is an underlying medical illness, but stress and psychological state can affect the course of that illness. Migraine, hypertension, certain skin problems, gastrointestinal complaints, or pain presentations can increase and decrease with stress.

In somatic symptom disorder, the center of the picture is one or more physical symptoms together with intense thoughts, anxiety, and behavioral preoccupation relating to those symptoms. Current diagnostic approaches do not require that the symptom be strictly 'medically unexplained.' What matters is that the symptom settles at the center of the person's life and that excessive preoccupation with it disrupts functioning.

In illness anxiety disorder, the person typically fears that they have or will develop a serious illness. Symptoms may be few, yet the possibility of illness occupies the center of the mind. This topic can be covered in more detail in a separate booklet.

One of the most important mechanisms in the persistence of somatic symptoms is excessive focus on the body. All of us have small sensations in the body throughout the day. There may be pressure in the head, a quickening of the heart, tension in the stomach, aching muscles, or brief numbness. These sensations usually come and go. But when a person focuses on a sensation intensely, it can grow.

The more attention turns toward the body, the more data the body seems to produce. As the person thinks 'what is this', 'will it pass', 'did the doctor miss something', 'could this be a serious illness', anxiety increases. As anxiety increases, bodily arousal increases. In this way symptoms, anxiety, and checking behaviors feed one another.

Frequent visits to doctors, requesting the same tests again, continually searching for illnesses online, checking the body, seeking reassurance from loved ones, or gradually narrowing life because of symptoms can sustain the loop. These behaviors bring short-term relief but can keep bodily anxiety alive in the long run.

The stance of family and close others matters a great deal. Dismissing a person's symptoms, saying 'it is all in your head', mocking them, or leaving them alone is harmful. But showing interest only when the person is experiencing symptoms, and failing to make emotional contact in other areas of daily life, can unintentionally reinforce those symptoms.

A healthier stance is to acknowledge the reality of the symptom, to listen to the person's distress, but not to let all of life revolve solely around the symptom. Interest, warmth, and support should be consistent during illness and during the times when the person is doing well.

Some people who have spent years going from doctor to doctor may feel hurt when psychological support is suggested. They may interpret it as 'they do not believe me' or 'they are saying I am making it up.' For this reason, clinicians must be very careful with their language. Suggesting psychological support does not mean the symptom is not real. On the contrary, it is an effort to address the person's distress in a holistic way.

The first step in treatment is a reliable and consistent evaluation. Necessary medical investigations should be carried out, but unnecessary repetitions and an endless search for tests should not push the person deeper into an anxiety loop. Follow-up through a single physician or a coordinated team is usually healthier.

Psychoeducation helps the person understand their symptoms within the interaction of body and mind. Cognitive behavioral therapy can work on excessive body focus, catastrophizing, reassurance seeking, avoidance, and loss of functioning. Stress management, sleep routine, activity planning, emotion regulation, and problem solving skills can be supportive.

If accompanying depression, panic, generalized anxiety, or trauma symptoms are present, these should be assessed separately. Medication should not be thought of as a standalone solution that directly eliminates somatic symptom disorder itself. If accompanying psychiatric conditions are present, they can be evaluated by a physician.

When a symptom has settled at the center of life for at least several months. When anxiety does not decrease despite medical evaluations and the need for new tests keeps going. When the person is significantly limiting their work, school, family, and social life because of symptoms. When depression, panic, trauma, or intense anxiety accompanies the symptoms. When the person is becoming isolated with the feeling that 'no one believes me.'