SSD - Somatic Symptoms and Related Disorders

SSD- Somatic Symptoms and Related Disorders

Flow Chart for Suspicious Symptoms

Etiology of Somatic Symptoms and Related Disorders

• Somatic sensations arising from physiological and pathological processes
  • Illness knowledge and experience of self, family, and others
    • Interpretation of somatic sensations as symptoms
      • Emotional arousal
      • Maintaining factors, including depression and anxiety, reactions of others, and iatrogenesis
        • Chronic symptoms
          • Disability
          • Seeking of medical care

Brain is a predictive coding machine which makes and tests predictions about the body rather than constructing perceptions from scratch.

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DSM-5 Criteria of Somatic Symptom Disorder (SSD)

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.

B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

2. Persistently high level of anxiety about health or symptoms.

3. Excessive time and energy devoted to these symptoms or health concerns.

C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Specify if: With predominant pain.

For patients with a medical illness, the reaction would have to be maladaptive, extreme, intrusive, impairing, and grossly in excess.

Management of Somatic Symptoms and Related Disorders

Do

• Empathize/Allow patient role.
• Emphasize body-brain (mind) connections.
• Don’t harm.
• Concentrate on functions/Coping not curing.
• Frequent, regular, short visits with a single doctor.
• Assess and treat medical/psychiatric dx either as differential dx or comorbid dx.
• Collaborate with other doctors.
• Individual or Group psychotherapy.
• May use SSRIs high doses, esp. for illness anxiety disorder.

AVOID

• Concentrating on Symptoms.
• Need for symptoms to get appointments.
• Say (It’s just in your mind, take it easy..)
• Tests or Rx without Dx.
• Unnecessary Referrals/consultations.