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Somatic symptom disorder is a disorder characterised by the presence of persistent somatic symptoms accompanied by thoughts, feelings and behaviours related to health that are excessive and disproportionate. The symptoms may have a known medical cause or not, and cause the patient to frequently attend primary care departments, A&E and/or specialists.
Somatic symptom disorder, according to the diagnostic and statistical manual of mental disorders (DSM-5) from the American Psychiatric Association, is a disorder involving one or more persistent somatic symptoms, with or without a medical explanation, accompanied by excessive and exaggerated thoughts, feelings or behaviours. At the same time, there is a severe decrease in the quality of life of the people who suffer from the condition.
The origin of the disorder is unknown, but we do know that it is exploited by multiple biological, psychological and environmental conditions, which interact in a non-linear way and predispose the patient to present with the condition. There is often a tendency for patients to attend multiple specialists, with several requests for complementary testing, which can often become iatrogenic, with the patient often feeling misunderstood and ill-treated by the healthcare system. The most common symptom is pain and the systems most commonly affected are the digestive system, the musculoskeletal system and the skin.
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings or behaviours 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.
The prevalence of the disorder in the general population is around 5-7% and in primary care populations it broadly ranges from 5-35%. It is proportionately more common in women, with a ratio of 2:1 compared to men and often starts towards the beginning of adulthood. 30% of people suffering this disorder tend towards chronicity.
Diagnosis is CLINICAL. An appropriate clinical history needs to be conducted with the patient and/or relatives by a specialised healthcare professional. There are several scales to evaluate the severity of symptoms or associated comorbid disorders.
It needs to be tackled in various ways: Psychoeducation, cognitive behaviour therapy and pharmacological treatment in the case of comorbid psychiatric conditions. The cornerstone of treatment is a good doctor/patient relationship, avoiding unnecessary and iatrogenic complementary testing.
Clinical history. Psychological evaluation. Blood test, vital signs, weight and height.
Work with healthcare professionals through regular and scheduled appointments and adequate management of requests for complementary tests in order to avoid iatrogenic illness. Do regular physical exercise, try to rest well at night, stay active and take part in employment and/or leisure activities, learn and practise relaxation therapies such as mindfulness and avoid consuming toxic substances.
Dra. Amanda Rodriguez-Urrutia
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