“Female or male, of any age, although increasingly younger, who have varied symptoms, generally chronic and subjective in nature, with the history of studies by various medical specialists, and very exhaustive complementary studies, with no definite findings of concrete organic disease currently known, and poor response to treatments”.
This would be, broadly speaking, the summary of Somatic Symptom Disorder (DSM-5 classification / year 2013), an increasingly frequent pathology (between 15 and 25% of primary care consultations), and previously known as “somatization”. Patients who suffer from it experience a real symptomatology, with a perception of poor health, which hinders their daily life, both in their personal and family life, as well as in their work and social life, causing a poor quality of life.
In addition, consultation of Internet sites, not always of acceptable quality, often adds an additional difficulty to the solution of the problem. And the health professional finds himself in a difficult situation, in which it is essential to dedicate a lot of time to the patient, in an empathic way, since those affected insistently seek a diagnosis of organic disease, which is almost never possible to establish, although sometimes, after carrying out numerous tests, the finding of some of them suggestive of organicity, do not justify the symptomatology referred by the patient. The personality of this group of patients tends to be rather introspective and anxious, sometimes with significant levels of stress, a high tendency to self-observation and a certain obsession to clarify the origin of their clinical manifestations, although they do not always present hypochondriacal features.
The interaction of this personality together with the perception of a symptomatology as varied as it is real, makes the person feel in a negative loop and enters a progressive dynamic towards worsening, accompanied by emotional distress.
Cause of somatic symptom disorder
The exact cause of this pathology is not known, although genetic factors, increased sensitivity to pain (sometimes called central sensitivity syndrome, characterized by a lowering of the pain threshold), childhood experiences and traumas, as well as learned behaviors in the face of family pathological situations, problems in the perception of emotions and a tendency to focus more on physical symptoms may have an influence. In addition, the existence of stress, due to personal, family, social or work-related problems, anxiety or depression, family history of serious diseases, are known risk factors for suffering from this disease.
In any case, it is always necessary to rule out the existence of an organic pathology that justifies it and to consider the possibility of alcohol consumption, drugs or other substances, either as triggers of the process or secondary to the continuous feeling of discomfort and hopelessness. Although it can occur at any age and affect both women and men, it is more frequent in women, and often the symptomatology appears for the first time before the age of 30.
Symptomatology of Somatic Symptom Disorder
Symptoms can be mild, moderate or intense, few or numerous, acute or chronic, being the most frequently reported pain at any level, tiredness and weakness, feeling short of breath to breathe, but any other symptom or finding in their body can be referred, such as headaches, “tingling”, dizziness, instability, difficulty to concentrate, loss of abilities, sleep disorders, digestive heaviness, intestinal habit disorders, palpitations, pruritus, etc…., and always emphasizing the intense and worried way of experiencing these manifestations, with the belief that they are surely the expression of a serious disease, which has not been correctly diagnosed. For this reason, consultations to a wide variety of specialists, emergency services and alternative therapies are very frequent. Likewise, they often interpret various physical sensations, which are normal, as signs of illness.
Day-to-day life becomes increasingly difficult because of this symptomatology, which is at the center of their lives, leading them to a constant struggle to clarify the disease they suffer from, with the consequent loss of time, expense and possibility of side effects, both for the performance of tests, sometimes aggressive and not always justified, and for the pharmacological treatments prescribed.
Diagnosis of somatic symptom disorder
Patients have one or more somatic symptoms, real, although sometimes vague and diffuse, which can be very broad and vary over time, usually lasting more than 6 months and accompanied by excessive and constant thoughts about the severity of the symptoms.
This pathology is an important challenge for the physician, and the professional must dedicate time to the patient, and empathize with him and his interest in obtaining a diagnosis, although the lack of significant exploratory findings and the existence of numerous normal complementary tests do not confirm the organic origin of the symptoms.
However, telling a patient that we have not found an organic disease that justifies the great majority of his symptoms is very complicated, is often not accepted and produces disappointment and a feeling that “you are not getting my disease right”. On the other hand, we must be very cautious when it comes to being categorical in our opinion, since there are many infrequent diseases that are difficult to identify with current scientific knowledge and others that take a little longer to manifest themselves in a more definite way. As always in the care of any patient, the realization, without haste, of a very detailed clinical history and physical examination, by organs and apparatus, is fundamental, as well as the follow-up of the patient, providing proximity and accessibility, for the evaluation of new symptomatology, mainly if symptoms or objectifiable physical signs appear. The performance of complementary tests, analyses, imaging studies, etc. will always be indicated according to the principle of lesser to greater aggressiveness and cost, and provided that they are justified by the symptoms reported by the patient.
Treatment of somatic symptom disorder
In the first place, it is very important that they are attended very attentively when they describe their symptoms to us, and subsequently they should be explained in detail, in a very clear way, what this pathology consists of, recognizing and legitimizing their symptoms, and trying to help them to reduce their excessive concern about the origin and treatment of their symptoms. In addition, it is not uncommon for these patients not to tolerate or to be very sensitive to medication, which on the other hand does not usually produce relief in many of the symptoms.
In my experience, that the patient is reasonably satisfied with the detailed explanation of the professional, after an exhaustive clinical history and physical examination and analysis of the entire medical history that is always attached, is fundamental for the onset of improvement. And, it seems to me very important to always recognize the limitations of current medicine and the possibility that in the future the organic bases of its symptomatology will be identified, although at the present time we only know, in part, the relevance of the psychological aspects.
And of special importance, I consider that specialized psychological support is very convenient, for learning relaxation techniques and early recognition and treatment of stress, cognitive-behavioral therapy, as well as psychoeducation to learn to live with some physical symptoms, and try to stop them from being the main protagonist of their lives.
The practice of yoga, meditation and physical exercise, for example, daily walking at least 30 minutes, swimming, or any physical activity of personal taste, can be helpful, overcoming the possible belief that they are not capable or that physical exercise makes them worse. It is very important to advise them not to make indiscriminate searches on Internet pages and to avoid repeated observation of symptoms or signs in their body.
In case of obvious symptoms of anxiety or depression, pharmacological treatment by psychiatric specialists may be necessary.
For more information, consult a specialist in Internal Medicine.