Somatic Symptom Disorder
Somatic symptom disorder is characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis. Patients’ suffering is authentic, and they typically experience a high level of functional impairment.
The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men (So, 2008).
In particular, young women, aged 16 to 25, are more likely to receive a somatic diagnosis than men or older individual (Huang & McCarron, 2011). Symptoms may be initiated, exacerbated, or maintained by combinations of biological, psychological, and sociocultural factors.
Somatic symptom disorder is difficult to distinguish from physical disorders with organic causes, and the patient’s history is extremely important for accurate diagnosis. Often, the patient has a comorbid psychiatric disorder such as depressionOpens in new window, anxietyOpens in new window, and/or a personality disorder.
There may be a high level of medical care utilization, which rarely alleviates the patient’s concerns. Included in the most common symptoms for visits to primary care providers are chest painOpens in new window, fatigueOpens in new window, dizzinessOpens in new window, headacheOpens in new window, swellingOpens in new window, back painOpens in new window, shortness of breathOpens in new window, insomniaOpens in new window, abdominal painOpens in new window, and numbnessOpens in new window.
They account for 40% of all visits to primary care providers; however, a biological cause for these symptoms is identified in only 26% of patients (Edwards et al., 2010). Health-related quality of life is frequently severely impaired, and patients appraise their bodily symptoms as unduly threatening, harmful, or troublesome, often fearing the worst about their health.
Some patients feel that their medical assessment and treatment have been inadequate. When the health care provider is unable to provide a clear diagnosis for discomfort, patients can feel discounted and misunderstood. These patients tend to be devalued, stigmatized, and told the problem is only in their heads (Noyes et al., 2010).
Likewise, health care workers experience frustration in providing care for people who are not organically ill. Providers tend to use less patient-centred communication in comparison to patients with straightforward symptoms, even though somatic symptom visits are longer (Huang & McCarron, 2011).
A “difficult” patient may receive a somatic diagnosis more readily than a “pleasant” patient, which could contribute to an inadequate workup. Studies show that the strongest predictor of misdiagnosing somatic disorders is the primary care provider’s dissatisfaction with the clinical encounter (Huang & McCarron, 2011).