Somatic symptom disorder

Diagnosis

To determine a diagnosis, you'll likely have a physical exam and any tests your doctor recommends. Your doctor or other health care provider can help determine if you have any health conditions that need treatment.

Your medical care provider may also refer you to a mental health professional, who may:

• Conduct a psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history
• Have you fill out a psychological self-assessment or questionnaire
• Ask you about alcohol, drug or other substance use

Criteria for diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, emphasizes these points in the diagnosis of somatic symptom disorder:

• You have one or more somatic symptoms — for example, pain or fatigue — that are distressing or cause problems in your daily life
• You have excessive and persistent thoughts about the seriousness of your symptoms, you have a persistently high level of anxiety about your health or symptoms, or you devote too much time and energy to your symptoms or health concerns
• You continue to have symptoms that concern you, typically for more than six months, even though the symptoms may vary

Treatment

The goal of treatment is to improve your symptoms and your ability to function in daily life. Psychotherapy, also called talk therapy, can be helpful for somatic symptom disorder. Sometimes medications may be added, especially if you're struggling with feeling depressed.

Psychotherapy

Because physical symptoms can be related to psychological distress and a high level of health anxiety, psychotherapy — specifically, cognitive behavioral therapy (CBT) — can help improve physical symptoms.

CBT can help you:

• Examine and adapt your beliefs and expectations about health and physical symptoms
• Learn how to reduce stress
• Learn how to cope with physical symptoms
• Reduce preoccupation with symptoms
• Reduce avoidance of situations and activities due to uncomfortable physical sensations
• Improve daily functioning at home, at work, in relationships and in social situations
• Address depression and other mental health disorders

Family therapy may also be helpful by examining family relationships and improving family support and functioning.

Medications

Antidepressant medication can help reduce symptoms associated with depression and pain that often occur with somatic symptom disorder.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms.

Talk with your doctor about medication options and the possible side effects and risks.

Lifestyle and home remedies

While somatic symptom disorder benefits from professional treatment, you can take some lifestyle and self-care steps, including these:

• Work with your care providers. Work with your medical care provider and mental health professional to determine a regular schedule for visits to discuss your concerns and build a trusting relationship. Also discuss setting reasonable limits on tests, evaluations and specialist referrals. Avoid seeking advice from multiple doctors or emergency room visits that can make your care more difficult to coordinate and may subject you to duplicate testing.
• Practice stress management and relaxation techniques. Learning stress management and relaxation techniques, such as progressive muscle relaxation, may help improve symptoms.
• Get physically active. A graduated activity program may have a calming effect on your mood, improve your physical symptoms and help improve your physical function.
• Participate in activities. Stay involved in your work and in social and family activities. Don't wait until your symptoms are resolved to participate.
• Avoid alcohol and recreational drugs. Substance use can make your care more difficult. Talk to your health care provider if you need help quitting.

Preparing for your appointment

In addition to a medical evaluation, your primary care provider may refer you to a psychiatrist or psychologist for evaluation and treatment.

What you can do

Before your appointment, make a list of:

• Your symptoms, including when they first occurred and how they impact your daily life
• Key personal information, including traumatic events in your past and any stressful, major events
• Medical information, including other physical or mental health conditions that you have
• Medications, vitamins, herbs and other supplements, and the dosages
• Questions to ask your medical care provider or mental health professional

Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.

Questions to ask may include:

• Do I have somatic symptom disorder?
• What treatment approach do you recommend?
• Would therapy be helpful in my case?
• If you're recommending therapy, how often will I need it and for how long?
• If you're recommending medications, are there any possible side effects?
• For how long will I need to take medication?
• How will you monitor whether my treatment is working?
• Are there any self-care steps I can take to help manage my condition?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your medical care provider or mental health professional may ask you questions, such as:

• What are your symptoms, and when did they first occur?
• How do your symptoms affect your life, such as at school, at work and in personal relationships?
• Have you or any of your close relatives been diagnosed with a mental health disorder?
• Have you been diagnosed with any medical conditions?
• Do you use alcohol or recreational drugs? How often?
• Do you get regular physical activity?

Your medical care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.