This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Evidence Based Treatments for Somatic Symptom and Related Disorders by Lori Parker
The Somatic Symptom and Related Disorders is a class of disorders dominated by somatic symptoms. These physical symptoms may, or may not, have a medical cause; however, the symptoms do cause significant distress and impairment for the individual and their families. Persons with somatic symptoms are more often seen in primary care settings such as a physician’s office or a hospital rather than by a mental health professional. One of the biggest difficulties facing a person with somatic symptoms is that a physician may not believe the person. Another difficulty facing someone with somatic symptoms is the cause could be one of several options: a medical disease, another mental disorder such a depression, or there could be no apparent cause leading to a diagnosis of one of the Somatic Symptom and Related Disorders. While cause may be difficult to determine, there is effective treatment.
If it is determined that the somatic symptoms are the result of a medical disease, treatment will follow the course of treatment for that particular disorder. If the cause appears to be another mental health disorder, such as depression, the treatment will generally be an antidepressant. If the somatic symptoms cannot be attributed to a medical disease or another mental disorder, both pharmacological and psychological treatments are available.
For medications, the most commonly prescribed type of medication is antidepressants. The most effective antidepressants appears to be the selective serotonin reuptake inhibitors (SSRI’s). However, there are side effects and withdrawal symptoms associated with the SSRI’s. In a meta-analysis done by Sumathipala (2007), withdrawal symptoms were seen in 69% of the studies and side effects were seen in 37% of the studies.
By far, the most effective treatment for all of the Somatic Symptom and Related Disorders is Cognitive Behavioral Therapy (CBT). CBT is effective if administered to a single individual or in group therapy. Sessions can last anywhere from six 40-minute sessions for individuals to eight 3-hour sessions for groups (Sumathipala, 2007). CBT has the added benefit in that it teaches the individual how to handle symptoms as they arise. For many people diagnosed with Somatic Symptom and Related Disorders, symptoms change over time and few experience the same symptom in the long term. Another major component in CBT is educating the person on how stress effects physical symptoms. The ultimate goal is to reduce the anxiety associated with the somatic symptoms, which in turn, reduces the amount of somatic symptoms a person exhibits.
CBT encompasses, “cognitive restructuring, cognitive coping, problem-solving training, assertiveness training, visualization, and the use of behavioral experiments (i.e. having the patients “test” out assumptions)” (Nezu, Nezu, & Lombard, 2001). Cognitive restructuring involves adjusting thoughts and perversions of perceived physical sensations and reattributing them to common occurrences versus medical causes (Looper & Kirmayer, 2002). Other cognitive aspects included in CBT center around past illness experiences and changing learned patterns of behavior. Behavioral components are focused on behaviors such as avoidance of care or certain activities and care seeking. Therapeutic intervention includes desensitization, returning to previous activities, and exposure with response prevention to induce anxiety but not allow the person to seek medical treatment.
CBT can also involve the family and physician of the person involved as well. Involving the family can help to restructure the home environment so that there are fewer maintaining factors of the Somatic Symptom and Related Disorder. Involving the physician can help the patient and physician be better prepared in the future as the patient may return to the physician with different somatic symptoms. This can also validate the fact that the patient experienced a symptom, even if a medical cause could not be determined. This is of particular importance as many people with Somatic Symptom and Related Disorders feel they are not believed when seen by medical professionals. However, it is of higher importance to not reinforce the fixation on having an illness when validating the occurrence of somatic symptoms.
While medication and CBT are effective in treating Somatic Symptom and Related Disorders, it is not effective for the physician to simply tell the patient that there is no cause for their somatic complaint. It is equally as ineffective for a person with a somatic disorder to be shown negative test results. In many cases, seeing the results only exacerbates the symptoms and the person will go to another physician for the same, or new, tests. However, a primary care physician receiving a consultation letter from a psychiatrist with a treatment plan, appears to be effective in reducing symptoms and health care costs (Kroenk, 2007 and Sumathipala, 2007).
Somatic Symptom and Related Disorders are marked by physical symptoms that may appear to have no medical cause. Most people with this disorder are seen by a primary care physician instead of psychiatrist as they are seeking a medical cause for their physical symptom. The most effective treatment for this class of disorders is Cognitive Behavioral Therapy, but positive results have been seen with antidepressants and a consultation letter from a psychiatrist. It is important to treat and educate the patient, as well as their family, without reinforcing preoccupation with the illness. In order to treat as many people as possible, it is important for medical professionals, both physicians and psychiatrists, to be trained in CBT. It is of equal importance for persons presenting with somatic symptoms to be taken seriously so treatment can be received as well as creating a strong physician-patient relationship.