Disease Description (Causes and Symptoms)
- Summary of definition: Somatic symptom disorder is a mental health condition in which one or more physical symptoms are present, and the resulting psychological overreaction (excessive worry, anxiety, and expenditure of time and energy) causes primary functional impairment. In many cases, no clear organic disease is found on examination, or the person experiences distress that is difficult to explain by the disease that has been identified.
- Causes and pathophysiology: Major mechanisms include excessive internal attention to stress and negative emotions, suppression of emotional expression, and a cognitive tendency to negatively interpret ambiguous bodily sensations. Psychological factors affect the brain's sensory and emotional processing circuits, causing bodily symptoms to be perceived or causing symptoms to worsen.
- Main symptoms (examples): Headache, abdominal bloating, nausea and vomiting, chest tightness, chest pain and palpitations, dizziness, muscle pain and fatigue, sweating, dry mouth and facial flushing, hand tremor and tingling, menstrual irregularities, etc. Symptoms may occur across multiple systems and may change over time.
- Diagnostic points: Assessment includes not only the physical symptoms themselves but also whether the person excessively worries about the symptoms or repeatedly seeks medical confirmation (excessive health anxiety, excessive diagnostic procedures, etc.). In general, symptoms often persist for 6 months or longer (depending on the diagnostic criteria).
Treatment Methods
- Non-pharmacological treatment (first-line recommendation)
- Cognitive behavioral therapy (CBT): Changes interpretations of bodily sensations and trains symptom coping strategies (shifting attention, relaxation, increasing activity, etc.). It is effective in improving symptoms and functioning.
- Regular outpatient follow-up (keeping appointments with the treating physician at set times and intervals) helps reduce unnecessary tests and ensure continuity of treatment.
- Stress management and lifestyle improvements, including sleep, exercise, and diet, as well as relaxation training and breathing techniques, are recommended.
- A multidisciplinary approach (psychiatry, internal medicine, family medicine, physical therapy, etc.) may be used when necessary.
- Pharmacological treatment
- The main goal is to alleviate accompanying depressive and anxiety symptoms. Selective serotonin reuptake inhibitors (SSRIs) or SNRIs may be used (e.g., sertraline, fluoxetine, venlafaxine, etc.). Medication alone does not completely eliminate physical symptoms, but it can help improve overall anxiety and mood.
- Benzodiazepines may be used for short-term anxiety control, but long-term use is not recommended because of the risk of dependence and adverse effects.
- Procedures/surgery: If an organic disease is confirmed, the relevant treatment is provided. Surgical treatment does not apply to somatic symptom disorder itself.
- Precautions and risk of complications
- Do not simply label the patient as “faking.”
- Repeated and unnecessary tests and treatments increase medical costs and the risk of adverse effects and iatrogenic harm (medical complications).
- Be alert to accompanying depression and suicide risk, as well as functional decline (reduced work and social activities).
Outpatient Visit Checklist (Including Preparations and Example Questions)
- Preparations (recommended to bring)
- List of medications and supplements currently being taken (name, dose, and time taken)
- Previous test results (blood tests, imaging tests, etc.) or copies of test records
- Symptom diary (when symptoms occur, type and intensity, duration, triggers and relieving factors, and impact on daily functioning)
- Records of medical and family history (psychiatric disorders, physical illnesses, etc.)
- A brief note on current lifestyle patterns (sleep, diet, exercise, and stressors)
- Information useful to share with the doctor during the outpatient visit
- When the symptoms first began and how they have progressed
- Situations in which the symptoms worsen (stress, lack of sleep, etc.)
- Limitations in daily life caused by the symptoms (absence from work, reduced social activities, etc.)
- Previous treatments (medications and psychotherapy) and whether they were effective
Examples of General Questions to Ask the Doctor
- “How can you determine whether this symptom is caused by a serious physical illness?”
- “What are the expected effects and adverse effects of the recommended treatment options (psychotherapy and medication)?”
- “Do I need to undergo more tests, or is it safe not to have any further tests?”
- “What lifestyle changes should I prioritize?”
- “How long is treatment expected to take, and what is the prognosis?”
Examples of Condition-Specific Questions
- “How exactly is cognitive behavioral therapy conducted, and after approximately how many sessions can I expect to see benefits?”
- “When current symptoms are severe, what are the criteria for starting medication (such as the degree of functional impairment or the presence of accompanying anxiety or depression)?”