Somatic Symptom Disorders Treatment & Management
- Author: William R Yates, MD, MS; Chief Editor: Eduardo Dunayevich, MD more...
Somatic symptom disorder emergency department care
Somatic symptom disorders may present to the emergency room for assessment and treatment during periods of acute increase in symptom severity.
Electroconvulsive therapy is not effective for somatic symptom disorders, but it may successfully treat somatic symptoms related to an underlying mood disorder.
Obtain necessary studies to rule out physical causes such as myocardial infarction or appendicitis.
Intravenous or oral acute sedation with benzodiazepines may be used. Avoid long-term benzodiazepines for somatic symptom disorders. Avoid acute or long-term narcotic analgesics for somatic symptom disorders.
Conversion disorder emergency department care
Conversion disorder may be interpreted by the patient and family as a sign of an acute and potentially catastrophic medical condition. Emergency department personnel should quickly rule out potential life-threatening, disabling, or treatable causes for the symptoms. Emotional support should be provided to patient's family members.
Early consultation with a psychiatrist may limit unnecessary medical or surgical interventions. Referral to psychiatrist may be prefaced by stating that the cause for the medical symptoms have not been found and that in similar cases, assessment of the role of stress by a medical psychiatrist may be helpful in reducing the discomfort experienced by the patient.
Psychosocial interventions (primary care management)
Randomized trials have demonstrated the value of physician education in the management of the patient with somatization.[12, 13] Cognitive-behavioral psychotherapy strategies may be specifically helpful in reducing distress and high medical use. Psychosocial interventions directed by physicians form the basis for successful treatment. A strong relationship between the patient and the primary care physician can assist in long-term management.
Psychoeducation can be helpful by letting the patient know that physical symptoms may be exacerbated by anxiety or other emotional problems. However, be careful because patients are likely to resist suggestions that their condition is due to emotional rather than physical problems.
The primary care physician should inform the patient that the symptoms do not appear to be due to a life-threatening, disabling, medical condition and should schedule regular visits for reassessment and reinforcement of the lacking severity of ongoing symptoms.
The patient also may be told that some patients with similar symptoms have had spontaneous improvement, implying that spontaneous improvement may occur. However, the physician should accept the patient's physical symptoms and not pursue a goal of symptom resolution.
Indeed, regular, noninvasive, medical assessment reduces anxiety and limits health care–seeking behavior; this may be facilitated by regularly scheduled visits with the patient's primary care physician.
Encourage patients to remain active and limit the effect of target symptoms on the quality of life and daily functioning.
Family members should not become preoccupied with the patients physical symptoms or medical care. Family members should direct the patient to report symptoms to their primary care physician.
Psychosocial interventions for specific somatic symptom disorders
This is now typically diagnosed as somatic symptom disorder. Patients may resist suggestions for individual or group psychotherapy because they view their illness as a medical problem. Patients who accept psychotherapy may be able to reduce health care utilization. Psychosocial interventions that focus on maintaining social and occupational function despite chronic medical symptoms may be helpful.
Limited studies about specific psychotherapy exist for conversion disorder. Behavior therapy or hypnosis may be effective. Symptoms often resolve spontaneously.
This is now typically diagnosed as a somatic symptom disorder or primary anxiety disorder. Physicians should attempt to answer questions and reduce the patient's fear of a specific illness. Group psychotherapy may provide social support and reduce anxiety. Cognitive therapy strategies may help by focussing on distorted disease-related cognitions. Individual insight-oriented psychotherapy has not been proven effective.
Cognitive-behavioral therapy 
Recent studies have shown that cognitive-behavioral therapy reduces depressive symptoms in people with somatic diseases. In particular, this type of therapy is especially effective for patients who fit the criteria for a depressive disorder. Cognitive-behavioral therapy was superior to control conditions, with even greater effects to groups restricted to participants with depressive disorder.
See the list below:
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Fourth Edition. Washington, DC: American Psychiatric Association; 2000. Text Revision.
Atmaca M, Sirlier B, Yildirim H, Kayali A. Hippocampus and amygdalar volumes in patients with somatization disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Aug 15. 35(7):1699-703. [Medline].
van der Kruijs SJ, Bodde NM, Vaessen MJ, Lazeron RH, Vonck K, Boon P, et al. Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatry. 2012 Mar. 83(3):239-47. [Medline].
Baumeister H, Härter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. 2007 Jul. 42(7):537-46. [Medline].
Baruffol E, Thilmany MC. Anxiety, depression, somatization and alcohol abuse. Prevalence rates in a general Belgian community sample. Acta Psychiatr Belg. 1993 May-Jun. 93(3):136-53. [Medline].
Chioqueta AP, Stiles TC. Suicide risk in patients with somatization disorder. Crisis. 2004. 25(1):3-7. [Medline].
Kendler KS, Aggen SH, Knudsen GP, Røysamb E, Neale MC, Reichborn-Kjennerud T. The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. Am J Psychiatry. 2011 Jan. 168(1):29-39. [Medline]. [Full Text].
Maes M, Galecki P, Verkerk R, Rief W. Somatization, but not depression, is characterized by disorders in the tryptophan catabolite (TRYCAT) pathway, indicating increased indoleamine 2,3-dioxygenase and lowered kynurenine aminotransferase activity. Neuro Endocrinol Lett. 2011. 32(3):264-73. [Medline].
Katzer A, Oberfeld D, Hiller W, Gerlach AL, Witthöft M. Tactile perceptual processes and their relationship to somatoform disorders. J Abnorm Psychol. 2012 May. 121(2):530-43. [Medline].
Werring DJ, Weston L, Bullmore ET. Functional magnetic resonance imaging of the cerebral response to visual stimulation in medically unexplained visual loss. Psychol Med. 2004 May. 34(4):583-9. [Medline].
Martin A, Rauh E, Fichter M, Rief W. A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics. 2007 Jul-Aug. 48(4):294-303. [Medline].
Smith GR Jr, Monson RA, Ray DC. Psychiatric consultation in somatization disorder. A randomized controlled study. N Engl J Med. 1986 May 29. 314(22):1407-13. [Medline].
Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. 2004 Mar 24. 291(12):1464-70. [Medline].
Bleichhardt G, Timmer B, Rief W. Cognitive-behavioural therapy for patients with multiple somatoform symptoms--a randomised controlled trial in tertiary care. J Psychosom Res. 2004 Apr. 56(4):449-54. [Medline].
Beltman MW, Voshaar RC, Speckens AE. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br J Psychiatry. 2010 Jul. 197(1):11-9. [Medline].
Huang M, Luo B, Hu J, Wei N, Chen L, Wang S, et al. Combination of citalopram plus paliperidone is better than citalopram alone in the treatment of somatoform disorder: results of a 6-week randomized study. Int Clin Psychopharmacol. 2012 May. 27(3):151-8. [Medline].
Egloff N, Cámara RJ, von Känel R, Klingler N, Marti E, Ferrari ML. Hypersensitivity and hyperalgesia in somatoform pain disorders. Gen Hosp Psychiatry. 2014 May-Jun. 36(3):284-90. [Medline].
Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007 Dec. 69(9):881-8. [Medline].
Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B. The economic cost of brain disorders in Europe. Eur J Neurol. 2012 Jan. 19(1):155-62. [Medline].
Roca M, Gili M, Garcia-Garcia M, Salva J, Vives M, Garcia Campayo J, et al. Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord. 2009 Apr 9. [Medline].
Sumathipala A, Siribaddana S, Abeysingha MR, De Silva P, Dewey M, Prince M, et al. Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial. Br J Psychiatry. 2008 Jul. 193(1):51-9. [Medline].
van Ravesteijn H, Wittkampf K, Lucassen P, van de Lisdonk E, van den Hoogen H, van Weert H, et al. Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med. 2009 May-Jun. 7(3):232-8. [Medline].