3 Signs Your Health Anxiety Is Somatic Symptom Disorder
WHETHER YOU HAVE pain related to an injury, chronic symptoms from an illness, or just feel tired all the time, it’s understandable to worry about your health and even experience anxiety over it. But if your worries are turning into obsessions that are taking over your daily life, you could have somatic symptom disorder (SSD).
SSD is a mental health condition where you’re intensely focused on physical symptoms—like pain, fatigue, shortness of breath, or anything else. That focus is so significant that it causes major distress and might interfere with your day-to-day functioning, according to the American Psychiatric Association.
“It’s a preoccupation with some aspect of one’s physical health, a symptom or pain,” says Alex Dimitriu, M.D., a double board-certified physician in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine and BrainfoodMD.
The feelings about health go beyond worrying and are more intense than what might be typically expected, says Jennifer Dragonette, PsyD, clinical services instructor at Newport Healthcare.
“It’s very scary to be living with this condition,” she says. “There’s a lot of fear. Often these are folks who are looking for information from doctors or online, trying to figure out what's wrong with them, and not getting good explanations or not being able to work through their symptoms.”
People with SSD experience real symptoms—that is, they’re not faking an illness. But the symptoms might not be linked to a diagnosed medical condition. The lack of a medical diagnosis can add a layer of uncertainty and increase anxiety, especially since people are sometimes told their symptoms are just “in their head,” Dragonette says.
“It can feel very invalidating and frustrating to be told you don’t have the symptoms that you feel that you have,” she explains. “It can also be isolating and cause problems in a family or in a relationship.”
What Is Somatic Symptom Disorder?
Intense but abnormal distress about physical symptoms is the central characteristic of SSD, according to the Cleveland Clinic. Someone is truly experiencing the symptoms, Dragonette says, but the specifics can vary.
"It's a tricky diagnosis because a lot of the diagnostic criteria are in and of themselves fairly subjective," she explains. Also, sometimes physical symptoms legitimately aren't taken as seriously as patients would like them to be. And, sometimes, there's no medical explanation for someone's symptoms. But, with SSD, even when there is, the feelings and worry about it are far out of proportion. Someone also might not recognize that their mental health condition could be causing physical symptoms. Research shows that depression, for example, brings a range of physical symptoms, like pain and gastrointestinal problems.
Another issue that comes up with SSD is that it’s often tough to objectively measure pain, Dragonette says.
“So, the symptoms are very real to the person who's experiencing them, but it's out of the realm of what we would expect for that particular medical condition, or there may not be an obvious medical explanation for why they're experiencing those symptoms,” she explains.
SSD is rooted in anxiety, Dr. Dimitriu says. It could be related to learned patterns of how someone relates to pain or bodily processes. Childhood physical and sexual abuse might also increase the risk for the disorder.
People with SSD are more likely to be diagnosed with anxiety and depression, as well.
What Are the Signs of Somatic Symptom Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders, the main signs of SSD are “excessive thoughts, feelings, or behaviors” related to symptoms or health concerns that include:
Having disproportionate and persistent thoughts about how serious symptoms are
Experiencing high levels of anxiety about health or symptoms
Devoting excessive time and energy to the symptoms or health concerns
Someone must experience these symptoms for at least six months to be diagnosed with SSD, with the feelings disrupting their daily lives.
People with SSD might also:
Believe mild symptoms are signs of serious illness
Visit their doctor for multiple tests and exams but do not believe the results
Feel that their doctors aren’t taking their symptoms seriously enough
Seek treatment from multiple healthcare providers
Demand emotional support and help from others, and feel angry when their needs aren’t met
Why SSD Isn’t The Same as Hypochondria
SSD isn’t the same as illness anxiety disorder, sometimes referred to as hypochondria, which Dr. Dimitriu says is a stigmatized term.
With illness anxiety disorder, a person is preoccupied or intensely worried about getting an illness or being sick—but they usually don’t experience physical symptoms.
SSD also differs from conversion disorder, a mental health condition where someone has symptoms like blindness, paralysis, or neurological issues without a medical explanation. People can have SSD and conversion disorder at the same time.
How Is SSD Diagnosed and Treated?
Usually, SSD is diagnosed by a healthcare provider. Dr. Dimitriu says internal medicine physicians tend to see SSD cases more frequently. Doctors may refer patients for mental health treatment to improve how they relate to their physical health.
“A therapist or psychiatrist would get a thorough history and look at patterns of anxiety or depression, as well as psychological styles relating to pain or illness,” Dr. Dimitriu says.
It’s sometimes a struggle for people with SSD to seek treatment because many don’t see their symptoms as mental-health related, Dragonette says. “They really feel like this is a medical problem, and maybe doctors aren’t giving it enough attention.”
People might also seek mental health treatment at the urging of family and friends, she adds.
Cognitive behavioral therapy is a common treatment for SSD. Sometimes medication for anxiety is prescribed, too. Treatment might also involve a team approach with other healthcare providers, Dragonette says.
“It’s about teaching people about mindfulness, ways to reduce stress, ways to reduce distress when it flares up in the moment, and how to take care of the body,” she says. “We’ll also work with anxiety symptoms when they pop up and how to manage thoughts that are distressing.”
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