psychiatric disorders
Somatic Symptom Disorder
Symptoms and Signs of Somatic Symptom Disorder
Recurring physical complaints usually begin before age 30; most patients have multiple somatic symptoms, but some have only one severe symptom, typically pain. Severity may fluctuate, but symptoms persist and rarely remit for any extended period. The symptoms themselves or excessive worry about them is distressing or disrupts daily life. Some patients become overtly depressed. When somatic symptom disorder accompanies another medical disorder, patients overrespond to the implications of the medical disorder; for example, patients who have had complete physical recovery from an uncomplicated myocardial infarction (MI) may continue to behave as invalids or constantly worry about having another MI. Whether or not symptoms are related to another medical disorder, patients worry excessively about the symptoms and their possible catastrophic consequences and are very difficult to reassure. Attempts at reassurance are often interpreted as the physician not taking their symptoms seriously. Health concerns often assume a central and sometimes all-consuming role in a patient's life. Patients are very anxious about their health and frequently seem unusually sensitive to adverse drug effects. Any body part may be affected, and specific symptoms and their frequency vary among cultures. Whatever the manifestations, the essence of somatic symptom disorder is the patient's excessive or maladaptive thoughts, feelings, or behaviors in response to the symptoms. Patients may become dependent on others, demanding help and emotional support and becoming angry when they feel their needs are not met. They may also threaten or attempt suicide. Often dissatisfied with their medical care, they typically go from one physician to another or seek treatment from several physicians concurrently. The intensity and persistence of symptoms may reflect a strong desire to be cared for. Symptoms may help patients avoid responsibilities but may also prevent pleasure and act as punishment, suggesting underlying feelings of unworthiness and guilt. 