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Many patients of somatic symptom disorder complain about pain on different places of the body or fatigue, weakness or cardiovascular disturbances. In most patients, suffering entails psychological and behavioural aspects like anxiety and checking behaviour. The spectrum is wide and bodily complaints are often attributed to organic disease. Somatoform disorders are single functional somatic syndrome diagnoses (such as fibromyalgia syndrome, FMS). After suffering unsuccessful treatment, patients often feel frustrated. Overall severity is explained by the total number of bodily symptoms and the health anxiety. Depression and anxiety, together with the bodily distress of the well-defined pathology characterize patients.
The criteria that must be met according to the DSM-V are the following:
When one of the symptoms is present the disorder is moderate, when two or more symptoms are present and there are multiple somatic complaints the classification is severe. Illness anxiety disorder is when people experience hypochondriasis without bodily complaint. Because many patients have been mislabelled in the past, the classification of “medically unexplained” is not present in the DSM-V. The term bodily distress may describe the suffer from bodily symptoms but can be just psychological distress.
Genetics can contribute to the predisposition and chronic pain in general. However, the extend is limited. Epigenetic mechanisms are relevant as they are shaped by prenatal experiences. Childhood adversities seem to be a predictor of development of bodily distress. Attachment patterns formed in childhood can contribute, attachment anxiety can lead to health anxiety. Cultural influences can also contribute to the development of bodily distress, stressful work conditions and adverse life events can cause organic illness, but also bodily distress.
When individuals are referred with SSD in mind, it is not difficult to define the presence or absence of criteria. Measurement instruments include the Patient Health Questionnaire-15 (PHQ-15) for somatic symptom burden and the Whiteley index for health anxiety. There are some recommendations for adequately diagnosing SSD:
Treatment currently has moderate effect because bodily distress in general is covered by categories (such as SSD) that are used in mental health settings. However, research of the bodily patterns and psychobehavioural features of SSD should include a broader perspective. Currently there is no evidence for the efficacy of training and enhanced care of physicians. Not much evidence has been found for the effectiveness of antidepressants or hypnotherapy either.
Treatment exists of good management of this group of patients, the bodily complaints must be taken seriously even without a well-defined pathology. Encouraging the patient to take on a healthy lifestyle, hobbies and regular exercise can be helpful. In mild cases, these principles combined with waiting is enough but when the case is more severe, other approaches may help:
Psychotherapy is an established treatment but challenging in the beginning when patients often have difficulty accepting talking can help their cure. Some things could be helpful in such a situation:
Je vertrek voorbereiden of je verzekering afsluiten bij studie, stage of onderzoek in het buitenland
Study or work abroad? check your insurance options with The JoHo Foundation
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