Somatic Symptom Disorders

Somatic symptom disorders (SSD), formerly known as somatoforms, are characterized by one or more somatic symptoms, meaning physical symptoms, which are accompanied by excessive thoughts, feelings and attitudes towards said symptoms, with a significant demand for medical attention, particularly in emergency departments. The terms “somatization” and “somatoform disorder” have been avoided, as they are considered by many authors to be pejorative and they print a label on patients which should be avoided. The SSD represents one of the most frustrating and least understood cases in emergency medicine and medicine in general. SSD patients are often labeled as "difficult" patients, but appropriate mental health referrals are not made and the psychological and psychosocial causes of their presentation remain unaddressed. 

SSD patients have multiple physical symptoms in the absence of detectable physical illnesses and lead to excessive concerns that are expressed emotionally, cognitively and behaviourally. There is great confusion between the TSS and the term “hypochondria”, which represents the misinterpretation of one or more somatic symptoms as representing a serious disease. Of the patients labeled as having hypochondria, 75% have SSD. Individuals with SSD have a wide range of symptoms that could represent serious pathologies, including chest pain, gastrointestinal, cardiovascular, and pseudoneurological symptoms, which cause persistent worry, distress and social dysfunction, although the patient does not necessarily believe that he or she has a serious illness . 

Somatization is best understood by focusing on the abnormalities of the patient's response to his or her somatic symptoms, rather than the absence of a discernible medical cause for these symptoms. The patient's poorly adapted response to somatic symptoms is the reason that this behavior is classified as a psychiatric disorder. Somatoform disorders, due to their nature and presentation, have consistently had diagnoses that are difficult to make with any certainty, even after several visits with the same primary care physician. It is, therefore, a challenging diagnosis within the busy limits of a brief visit to the ER. For patients with functional symptoms, the strategy of seeking a medical cause with invasive diagnostic procedures, unnecessary surgeries and misdirected drugs can be fatal, and the unjustified costs of these measures may worsen the situation. 

SSD is typically more common in women of low socioeconomic status, who are between 20 and 30 years old, with a high incidence of comorbidities such as anxiety or depression. The diagnosis of SSD is made when there are persistent and clinically significant complaints, accompanied by excessive and disproportionate health-related concerns, thoughts, feelings and behaviors regarding these symptoms. The success or failure of the management of patients with SSD in the ER depends on the ability to establish a relationship with the patient. Patients with these disorders can be more challenging to care for than those with most other psychiatric disorders; therefore, medical knowledge and patient attitudes are fundamental. 

References: 

https://www.aafp.org/afp/2007/1101/p1333.html  

https://www.webmd.com/mental-health/somatoform-disorders-symptoms-types-treatment#1