Mental health conditions often extend beyond thoughts and emotions—sometimes, they manifest as physical symptoms without a clear medical explanation. These are known as Somatic Symptom and Related Disorders (SSRDs), or Somatoform Disorders.
People with these disorders experience real distress through symptoms such as pain, weakness, seizures, or sensory loss, yet medical tests fail to identify an underlying disease. This doesn’t mean the symptoms are “fake” or “imagined.” Instead, they represent how psychological stress expresses itself physically.
The major disorders under this category include:
Somatic Symptom Disorder (SSD)1. Somatic Symptom Disorder (SSD)
Definition
Somatic Symptom Disorder occurs when an individual is consumed by physical symptoms—such as pain, fatigue, or gastrointestinal issues—that cannot be explained by medical conditions. These symptoms disrupt daily life and often lead to repeated medical visits.
Manifestations
- Physical symptoms dominate daily life.
- Frequent medical consultations from multiple providers.
- Symptoms wax and wane (remission & exacerbation).
- Overuse of analgesics and anti-anxiety medications.
- Stress increases the intensity of symptoms.
Nursing Considerations
Safety first: Screen for self-harm or suicidal thoughts.
- Recognize that symptoms feel real to the patient, even without pathology.
- Help clients verbalize feelings, but avoid over-focusing on symptoms.
- Educate on alternative coping mechanisms (stress management, relaxation).
Diagnosis Tool
PHQ-15 (Patient Health Questionnaire-15):
Assesses the 15 most common somatic symptoms such as pain, dizziness, fatigue, and stomach upset.
2. Conversion Disorder (Functional Neurological Symptom Disorder)
Definition
Sudden appearance of neurological symptoms without a medical explanation, often linked to unconscious psychological conflict. Symptoms are not voluntary and lie beyond the client’s conscious control.
Manifestations
Motor Symptoms:
- Paralysis, weakness, or tremors.
- Pseudoseizures (seizure-like activity without epilepsy).
Sensory Symptoms:
- Blindness, deafness.
- Burning, tingling, or numbness.
- Inability to smell, speak, or swallow.
Other Manifestations:
Pseudocyesis (false pregnancy): Signs of pregnancy without a fetus, often in women desiring pregnancy.Nursing Considerations
- Ensure safety (prevent falls during pseudoseizures, monitor nutrition).
- Build trust and rapport with the client.
- Teach stress management methods.
- Encourage individual, group, or support therapies.
- Educate about coping strategies instead of symptom focus.
Medications
Antidepressants (SSRIs, SNRIs).3. Post-Traumatic Stress Disorder (PTSD)
Definition
PTSD develops after exposure to traumatic events such as accidents, war, assault, or natural disasters. Unlike somatic symptom or conversion disorder, PTSD stems from a clear event but manifests psychologically and physically.
Manifestations
- Symptoms lasting longer than 1 month.
- Anxiety and hypervigilance.
- Detachment from others.
- Nightmares and flashbacks.
- Emotional numbness.
Nursing Considerations
- Teach relaxation techniques (deep breathing, meditation).
- Encourage participation in support groups.
- Educate clients on anxiety reduction strategies.
- Provide reassurance and safety.
Medications
Antidepressants (SSRIs, SNRIs).Causes and Risk Factors of SSRDs
Psychological conflict or trauma.Treatment Approaches
Medications
Antidepressants: SSRIs (fluoxetine, sertraline) are effective.Psychotherapy
Cognitive Behavioral Therapy (CBT): Identifies links between stress and symptoms.Non-Pharmacological Interventions
- Relaxation training (breathing, yoga, mindfulness).
- Physical activity to reduce stress.
- Education about stress-symptom connection.
Quick Comparison Table
| Disorder | Key Features | Symptoms | Nursing Focus | Treatment |
|---|---|---|---|---|
| Somatic Symptom Disorder | Psychological stress → physical symptoms | Pain, fatigue, GI upset, dizziness | Safety, validate symptoms, teach coping | CBT, SSRIs, coping skills |
| Conversion Disorder | Neurological-like symptoms without pathology | Paralysis, blindness, pseudoseizures, false pregnancy | Safety, trust, stress management | Therapy, antidepressants, anxiolytics |
| PTSD | Trauma-related disorder | Anxiety, nightmares, flashbacks, detachment | Relaxation, support, reduce anxiety | Antidepressants, trauma therapy |
Frequently Asked Questions (FAQ)
Q1. Are somatic symptoms “fake” or “imagined”?
No. The symptoms are real to the person. They stem from psychological stress but lack a medical explanation.
Q2. What is pseudocyesis?
A false pregnancy where the body shows pregnancy signs without an actual fetus.
Q3. How is PTSD different from somatic symptom disorder?
PTSD is triggered by a trauma, while somatic symptom disorder involves physical complaints without pathology.
Q4. Can stress really cause physical illness?
Yes. Stress activates the nervous system, causing real symptoms like pain, fatigue, or numbness.
Q5. What is the role of nurses in managing SSRDs?
Nurses ensure safety, validate symptoms, build trust, teach coping skills, and encourage therapy.
Q6. Which assessment tool is used for somatic symptoms?
The PHQ-15 questionnaire screens for the 15 most common somatic symptoms.
Q7. What therapies work best?
CBT, relaxation therapy, and trauma-focused interventions (for PTSD) are most effective.
