Somatic symptom disorder is a condition where psychological stressors manifest as physical symptoms that cannot be fully explained medically. It affects 5-7% of the population, with women experiencing somatic pain about 10 times more often than men. Anyone can develop the disorder due to factors like a chaotic lifestyle, difficulty expressing emotions, childhood neglect, substance abuse, or other mental health conditions. Common physical symptoms include fatigue, pain, digestive issues, and skin problems. While the exact causes are unknown, stress is thought to release hormones that damage the body. Treatment involves cognitive behavioral therapy, medication, and working with mental health specialists to address the underlying psychological issues contributing to the somatic symptoms.

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PSD is a rare psychodynamic occurrence that consists of the physical expression
of an unconscious conflict or stressor in a person’s life.
This physical expression is characterized by a recent psychological stressor that
converts into physical signs and symptoms that are inconsistent or cannot be
explained by known anatomy or physiology.
It can affect almost any part of the body. People with the disorder tend to seek
frequent medical attention, becoming frustrated with no diagnosis.
Psychosomatic disorders

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Somatic symptom disorder is common, occurring in about 5% to 7% of the
general population. For reasons that are not understood, women have somatic
pain about 10 times more often than men.
Prevalence

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Anyone can have somatic symptoms at any age.
• Chaotic lifestyle.
• Difficulty recognizing and expressing emotions.
• Childhood neglect.
• History of sexual abuse.
• Other psychological conditions, such as depression or personality disorders.
• Substance abuse (such as alcoholism or drug addiction).
• Unemployment.
Who can be affected?

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• Fatigue
• Insomnia
• Aches and pains, such as muscle pain or back pain.
• High blood pressure (hypertension).
• Trouble breathing (dyspnea, or shortness of breath).
• Indigestion (upset stomach).
• Headaches and migraines.
• Erectile dysfunction (impotence).
• Skin rash (dermatitis).
• Stomach ulcers (peptic ulcer disease).
Effect of PSD on body

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Unknown etiology
Stress releases hormones and chemicals in the body that cause damage or
dysfunction.
Etiology

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General:
• Sudden, acute onset
• Lack of concern about the symptoms
• Unexplainable motor or sensory function impairment
Motor:
• Impaired coordination or balance and/or bizarre gait pattern
• Paralysis or localized weakness
• Loss of voice, difficulty swallowing, or sensation of a lump in the throat
• Urinary retention
Sensory:
• Altered touch or pain sensation (paresthesia or dysesthesia)
• Visual changes (double vision, blindness, black spots in visual field)
• Hearing loss (mild-to-profound deafness)
• Hallucinations
• Seizures or convulsions
• Absence of significant laboratory findings
• Electrodiagnostic testing within normal limits
• Deep tendon reflexes within normal limits
Characteristics/Clinical Presentation

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• Do you have trouble sleeping at night?
• Do you have trouble focusing during the day?
• Do you worry about finances, work or life in general?
• Do you feel a sense of dread or worry without cause?
• Do you ever feel happy?
• Do you have a fear of being in groups of people? Fear of flying? Public speaking?
• Do you have a racing heart, unexplained dizziness, or unexpected tingling in your
face or fingers?
• Do you wake up in the morning with your jaw clenched or feeling sore muscles and
joints?
• Are you irritable or jumpy most of the time?
Screening Questions for
Psychogenic Source of Symptoms:

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• History of visits to healthcare providers.
• Physical exam
• Series of negative results on tests.
• To be diagnosed with somatic symptom disorder, a person must have:
• One or more symptoms that are distressing or disruptive to daily life.
• A history of those symptoms for at least six months.
• Persistent thoughts, worries or anxiety about the symptoms.
Diagnosis

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• Cognitive behavioral therapy.
• Medications, such as antidepressants.
• Mindfulness-based therapy.
• Referral to a specialist in mental health (for example, a psychiatrist or
psychologist).
• Regular contact with your primary care provider.
Treatment

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Physical therapy can help prevent secondary complications like
• Weakness or paralysis
• Abnormal movement, such as tremors or difficulty walking
• Loss of balance
• Difficulty swallowing or "a lump in the throat"
• Seizures or convulsions
• Episode of unresponsiveness
Physical Therapy Management

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The therapist should develop good rapport with this patient as they are currently
experiencing psychological stress.
Progressive exercises like motor skill and provide less verbal and tactile cueing
along with less assistance.
Aerobic exercise or strength training have both been shown to be effective in
moderating psychogenic symptoms.
The therapist should educate the family members and other interdisciplinary
team members on the behavioral component to lead to a better recovery for the
patient.
Pre-gait activities such as sit-to-stands, weight-shifting in multiple planes, mini-
squats, lunge matrices, balance activities, etc.

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