Somatic Symptom Disorder

Finding The Right Treatment

Treatment

Treatment for somatic symptom disorders involves a combination of psychotherapy and medication.

Talk therapy

While medications can be a catalyst for change in people with somatic symptom disorder, therapy can support individuals through teaching new ways to work with symptoms, and an increased awareness of thoughts and feelings. Most therapists have experience working with adults with anxiety and mood disorders, which often underlie somatic symptom disorder. Not all therapists, however, have experience with somatic symptom disorder and it is important to find a therapist that has experience treating this diagnosis.

There are different kinds of professionals who can provide effective therapy, including:

• Clinical psychologists (PhD or LLP)
• Licensed clinical social workers (LMSW or LCSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)
• National certified counselors (NCC)

Therapists can help patients address the physical symptoms, the associated fear, and associated actions that come with somatic symptom disorder. Many therapists who treat somatic symptom disorder use cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns and associated emotions and behaviors. Together with the therapist, the patient learns how to challenge and replace self-destructive cognitions and learn tools to reduce symptoms associated with somatic symptom disorder.

The decision to start therapy

Many people try to cope with their distress on their own, then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Medications to treat somatic symptom disorder can often be helpful.

Antidepressants

Antidepressants are often recommended by healthcare providers for people with somatic symptom disorder, and these medications often relieve the anxiety or depression that usually underly the condition, and help the person attain the relief that has evaded them for so long. While these medications are used to treat a number of mental health conditions, including depression, OCD, and some pain conditions, the dosing and the use of concomitant medications differs across conditions.

Medications in the selective serotonin reuptake inhibitor class (SSRI) and the serotonin norepinephrine reuptake inhibitor class (SNRI) have proven effective in treating this disorder. However, experts recommend avoiding benzodiazepines, narcotics, and other sedatives because they are generally unnecessary, and they are also potentially addictive. In addition, sometimes people with somatic symptom disorder are already using alcohol or sedating drugs, and adding a benzodiazepine or narcotic would be extremely dangerous for them.

Antidepressants are typically started at the lowest possible dose and increased slowly, as needed. As a class of medications, antidepressants often take 10 days to two weeks to begin working. The full effect of the medication is not realized for two months.

If one of the SSRI/SNRI medications does not initially work, a prescriber has many options. The first is to ensure that the SSRI/SNRI is dosed adequately. Sometimes, however, high doses are not tolerated due to side effects. And, in those situations, other strategies may be employed.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, they should stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven. Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.