A relationship can be challenging when your partner has somatic symptom disorder, because you need to do the things your partner can’t due to their physical symptoms. From running small errands to taking up another job to make ends meet, and from a sense of responsibility (to take care of the family) to feelings of frustration and helplessness regarding this situation. For some, however, it is rewarding when their partner has somatic symptom disorder, because the responsibility and caring tasks are good for their self-esteem. This is called codependency. Unfortunately, someone with somatic symptom disorder (SSD) does not benefit from a codependent partner on the long run. This page focuses on reducing codepent behaviour, on minimizing the effect of your partner’s subconscious guilt inducing comments/behaviour, and on motivating your partner to change. NOTE: This page is only for those people whose partner has somatic symptom disorder. If you believe your partner is suffering from SSD, but there is no official diagnosis, we strongly recommend you to reach out to a professional for an official diagnosis before applying the tips on this page.
At Barends Psychology Practice, we offer (online) therapy for somatic symptom disorder. Contact usto schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).
Partner has somatic symptom disorder – codependency
Codependency is characterized by an unhealthy balance in the relationship causing partner A to support or enable partner B’s unhealthy, mental disorder related, behaviours, thoughts, and symptoms. Partner A benefits from this balance by feeling important, loved, responsible, and in control, whereas partner B benefits from this balance because partner B doesn’t need to change and takes advantage of partner A’s efforts to help.
If both partners benefit, why is codependeny a bad thing?
Codependency doesn’t need to be a bad thing at all. As long as the balance in the relationship is not too skewed to one side, codependency can actually work out for both partners. If, however, your partner has somatic symptom disorder or suffers from a mental disorder and/or you are suffering from this skewed balance, then codependency is a problem.
Codependent signs in a relationship with someone with SSD.
There are a few codependent signs worth mentioning in a relationship with someone with SSD:
Your mood is dependent on your partner’s mood, behaviour, and symptoms.
Your partner’s SSD symptoms dictate your plans for the day.
You feel guilty if you put yourself first and ignore or minimize your partner’s SSD symptoms.
You feel as if your efforts are taken for granted by your partner.
You make sure your partner doesn’t have to do things that increase their SSD symptoms.
You have the feeling that your partner only suffers of SSD symptoms when it suits him/her best.
There is little to no place for you to show your emotions or feelings.
Reducing codependent behaviour.
When your partner has somatic symptom disorder (SSD), it is good to realize that a good support network is important, because it reduces stress and thus improves the quality of life . However, too much support can be counter effective; as research suggests, most people with SSD have problems regulating their emotions, resulting in a more emotional response to certain (physical) stimuli, compared to people without SSD . Although it is important to take their physical complains serious, it is even more important to not emphasize too much on the somatic symptoms part. By putting to much emphasis on it, people with SSD will be validated in their interpretation of physical sensations as a sign of a serious medical condition. In stead, they need to learn that most physical sensations come and go and that they should not focus on them too much. After all, the general practitioner and/or the psychologist have diagnosed your partner with SSD already.
At the same time, it is important to look at your own needs and behaviours as well. Why do you prefer a caregiver role and how would it feel if your partner becomes less dependent on you? Do you feel important, responsible, in control, powerful, happy, or worthy when you take care of your partner or are you afraid of abandonment, rejection, and selfishness if you do not help your partner? Sometimes people do things because it gives them a good feeling, and sometimes people do things to avoid certain negative feelings. These negative feelings could be caused by your partner’s comments or by yourself.
If you are experiencing positive feelings while taking care of your partner:
write down when you experience positive feelings regarding taking care of your partner,
find alternative things to do that give you the same feeling,
explain to your partner with SSD that your behaviour maintains her SSD symptoms and that a change is needed,
motivate your partner to do certain things by themselves (if they are able to),
keep track of positive changes in your partner,
keep track of your own feelings and mood now that you are doing less for your partner. After a few weeks you will notice positive changes in the both of you.
If you are avoiding negative feelings by taking care of your partner:
write down which negative feelings you are trying to avoid,
write down how you avoid getting these negative feelings,
find the source of these negative feelings: does your partner make certain comments to put you down or do you do this to yourself? In case of the latter: please consider reaching out to a professional. In case of the first, continue reading,
make a list of comments, non verbal behaviour (the silent treatment, for instance) or other things your partner uses to give you a bad feeling about yourself,
discuss these (non verbal) behaviours with your partner and let them know that you will not continue to help out if they continue to put you down. (this may be a difficult step, but it is a necessary one. Your partner may not change in the beginning, but give it a few days and keep your word: if he or she puts you down, you don’t help out),
reward your partner for positive behaviour: each time they respond in a friendly, loving, and caring way, you show your appreciation/happiness about it.
NOTE: If this proves to be too difficult, consider reaching out to a professional. In many cases you only need a few cognitive behavioural therapy sessions to make significant progress.
Partner has somatic symptom disorder – promote behavioural change
Your partner’s memory and attentional bias makes it difficult for them to ignore physical sensations and it’s these sensations that prevent them from performing physical sensations. It is, therefore, important to stimulate them to try certain activities and to focus on the fact that they tried, and perhaps even succeeded, and to put as little emphasize as possible on their somatic symptoms. Your partner needs praise and stimulation right before, during, and after these physical symptoms. At the same time it is important to put their somatic symptoms in perspective and to focus on the disappearance of these symptoms in time.
 Ali, A., Deuri, S. P., Deuri, S. K., Jahan, M., Singh, A. R., & Verma, A. N. (2010). Perceived social support and life satisfaction in persons with somatization disorder. Industrial psychiatry journal, 19, 115.
 van Dijke, A., Ford, J. D., van der Hart, O., van Son, M., van der Heijden, P., & Bühring, M. (2010). Affect dysregulation in borderline personality disorder and somatoform disorder: Differentiating under-and over-regulation. Journal of Personality Disorders, 24, 296-311.