Somatic symptom disorder treatment

Somatic symptom disorder treatment options

Somatic symptom disorder treatment

Somatic symptom disorder facts

Somatic symptom disorder (SSD) can be treated effectively in different ways [2],[3],[4]. Some treatment options are more effective than others, and some of them are still in a developmental stage: promising but needs more research to draw conclusions [4],[9]. Effective somatic symptom disorder treatment is not only important for the individual, but also for the healthcare system; people with SSD have twice the annual medical care costs of nonsomatizing patients [6]. Fortunately, somatic symptom disorder treatment services can be offered both online (Skype) and face-to-face and are equally effective.
This pages discusses effective and promising somatic symptoms disorder treatments and explains the focus of each treatment.
If you are interested in the somatic symptom disorder test, please click here.

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    At Barends Psychology Practice, we offer (online) therapy for somatic symptom disorder. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).


    Somatic symptom disorder treatment – Cognitive Behavioural Therapy (CBT)

    The most effective treatment for somatic symptom disorder (SSD) is Cognitive Behavioural Therapy (CBT) [2],[3], also in older adults (aged 60 and older) [10]. People with SSD who were treated with CBT reported significantly more improvement on somatic symptoms and self-reported functioning, compared to standard medical care [8]. The average amount of sessions needed to treat SSD with CBT is 10 [2],[8]; this amount depends on the severity of the somatic symptoms and comorbidity with other mental disorder.
    CBT focuses on stress reduction, reduction of preoccupation with somatic symptoms, learning to cope with physical symptoms, and depression and other psychological issues. Also, CBT aims to improve the quality of life.

    There are signs that a CBT therapy type, mindfulness based therapy (MBT), may be more effective in treating some aspects of SSD, but more research is needed. Also, the traditional CBT is more effective than MBT [9]. MBT focuses on a non-judgemental acceptance of physical pain or psychological distress, which reduces the tendency to ruminate over these experiences.

    Somatic symptom disorder treatment – Psychodynamic interpersonal psychotherapy (PIT)

    Difficult to treat and medically unexplained somatic symptoms can be treated effectively with psychodynamic interpersonal psychotherapy (PIT). PIT improves patient’s physical quality of life and reduces somatization symptoms [11],[12]. Also, social-occupational function improved in most patients [12]. Unfortunately, depression and health anxiety did not significantly improve in these patients [11].
    The focus of PIT is reduction of rumination about the symptoms, reduction of the symptoms through bodily relaxation training, the therapeutic relationship, and finding connections between early childhood experiences and physical symptoms.
    Although PIT is effective in regards to certain somatic symptom disorder symptoms, it is not as effective as CBT in treating somatic symptom disorder and it takes 2 sessions more, 12 to be precise. More research is needed to improve PIT for SSD.

    Somatic symptom disorder treatment – Eye Movement Desensitization and Reprocessing (EMDR)

    Approximately 50% of the people with somatic symptom disorder (SSD) have been traumatized by a primary caregiver [14]. Eye Movement Desensitization and Reprocessing is effective in treating (childhood) traumatic experiences, which suggests that a possible somatic symptom disorder treatment could be EMDR. In one study, researchers found that EMDR indeed is effective in reducing chronic pains (especially when someone with SSD experienced something traumatic in their childhood) [4], and in another study EMDR was effective in treating phantom limb pain and the psychological consequences of amputation [5].
    According to study [13] EMDR is significantly more effective than antidepressants in the treatment of SSD. Not only reported patients a reduction of somatization, but also a significant reduction of other psychological symptoms were reported, such as chronic pain and depression symptoms [13].
    According to the Adaptive Information Process (AIP) model, pain reactions may be stimulated by physiologically stored memories of similar sensations, which contains thoughts, images and physical sensations [13]. When such memories are not processed correctly, these may cause someone to experience somatic symptoms and chronic pains. EMDR focuses on neutralizing these physiologically stored memories which leads to a significant reduction of all SSD symptoms. Depending on the amount of unprocessed memories, EMDR treatment could take between 2 and 8 sessions on average.
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    Somatic symptom disorder treatment – Consultation letter

    There is scientific evidence suggesting that a psychiatric consultation letter to the primary care physician about strategies for managing the somatizing patient improves physical functioning and reduce costs, but effects on somatic symptoms were not reported [2],[3]. This may be effective for people wild mild SSD, but not for those with more severe somatic symptom disorder symptoms.

    Somatic symptom disorder treatment – Medications

    3 studies reported small to moderate effect sizes of medication in the treatment of SSD; two trials of St. John’s wort and one of opipramol for SD-spectrum disorders [2]. More research is needed to be able to say something about medications in the treatment of SSD.


    • [1] Jacobi, F., Wittchen, H. U., Hölting, C., Höfler, M., Pfister, H., Müller, N., & Lieb, R. (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological medicine, 34, 597-611.
    • [2] Kroenke, K. (2007). Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosomatic medicine, 69, 881-888.
    • [3] Sumathipala, A. (2007). What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosomatic medicine, 69, 889-900.
    • [4] van Rood, Y. R., & de Roos, C. (2009). EMDR in the treatment of medically unexplained symptoms: A systematic review. Journal of EMDR Practice and Research, 3, 248-263.
    • [5] Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2007). EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82.
    • [6] Barsky, A. J., Orav, E. J., & Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of general psychiatry, 62, 903-910.
    • [7] 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.
    • [8] Allen, L. A., Woolfolk, R. L., Escobar, J. I., Gara, M. A., & Hamer, R. M. (2006). Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial. Archives of Internal Medicine, 166, 1512-1518.
    • [9] Lakhan, S. E., & Schofield, K. L. (2013). Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PloS one, 8, e71834.
    • [10] Verdurmen, M. J., Videler, A. C., Kamperman, A. M., Khasho, D., & van der Feltz-Cornelis, C. M. (2017). cognitive behavioral therapy for somatic symptom disorders in later life: a prospective comparative explorative pilot study in two clinical populations. Neuropsychiatric disease and treatment, 13, 2331.
    • [11] Sattel, H., Lahmann, C., Gündel, H., Guthrie, E., Kruse, J., Noll-Hussong, M., … & Schneider, G. (2012). Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial. The British Journal of Psychiatry, 200, 60-67.
    • [12] De Greck, M., Scheidt, L., Bölter, A. F., Frommer, J., Ulrich, C., Stockum, E., … & Northoff, G. (2011). Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder. The World Journal of Biological Psychiatry, 12, 296-308.
    • [13] Demirci, O. O., Sağaltıcı, E., Yıldırım, A., & Boysan, M. (2017). Comparison of Eye Movement Desensitization and Reprocessing (EMDR) and Duloxetine Treatment Outcomes in Women Patients with Somatic Symptom Disorder. Sleep and Hypnosis, 19, 70-77.
    • [14] Annemiek van, D., Julian D, F., Onno van der, H., Maarten JM, V. S., Peter GM, V. D. H., & Martina, B. (2011). Childhood traumatization by primary caretaker and affect dysregulation in patients with borderline personality disorder and somatoform disorder. European Journal of Psychotraumatology, 2, 5628.