Medically unexplained symptoms can be distressing for the individuals experiencing them, the primary caretakers, and their healthcare providers. The evaluation of unexplained symptoms is sometimes part of a continuous process to discover a challenging or complex diagnosis. However, some individuals experience symptoms that remain unexplained, as a somatic mental disorder. This is a condition whereby an individual becomes significantly distressed about physical symptoms that may or may not stem from a known medical cause. The distressing preoccupation with physical symptoms was previously known as hypochondria but is now known as somatic syndrome disorder (SSD).
Read on to understand more about what medically unexplained symptoms might be. Then review four key factors in identifying a somatic mental disorder. Finally, learn what treatment methods can effectively help individuals cope with medically unexplained symptoms.
About one in four individuals seeking care from a healthcare provider have medically unexplained symptoms. A definition of these includes persistent and clinically meaningful physical complaints not clearly related to an identifiable medical problem. These symptoms are also associated with excessive thoughts, feelings, and behaviors. Unexplained symptoms are frustrating for individuals and healthcare professionals alike since treatment without a clear understanding of the underlying problem may not relieve discomfort or pain.
Medically unexplained symptoms can occur for many reasons, making it challenging to narrow down a diagnosis. Typical examples can include:
Identifying a somatic mental health disorder can be a time-consuming and distressing process. An individual may need to go through multiple evaluations and tests to rule out likely medical disorders. Doing this for long periods of time means an individual may frequently feel discouraged, even worrying that their provider does not take their concerns seriously anymore.
Several risk factors may predispose an individual to develop somatic mental disorders. While these are not necessarily causal, certain conditions and experiences can make it more likely.
Studies have identified behavior patterns among high utilizers of health care, individuals who frequently seek care at primary clinics to address unexplained medical symptoms. The common feature among individuals displaying these behaviors was dysfunction, abuse, or trauma in their family. These patterns are differentiated by the individual’s capacity to function in daily life and how they perceive their symptoms.
Coping High Utilizers: These individuals have some insight and can function with some success. They seek answers and explanations but are not concerned about discovering a serious unknown illness and do not dwell on symptoms. Overutilization may occur because healthcare providers are reluctant to tell an individual they have medically unexplained symptoms. They instead pursue multiple courses of evaluation and treatments with little relief for the individual.
Classic High Utilizers: These patients frequently utilize healthcare services but remain focused on their ongoing symptoms. They also have little insight and expect to be excused from typical social obligations. Past traumatic experiences still impact them in the present day and have connections with their vague physical symptoms.
Worried High Utilizers: These individuals may have characteristics of both coping and classic high utilizers. However, they also demonstrate high health anxiety, expressing worry about the presence of an undiscovered severe illness. They also typically express dissatisfaction with healthcare services, often when they cannot see their provider at their preferred time or frequency.
Some patients have bad experiences with healthcare providers when attempting to understand their symptoms. They often feel dismissed, and many have been told their symptoms in their head. Sometimes, miscommunication is at the heart of the problem. Healthcare providers looking to assure patients that nothing is wrong may believe this is welcome news. But without much time spent exploring emotional wellbeing, patients looking for answers may interpret this well-intentioned approach as a rejection of their symptoms.
Positive encounters with healthcare providers can result in fewer visits. In these encounters, providers discussed a patient’s psychosocial history, openly communicated about the diagnosis, and left patients feeling reassured. Patients may seek repeated medical consultations at primary clinics without symptom resolution if they perceive their experience as unhelpful.
70% of individuals with medically unexplained symptoms also have comorbid depression and/or anxiety disorders. While these are treatable conditions, they may exacerbate these symptoms if they remain undiagnosed. Identifying these disorders can help create a clearer picture of the individual’s needs. Since several mental health disorders have somatic symptoms, such as headaches, fatigue, and digestive issues, treating an identified mental disorder may alleviate an individual’s otherwise unexplained symptoms. However, this may not lead to improvement in each case.
A high-quality relationship between a patient and their healthcare provider is vital for a positive outcome. Even if physical symptoms pose no health threat, the distress caused by a lack of resolution is still problematic. When providers and patients build trust, they can more thoroughly address the negative impact of unexplained symptoms. Some physical conditions can take months or years to be diagnosed accurately. And if symptoms are determined to be related to mental wellbeing instead of a biological disorder, a foundation of trust is essential going forward.
Well-intended reassurance is not enough and can be seen as dismissive of psychological symptoms. Validation and empowering explanations that clearly connect psychological symptoms and physical processes are most helpful for patients with these symptoms. Positive interactions like these may also be therapeutic in themselves.
Unfortunately, few studies have been done to help establish primary care guidelines for somatic mental disorders. Only a fraction of individuals with unexplained symptoms receive mental health referrals, and fewer attend treatment. For those who do engage in treatment, cognitive–behavioral therapy and antidepressants effectively improve depression and anxiety, two disorders that often co-occur with medically unexplained symptoms. Regardless of the specific symptoms, patient-centered care ultimately results in better adherence to treatment, reduced addictive substances, and more satisfaction with medical care.
While the evaluation of medically unexplained symptoms may eventually lead to a medical diagnosis for some individuals, many who cope with physical discomforts may instead have a somatic mental disorder. Past traumas and unresolved emotional issues can all contribute to the condition. Regardless of the cause of an individual’s physical distress, a trusting relationship with their healthcare provider is a vital part of helping them cope more effectively.
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