Afraid of wind? Afraid of cold? In fact, it is a "heart disease" covered with an invisible cloak!

Author: Xia Ye Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology

Reviewer: Yang Yuan, Chief Physician, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

In the hot summer, short-sleeved shirts, air conditioners and fans are the norm, but there is a group of people who always seem to be "out of tune" with the people around them. Even in summer, they wear winter hats, thick cotton coats, and hot packs, covering themselves up tightly. They are afraid of wind and cold, and dare not use air conditioners at home, or even fans.

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Whenever you see such a "weirdo", perhaps you will look at him differently?

Or are you or your family suffering from this "strange disease" and feeling extremely distressed?

In fact, these symptoms may be caused by a mental illness called "somatic symptom disorder".

So, what is somatic symptom disorder? Let’s learn more about it in this article.

What is Somatic Symptom Disorder?

Somatic symptom disorder (SSD) is a new classification name in the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) (DSM-5). It refers to neurotic physical disorders with prominent physical symptoms as the main characteristics, accompanied by abnormal sensations, thoughts and behaviors, which to a certain extent affect the patient's life, social interaction and other aspects. Its forms are diverse, recurring and often changing, and are often accompanied by anxiety or depression clinically.

According to statistics from the American Psychiatric Association, the incidence of SSD is 5% to 7%, and the ratio of male to female incidence is 1:10. In other words, on average, 1 in 20 people suffer from SSD, and the incidence rate of women is much higher than that of men, which shows that the incidence of this disease is not low.

Most patients with SSD are "frequent visitors" to hospitals, often visiting various departments of the hospital and undergoing many tests, but still no problems are found. They cannot accept their own test results that show no problems, so they repeatedly seek medical advice, causing great psychological distress to themselves.

What are the manifestations of somatic symptom disorder?

Fear of wind and cold is actually only part of the symptoms of SSD autonomic dysfunction, which manifests itself in various forms, mainly physical discomfort.

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What are the causes of somatic symptom disorder?

The specific pathogenesis of SSD is still unclear, and most scholars believe that it is related to the combined effects of multiple factors.

1. Personality traits and poor cognitive patterns : Such patients often have abnormal neurotic characteristics. They tend to focus on their own physical discomfort and negative life events, which leads to a lowered sensory threshold and increased sensitivity to physical sensations, resulting in various physical discomforts.

2. Sociocultural factors : Negative events in life, social culture, and social support all have an impact on the occurrence of somatic symptom disorders.

3. Physiological factors : Studies have shown that SSD is associated with abnormalities in brain functional areas such as the anterior cingulate gyrus, insular cortex, and fusiform gyrus.

4. Psychological factors : Due to the inability to actively express inner emotions, general discomfort may occur after long-term suppression.

5. Family factors : Rejection, denial and overprotection in the father's parenting style and excessive interference and overprotection in the mother's parenting style are all susceptible factors.

What are the treatments for somatic symptom disorder?

Patients should go to a psychiatrist and receive formal treatment.

1. Drug treatment : There is currently no "specific" drug for somatic symptom disorders, but patients with significant anxiety and depression disorders can use anti-anxiety and antidepressant drugs, as well as combined use of low-dose antipsychotic drugs, which can improve patients' physical symptoms and emotions.

2. Psychotherapy : including cognitive behavioral therapy, behavioral therapy, psychodynamic therapy and hypnosis.

3. Self-regulation : In life, you should learn to talk to your family or friends and express your emotions; at the same time, enrich your life, find hobbies, such as singing, sports, etc., to divert your attention, gain the joy of life, and reduce attention to your body.

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Diagnostic issues that cannot be ignored

Somatic symptom disorder is quite common in menopausal women, who often visit outpatient clinics in general hospitals for various physical symptoms. However, when patients visit psychiatric specialists, physical illnesses are easily missed because the diagnostic criteria for SSD are too loose. Studies have shown that patients diagnosed with SSD may include about 15% of cancer or heart disease patients and about 26% of irritable bowel syndrome or fibromyalgia patients. Therefore, comprehensive evaluation and continuous monitoring are essential to avoid misdiagnosis and missed diagnosis.

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I believe that after reading this article, everyone will no longer be unfamiliar with the disease of somatic symptom disorder, right? If you have a friend who is suffering from various physical symptoms in the future, please give him the confidence to overcome the disease, and remember to remind him: "Hey! You can go to a psychiatric specialist!" Let us help him lift this invisible cloak together!

References

[1] Mao Zhixia. Progress in non-drug treatment of somatic symptom disorder[J]. Journal of Tianjin University of Traditional Chinese Medicine, 2022, 41(03): 402-8.

[2] Ou Hongxia. Historical changes and research progress in the diagnostic nomenclature of somatic symptom and related disorders[J]. Chinese Journal of Psychiatry, 2021, 54(01): 66-70.

[3]Kurlansik SL, Maffei MS. Somatic Symptom Disorder [J]. Am Fam Physician, 2016, 93(1): 49-54.

[4] Zhou Jianli, Liu Shixiang. Research progress on the correlation of somatoform disorders[J]. Journal of Southwest National Defense Medicine, 2016, 26(04): 454-456.

[5] Jiang Molin, Lu Wei. Research progress in the treatment of somatic symptom disorder[J]. Medical Review, 2018, 24(20): 4039-4043.

[6]Frances A. The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill [J]. Bmj, 2013, 346: f1580.