It turns out that the body can also quietly become emo!

This is the 3569th article of Da Yi Xiao Hu

In the past 2021, emo has become a popular online term, which means "I am (negatively) emotional, I am depressed." Although emo is a popular term, it provides us with an interesting and "pretentious" way to express our emotions. Now that the emo in our hearts is expressed, do you know that our bodies can also quietly emo! In the field of psychiatry, there is a disease we call "somatic symptom disorder" (SSD). Before we understand it, let's take a look at a case.

Mr. Zhang, male, 52 years old. Two years ago, a fish bone got stuck in his throat when he was eating fish. He went to the ENT department of the local hospital to have the fish bone removed. Examination showed no obvious damage to the throat. Since then, the patient has been feeling neck pain, throat discomfort, and a foreign body sensation, thinking that the fish bone is still stuck in his throat. The patient went to several hospitals for examination and treatment, but no fish bones or other abnormalities were found. The patient was still worried, and he went to 5-6 hospitals and was hospitalized twice. The results were not ideal. The patient still felt that there was a foreign body in his throat, which led to poor diet and sleep, and he was upset and entangled in throat discomfort all day long. During one visit, the doctor said to him: You may need to go to the psychology department for an evaluation of this problem.

There are many patients like Lao Zhang in various hospitals. Faced with such a dilemma, what should patients do? In fact, this phenomenon is quite common in clinical practice, that is, patients feel symptoms of physical discomfort, but after sufficient examination, no physical disease that can explain the symptoms is found, which is generally considered to be "functional physical discomfort". Other names that have been used and are still used include "functional physical symptoms", "medically unexplainable/difficult to explain physical symptoms", "somatoform disorders", etc. However, these diagnoses emphasize that they need to be diagnosed on the basis of excluding other organic diseases. However, in reality, in order to avoid missed diagnosis of physical diseases and delayed treatment, doctors often dare not make a diagnosis easily, which has caused the dilemma of patients seeking medical treatment repeatedly for a long time. In order to alleviate this dilemma, the latest diagnostic criteria have added the item "Somatic Symptom Disorder (SSD)", which no longer emphasizes the need to exclude organic diseases, but instead allows doctors to pay more attention to the feelings, emotions and effects of patients' physical symptoms. Let's take a brief look at SSD.

What is an SSD?

Somatic Symptom Disorders (SSD) is a disease characterized by the patient's experience of one or more physical discomforts and abnormal thoughts, feelings, and behaviors in response to these symptoms.

SSD often manifests as chronic, fluctuating physical discomfort. The following figure lists some common SSD symptoms in some departments;

These symptoms are often vague and changeable, difficult to specify, and lack a definite pathophysiological basis. If relevant examinations do not reveal abnormalities, it is difficult to find the cause, or there are certain pathological changes or organic factors, but they are not enough to explain the appearance of these symptoms. If the course of the disease is long and the patient seeks medical treatment repeatedly, it will evolve into certain special complaints, such as pain, functional impairment, or loss of certain sensory experience changes, which will increase unnecessary waste of medical resources and the economic burden on patients. In addition, SSD patients often have multiple medical treatment experiences before coming to the doctor, and are more likely to distrust the doctor and refuse and resist diagnosis and treatment.

What is the reason for the emergence of SSD?

Recent foreign studies have divided the factors that lead to the occurrence and development of SSD into three aspects: susceptibility factors, inducing factors, and maintenance/aggravation factors.

Susceptibility factors: subclinical organic diseases, previous organic diseases, adverse childhood experiences, early life stress, cultural beliefs, etc.;

Predisposing factors: acute illness, accidental injury, current psychological stress events;

Maintaining/exacerbating factors: receiving inappropriate treatment (iatrogenic factors), avoidance and deconditioning behaviors, cognitive and emotional factors (anxiety, depression, illness beliefs), and secondary benefits;

These factors act on the brain and eventually form various symptoms of physical discomfort. However, how these factors affect the brain and then cause physical symptoms is still not well explained.

How to treat SSD?

If you suspect you have SSD, it is recommended that you seek treatment at a psychiatric department. The doctor will conduct a systematic and detailed assessment of you, including: 1. Current symptoms and related symptoms, 2. Mental state and emotional problems, 3. Recent environmental factors, including family, work, and interpersonal relationships, 4. The degree of current impairment of physical function, family function, and social function, 5. Expectations for SSD treatment and examinations and previous views on seeking medical treatment, etc.

The doctor will give the patient reasonable explanations and suggestions, psychological treatment, drug treatment and other comprehensive treatments according to the severity of the patient's symptoms;

After being persuaded by others, Lao Zhang came to the Department of Psychology for treatment. The doctor gave Lao Zhang a detailed psychological evaluation. Through active treatment, Lao Zhang's throat discomfort symptoms were eliminated, his mood improved, and he resumed his long-lost normal life.

"Somatic symptom disorder" may not cause serious damage to the body, but if it is not treated promptly and effectively, the symptoms of physical discomfort will gradually worsen. The continued discomfort will greatly reduce the quality of life, making your body emo. Therefore, establishing a good relationship with the doctor, not rejecting psychological evaluation, and actively facing it are the fundamental ways to treat SSD.

If emo means feeling sad emotionally, then SSD means feeling sad physically as well. I hope everyone will have neither emo nor SSD in the new year!

References:

1. Chinese expert consensus on “Clinical practice of medically unexplainable symptoms”

2. Diagnosis and treatment of symptoms that are difficult to explain medically

3. Current status of research on the psychological-physiological-pathological mechanism and clinical treatment of functional somatic complaints

4.Henningsen P, Zipfel S, Sattel H, et al. Management of functional somatic syndromes and bodily distress. Psychother Psychosom

Author: Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Dr. Ni Kaiji, Department of Psychiatry

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All names and place names are pseudonyms and any similarity is purely coincidental.