Diagnostic Overview
SSRDs include several distinct disorders:

1. Somatic Symptom Disorder (SSD)
   Characterized by one or more distressing somatic symptoms that are accompanied by excessive thoughts, feelings, or behaviors related to those symptoms. Importantly, the symptoms may or may not be medically explained. The focus is on the psychological response to the symptoms rather than the presence or absence of a medical explanation.
2. Illness Anxiety Disorder (IAD)
   Previously known as hypochondriasis, IAD involves preoccupation with having or acquiring a serious illness despite minimal or no somatic symptoms. Patients frequently misinterpret normal bodily sensations and engage in repeated health checks or avoidant behaviors.
3. Conversion Disorder (Functional Neurological Symptom Disorder)
   This condition involves neurological symptoms (e.g., paralysis, seizures, blindness) that are inconsistent with recognized medical conditions. Symptoms often emerge in the context of psychological stress or trauma.
4. Psychological Factors Affecting Other Medical Conditions
   This diagnosis applies when psychological or behavioral factors significantly affect the course, treatment, or outcome of a medical illness.
5. Factitious Disorder
   Involves intentional falsification of physical or psychological symptoms without obvious external incentives, distinguishing it from malingering.

Epidemiology and Clinical Features
SSRDs are common across healthcare settings. SSD affects approximately 5-7% of the general population, with a higher prevalence in women. IAD affects 1.3-10% of the population, with equal gender distribution. Conversion disorder is more frequently diagnosed in females and typically presents in adolescence or early adulthood.

Patients with SSRDs often have co-occurring psychiatric disorders such as depression or anxiety. Adverse childhood experiences, trauma, and chronic stress are significant risk factors. Additionally, these patients often have complex relationships with the healthcare system—frequent visits, diagnostic procedures, and a feeling of being misunderstood or invalidated are possible.

Challenges in Diagnosis
Diagnosing SSRDs requires careful differentiation from medical conditions, malingering, and other psychiatric disorders. The DSM-5-TR emphasizes the need to avoid over pathologizing patients with medically unexplained symptoms and instead focus on the degree of psychological distress and functional impairment.

Clinicians are best served to conduct comprehensive assessments that include medical, psychiatric, and psychosocial components. Collateral information from family and medical records is often helpful. Importantly, SSRDs are not diagnoses of exclusion but require positive identification of specific clinical features.

Best Practices in Treatment

1. Psychoeducation and Therapeutic Alliance
   Establishing a strong therapeutic alliance is foundational. Patients often feel invalidated by previous medical encounters, so clinicians must acknowledge their suffering without reinforcing somatic preoccupation. Psychoeducation should reframe the illness using a biopsychosocial model, emphasizing the truly felt nature of the symptoms while introducing the role of stress and emotional factors.
2. Cognitive Behavioral Therapy (CBT)
   CBT is the most evidence-based treatment for SSRDs. It targets beliefs and thoughts about illness and health, and avoidant or excessive health behaviors. CBT helps patients develop more accurate appraisals of bodily sensations and encourages gradual re-engagement in activities.
3. Mindfulness and Acceptance-Based Therapies
   Interventions such as mindfulness-based stress reduction (MBSR) and acceptance and commitment therapy (ACT) show promise by helping patients observe their symptoms non-judgmentally and reduce experiential avoidance. These approaches may be particularly helpful in patients with chronic pain or functional neurological symptoms.
4. Pharmacotherapy
   While no medications are FDA-approved specifically for SSRDs, selective serotonin reuptake inhibitors (SSRIs) may be helpful when comorbid depression or anxiety is present. SNRIs and tricyclic antidepressants have also shown utility in somatoform pain syndromes. For example, the SNRI Duloxetine has an FDA approval for chronic pain. However, polypharmacy and iatrogenic harm should be avoided.
5. Interdisciplinary Care and Coordination
   Patients benefit from collaborative care models involving primary care providers, psychiatrists, psychologists, physical therapists, and sometimes neurologists or pain specialists. Coordinated care prevents redundant testing and provides consistent messaging. Regular case conferences and shared treatment plans are key to success.
6. Limit Medical Investigations and Set Boundaries
   While it is essential to rule out medical conditions, repeated investigations reinforce illness behavior. Providers should adopt a “diagnostic closure” strategy, providing reassurance based on appropriate evaluation, and shift focus to functional recovery. Structured visits, time-limited appointments, and continuity with a single provider help reduce fragmentation.
7. Address Trauma and Comorbidities
   Because many patients have histories of trauma, integrating trauma-informed care is essential. Screening for PTSD, dissociation, and borderline personality disorder is often appropriate. Psychotherapy targeting trauma (e.g., EMDR, trauma-focused CBT) can reduce somatic symptom intensity.

Conclusion
Somatic Symptom and Related Disorders are complex conditions that straddle the boundary between psychiatry and medicine. When properly diagnosed and treated using evidence-based, multidisciplinary approaches, many patients experience significant improvements in functioning and quality of life. Mental health providers play a critical role in destigmatizing these conditions, guiding collaborative care, and helping patients shift from symptom preoccupation to adaptive functioning.

AUTHOR:

Shawn Singh Sidhu, MD, DFAPA, DFAACAP

Co-Medical Director, Vista Hill Foundation

Vista Hill Native American SmartCare Program

Background

We know that a person who has gone through a traumatic experience is at higher risk for developing a mental health concern, like post-traumatic stress disorder. The risk of developing an anxiety or depressive disorder is higher than for developing PTSD. Studies have shown that 80-90% of individuals who have experienced a traumatic event will go back to their normal functioning over time. The amount of time can vary, based on their functioning before the event, whether the trauma was human-caused or a natural disaster and whether harm was intended. Some can go back to their normal functioning after 2-4 weeks and, for others, it can take much longer. Some people are even able to make meaning or create purpose from a trauma they experienced.

The basic premise of Psychological First Aid is to use a non-pathologizing stance with the assumption of adaption and not of disease development. The goal is for crisis support to help survivors move to the adaptive side. There are 8 basic core actions that focus first on providing safety and comfort followed by coping skills and resources. The foundation is making sure people who have gone through a trauma have access to social support.

Reg Flags

There are certain “red flags” to be aware of as concerns that something else might be going on and further assessment and intervention could be helpful. These include social isolation and withdrawal, extreme avoidance of thinking/talking about the event, feeling numb or not feeling at all, intrusive images/flashbacks, nightmares and poor sleep, anger or violence, and excessive use of alcohol and drugs.

Core Action Steps:

1. Contact and Engagement

In the immediate aftermath of a trauma, people first need their basic needs met. Introducing yourself can help a person feel better connected.

2. Safety and Comfort

After letting someone know you are there to help, it can be nice to offer basic comforts like water and food, a blanket, etc. If there are children in the group, toys and plushies can be additional comforts.

3. Stabilization

People are understandably dysregulated after a trauma. There are some simple things that you can encourage someone to do to help him feel calmer and more regulated – deep breathing exercises, stretching and body movement. It can also help to validate how they are feeling and provide a quiet space.

4. Information Gathering

It is important to keep in mind that you don’t need to know details of a traumatic experience in order to help reduce symptoms and provide comfort and coping skills. It is better to not prompt for details. This is especially true for children. Some children play out their feelings about a traumatic experience and others use play as distraction to not think about the trauma. Research has shown that talking repeatedly about a traumatic experience does not necessarily help with recovery and can actually cause unintended consequences.

5. Practical Assistance

The next step is to help with basic needs including shelter, meals, etc.

6. Connection with Social Supports

PFA focuses on establishing social supports based on a homogenous experience. With mass disasters, not everyone experiences the same thing.  It is important to limit exposure to details of a traumatic event for those who hadn’t experienced those details to begin with. So groups should be put together keeping these factors in mind. It can be helpful to train someone within a particular culture on the PFA principles so that they can overlap their understanding of cultural factors and the PFA response to trauma.

7. Information on Coping

Basic CBT principles like reframing thoughts, focusing on doing enjoyable activities that bring happiness, and mindfulness practices can be useful coping strategies. Again one does not need to know the details of the trauma in order to be able to provide coping strategies.

8. Linkage with Collaborative Services

It is important to be aware of local resources, like SmartCare BHCS here in San Diego,  for when someone could benefit from further assessment or intervention after a trauma.

Further Resources

If interested in learning more, the National Center of Trauma and Stress Network offers a 6 hour course on PFA:

https://www.nctsn.org/resources/psychological-first-aid-pfa-online

There are also wonderful resources about school based PFA on their website:

https://www.nctsn.org/resources/psychological-first-aid-schools

Here is another resource on PFA for healthcare workers:

https://www.ptsd.va.gov/professional/treat/type/SFA/docs/SFA_HCW_Manual_508.pdf

AUTHOR:

Charmi Patel Rao MD, DFAACAP

Co-Medical Director, Vista Hill Foundation

Health Science Clinical Professor, UCSD Department of Psychiatry

President, San Diego Academy of Child and Adolescent Psychiatry