[100-Year Life Health] The Unrecognized Pain of 'Physical Symptom Disorder'

Professor Hye-Yeon Park, Department of Psychiatry, Bundang Seoul National University Hospital

# Mr. A has been suffering from abdominal pain for several months. His stomach hurts and feels bloated constantly, making it difficult to eat properly, and the throbbing headaches make it hard to concentrate at work. He frequently takes digestive medicine and headache pills, but his condition does not improve. He has undergone various tests at multiple hospitals, but no major abnormalities were found, and stress was identified as the cause. At work and home, people doubt his illness and suspect he is taking sick leave unnecessarily, which is very frustrating for him.

Somatic symptom disorder is commonly referred to as a ‘neurotic’ or ‘functional’ disorder. It is characterized by pain in various parts of the body such as joints and muscles, or persistent symptoms like indigestion, abdominal pain, loss of appetite, nausea, headaches, and dizziness. This disorder frequently occurs in women in their 20s and 30s, but it can also appear in children and adolescents. Functional gastrointestinal disorders and psychogenic dizziness are also related to somatic symptom disorder.

Patients with this disorder may actually experience weight loss, and symptoms can persist to the extent that daily life is disrupted. They undergo various tests, but most are diagnosed with no abnormalities or minor issues, and sometimes are advised to see a psychiatrist. However, psychological factors such as stress or depression do not always precede the condition, and since the physical pain is ‘real,’ patients often visit multiple hospitals out of frustration. Somatic symptom disorder arises from a complex mechanism involving mental, physical, and environmental factors. It occurs when there is a problem in the brain circuits that process bodily sensory signals, causing distorted pain perception and heightened sensitivity, accompanied by excessive worry and anxiety.

Treatment requires a comprehensive understanding that ‘the body and brain are closely connected and interact with each other.’ When the brain is overstimulated by stress, it releases various hormones and neurotransmitters that affect the cardiovascular, digestive, respiratory, and endocrine systems throughout the body. Therefore, a multifaceted approach is needed to reduce stress and anxiety that stimulate the brain, as well as harmful lifestyle factors such as excessive drinking, smoking, and poor dietary habits that threaten physical health. A representative treatment method is ‘cognitive behavioral therapy,’ which focuses on objectively understanding the disorder and condition and improving function and quality of life rather than simply eliminating symptoms. Additionally, regular exercise that provides normal sensory stimulation can alleviate symptoms. Medication may also be used, including antidepressants that regulate brain sensitivity, as well as digestive drugs or painkillers depending on the symptoms.

Somatic symptom disorder is a condition in which 60-70% of patients improve with appropriate diagnosis and treatment, but as in the case above, it often takes a long time to be diagnosed. Since most tests show no abnormalities, patients are sometimes mistaken for malingering. This isolates the patient and prolongs their symptoms, so family members and those around the patient should acknowledge the real pain as a disorder and support the patient by improving lifestyle and environment together, which is very helpful.

Hye-Yeon Park, Professor, Department of Psychiatry, Bundang Seoul National University Hospital

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