Somatic Disorders are the conditions that generally involve somatization – where emotional pain manifests itself as physical pain.

There are a few different conditions within this category, each of which cause suffering for both the victim, as well as health professionals, people in their care, and potentially the wider public.

The prognosis of these conditions is generally poor, however this does vary depending on many circumstances, as we analyse.

Somatic Disorders can cause many problems

What are Somatic Disorders?

Somatic Disorders: Somatic Disorders are a group of mental health conditions that involve emotional pain being expressed as physical symptoms, which cause significant distress. While the majority of mental health disorders are characterised by psychological symptoms, Somatic disorders instead see emotional pain expressed as physical symptoms. This process is known as Somatization – giving this group of disorders their name. Symptoms of this group of disorders vary considerably across the various Somatic disorders.

Different Somatic conditions

There are five different conditions that comprise the Somatic Disorders. While these conditions all have similar underlying traits, there are many differences.

Somatic Symptom Disorder involves physical pain, and is the classic case of somatization. Conversion Disorder includes pain being expressed as a nervous system disorder e.g. paralysis or blindness.

Factitious Disorder (also known as Munchausen’s Syndrome) involves someone either acting if they or someone in their care has an illness – going to great lengths to keep this charade up.

Illness Anxiety Disorder involves excessive worrying about minor symptoms. Finally, Psychological Factors Affecting Other Medical Conditions involves an individual’s behaviour having a negative impact on a general health disorder.

General factors affecting the prognosis

One area that affects the prognosis of all of these conditions is whether or not a comorbid mental health condition is present.

Somatic Disorders commonly co-exist alongside an Anxiety-based condition or Depression. Personality Disorders or neurological conditions being present are also common.

If more than one mental health condition is present, then the prognosis weakens, with the chances of success lowering. However, recovery is possible.

One constant throughout these conditions is that a good Doctor/therapist-patient relationship is important. Patients commonly feel that health professionals do not take their symptoms seriously, which can worsen their chances of recovering.

By instilling a good relationship, patients have a better chance of being motivated for change, which could facilitate recovery. Similarly, having a good support group of friends and family around the patient is important.

If an individual is prescribed medication for their condition, their adherence to this may also be another factor affecting the overall prognosis. Painkillers and antidepressants are commonly prescribed classes of medicines for Somatic Disorders. Painkillers rarely seem to work in the long-term, and antidepressants often prove ineffective in the management of these conditions.

Prognosis for different Somatic Disorders

We now take a look at the prognosis for each of the different conditions within this category.

Somatic Symptom Disorder:

Somatic Symptom Disorder has a poor prognosis. Symptoms can last in the long-term, and even talking therapy doesn’t always provide relief from symptoms.

Depression will often develop too, due to the individual feeling exasperated at their inability to see an improvement in their symptoms [1]. 

One study found remission rates tend to be around 20% – representing a poor prognosis [2]. However, one study bucked the trend by suggesting that up to 50% of patients with this condition achieve recovery within a year [3].

Conversion Disorder:

Conversion Disorder tends to also have a poor prognosis. As the symptoms – such as paralysis or blindness – are serious, they don’t tend to improve in time.

One study looked at a ten year follow up of patients with the condition. Over half of those researched had no relief from their symptoms, and many had experienced the worsening of symptoms. A small amount had achieved remission [4].

However, it is believed that up to 90% of patients with Conversion Disorder will see a short-term improvement in symptoms following diagnosis [5].

It is possible that in some cases, if the onset of symptoms are linked to stress, that symptoms will resolve once the identified stressor is solved.

Factitious Disorder (Munchausen’s Syndrome):

Unfortunately, Factitious Disorder, whether imposed on self or another, tends to be a chronic condition. Talking therapy can help, but for it to provide a complete turnaround is rare. In some cases however, the symptoms of sufferers can be short-term.

It can also be difficult to detect that Factitious Disorder is present – and it is normally up to a Doctor to investigate their suspicions.

Those with the condition will commonly put themselves at acute risk of serious illness in a bid to maintain their charade – and thus put themselves at risk of serious injury, or even death.

Those with Factitious Disorder need to be supported by those close to them – as sometimes the condition can be a cry for help or attention. Of course, for those affected, such as the children who have an illness imposed on them, it can commonly cause trauma.

Illness Anxiety Disorder:

Illness Anxiety Disorder is a condition that is associated with hypochondriasis, and generally has a better prognosis than other Somatic Disorders.

Generally, once the person has received enough attention from a health professional, they will achieve remission. Unfortunately, relapse is common – though talking therapy may circumvent this.

In a study looking at a ten-year follow up of hypochondriasis, 64% of patients had either recovered, or reached a point where they no longer believed a condition was present [6].

Psychological Factors Affecting Other Medical Conditions:

Psychological Factors Affecting Other Medical Conditions applies to instances where an individual acts or behaves in a way that is detrimental to a physical health condition, or in a way that directly contradicts an agreed treatment plan.

The prognosis of this condition varies significantly. If an individual is implored by their family and friends to change their behaviour, they will commonly see an improvement.

But, if they have no motivation to change, or little support from others, they may continue to act in a harmful manner.

Psychotherapy can help show an individual the impact their behaviour has, and may lead to an improvement in symptoms. The management of Stress may have an important role in the prognosis [7].

Risk of suicide in Somatic Disorders

All of the conditions in the Somatic Disorder category involve a risk of suicide. It can be very difficult to live with constant pain, and will often lead to an individual becoming depressed.

Studies suggest that the suicide risk is highest when a Somatic Disorder is combined with either Depression or a Personality Disorder [8].

A hospital-based study found that in a patient group with Somatic Disorders, 68% reported wishing to be dead [9]. These demonstrate the severe risk of suicide within these disorders.

Summary

As seen, a wide array of areas contribute to the overall prognosis of the various Somatic Disorders.

While the prognosis isn’t too positive in each case, it is important to seek treatment. Those who opt to not seek treatment have a very unlikely chance of attaining recovery.

By seeking treatment, it is possible that an individual will gain recovery. At the very least, they should see an improvement in their symptoms, which should hopefully provide an improvement in quality of life.

See Also

  1. Somatic Disorders: Everything You Need to Know
  2. What Are The Different Types of Somatic Disorders?
  3. What Are The Symptoms of Somatic Disorders?
  4. What Are The Causes of Somatic Disorders?
  5. How are Somatic Disorders Diagnosed?
  6. How Can Somatic Disorders be Treated?
  7. What is the Prognosis for Somatic Disorders?
  8. 10 Tips for Living With Somatic Disorders
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References

[1] Baune, B. T., Caniato, R. N., Garcia-Alcaraz, M. A., & Berger, K. (2008). Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population. Pain. 138 (2): p310-317. DOI: https://doi.org/10.1016/j.pain.2008.01.002.

[2] Behm, A. C., Husing, P., Lowe, B., & Toussaint, A. (2021). Persistence rate of DSM-5 somatic symptom disorder: 4-year follow-up in patients from a psychosomatic outpatient clinic. Comprehensive Psychiatry. 110: 152265. DOI: https://doi.org/10.1016/j.comppsych.2021.152265.

[3] Bass, C., & Murphy, M. R. (1991). Somatization disorder: critique of the concept and suggestions for future resear. In: Bass, C. (Ed). Somatization. Oxford: Blackwell.

[4] Mace, C. J., Trimble, M. R. (1996). Ten-Year Prognosis of Conversion Disorder. The British Journal of Psychiatry. 169 (3): p282-288. DOI: https://doi.org/10.1192/bjp.169.3.282.

[5] Hafeiz, H. (1980). Hysterical conversion: a prognostic study. British Journal of Psychiatry. 136: p548-551. DOI: https://doi.org/10.1192/bjp.136.6.548.

[6] Kellner, R. (1983). Prognosis of treated hypochondriasis: A clinical study. Acta Psychiatrica Scandinavica. 67 (2): p69-79. DOI: http://dx.doi.org/10.1111/j.1600-0447.1983.tb06725.x.

[7] Cutler, J (2014). Psychiatry. 3rd ed. New York: Oxford University Press. 

[8] Chioqueta, A. P. & Stiles, P. C. (2004). Suicide risk in patients with somatization disorder. The Journal of Crisis Intervention and Suicide Prevention. 25 (1): p3-7. DOI: https://doi.org/10.1027/0227-5910.25.1.3.

[9] Manoj, S., Anil, K., Ravichandra, K., Dilip, MR., Ganesh, K. & Chandran, M. (2018). Suicidality in somatization and undifferentiated somatoform disorders: A hospital-based study. Archives of Medicine & Health Sciences. 6 (1): p36-39. DOI: https://doi.org/10.1016%2Fj.jpsychores.2020.110290.