Somatic Symptom Disorder Diagnosis: Letter for Treating Therapist/School Counselor

Dear Psychotherapy partner,

I am writing this letter to assist in the psychological treatment of patient's name. I am involved through my role as provider role at hospital's name. Patient's name's medical care is currently provided by primary care provider.

After thorough medical assessment by a multi-disciplinary team at hospital's name, patient's name has been diagnosed with a Somatic Symptom Disorder. This is a serious but non-life-threatening disease in which physical symptoms occur due to a dysregulated nervous system response. Sometimes these symptoms are a response to stress, but not always. The symptoms of SSRD are real and distressing for children who experience them. Somatic symptoms are not produced intentionally or “faked” but rather due to alterations in brain signaling that can be corrected the right treatment. They may limit the child’s ability to function optimally at school, with friends, in activities, and at home. The good news is that these symptoms are treatable with the right combination of emotional and physical therapies.

Patient's name's symptoms include symptoms. There has been a significant impact on patient's name's functioning including functional limitations.

Treatment for Somatic Symptom Disorders involves a multi-pronged approach consisting of increasing functioning (often through physical/occupational therapy and graded/stepwise return to typical school/activities) and psychotherapy to address coping and areas of stress. The idea is that we can retrain both physical and emotional responses to stress and distress. From a psychotherapy perspective, we recommend focusing patient's name's psychological treatment on CBT-based techniques of anxiety and stress reduction and symptom management tools. There is an attached list of coping strategies that may also help them work through symptoms/functional challenges.

Psychotherapy is an essential component of SSRD treatment. We know that how children think about normal life and/or stressful events causes changes in the body’s autonomic arousal (i.e., the stress response) that serve to maintain symptoms. Additionally, personality characteristics such as perfectionism and pleasing tendencies can contribute to stressful thoughts in daily life, exacerbating the body’s stress response.

CBT-based strategies and tools, including focusing on changing and/or balancing unhelpful or stressful thoughts, have the best evidence for successful treatment of SSRDs. In your role as patient's name’s psychotherapist, we recommend using CBT-based tools such as Thought Records to help children identify and balance negative thoughts. Ultimately the goal is to help children change how they think about stressful situations and utilize coping strategies to work through functional challenges instead of avoiding them.

While patients are learning to work through their symptoms, we consider school participation an important part of treatment that retrains a dysfunctional nervous system. We encourage schools to support treatment and recovery by helping students utilize their coping skills to maintain typical school attendance, structure, and expectations. As such, we have provided a School Letter to patient's name's family that they may choose to show you, with recommended accommodations tailored to current level of disability if needed. As patient's name’s coping with symptoms improves, please consider working with patient's name and the school to wean these accommodations as appropriate.

While somatic symptoms should improve over time with appropriate treatment, symptoms often increase in times of increased stress, and new symptoms sometimes develop as others recede. This is a common pattern in SSRDs and usually does not point to a new or worsening medical problem, but it is also possible that a change in symptoms necessitates medical evaluation. We encourage you to partner with patient's name’s medical team if you have concerns about their symptom burden.

Below are examples of coping strategies children may use to work through their SSRD symptoms.

Coping Strategies

Cognitive

Distraction/Relaxation

Prompts

The multi-disciplinary team at hospital's name appreciates that the nature and treatment of somatic symptom disorders are challenging and that it may feel distressing or difficult to keep children with symptoms in school. However, maximizing school and returning to function is the cornerstone of treatment of this complex disorder, and we sincerely appreciate the school's efforts in making necessary temporary accommodations to promote patient's name's being in school as much time as possible.

While somatic symptoms usually abate over time, it is also possible that new symptoms develop as others recede. Usually, this is another manifestation of somatic symptoms, but not always, and new symptoms should be evaluated promptly and proactively. If new symptoms occur, please refer patient's name to his primary care doctor, who will be able to undertake appropriate evaluation.

 

Sincerely,

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