Somatic Symptom and Related Disorders (SSRDs): Treatments and Symptom Management

Somatic symptoms and related disorders (SSRDs) occur when there are problems with the mind-body communication system. Everyone has experienced somatic symptoms such as butterflies in the stomach or muscles tightening with anger. Most of the time these physical symptoms pass on their own and do not harm the body. For children with SSRDs, these symptoms may be intense enough to interfere with daily life, causing them to miss school or forgo activities they once enjoyed.

SSRDs are often related to both physical and psychological stress. The most effective treatment for SSRDs is psychotherapy, which can help children identify sources of stress and learn to cope with symptoms. This leads to symptoms improving over time. Psychotherapy focuses on strengthening the connection between the mind and body. How the body feels physically can affect mood and psychological state. Also, mood can affect body sensations and function.

A child’s particular symptoms, and the extent to which they affect daily functioning, will determine the appropriate point of intake at CHOP. Typically, the primary care provider (PCP) is the main point of contact, and the PCP or other healthcare providers may refer your child to one of CHOP’s  multidisciplinary teams that address specific SSRDs. These teams may include medical providers, physical and occupational therapists as well as psychologists.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is the type of psychotherapy that best helps children with somatic symptoms. CBT focuses on the relationship between thoughts, emotions, behaviors and the body.

CBT can help your child:   

• recognize and change unhelpful thoughts
• build coping techniques to work through symptoms toward a goal
• practice communication skills  
• learn strategies to decrease difficult feelings caused by symptoms
• experience fewer symptoms over time

How can I find a cognitive behavioral therapist for my child?

• Begin with your insurance provider, look for a therapist that is “in network.” It may also be helpful to get a referral from a friend, school counselor or your child’s primary care provider.
• Involve older children and teenagers in the search process. They are more likely to attend appointments if they have been involved from the start.
• Explore the “find a therapist” search function at PsychologyToday.com. Filter search by zip code, gender, specialty, insurance and cost.
• It is important that your child and family like the provider. It may take a few sessions to get to know a new therapist.
• Let the therapist know that your child’s medical team has diagnosed SSRD after a thorough evaluation. The recommended treatment focuses on increasing coping and function, along with stress and anxiety management through CBT. You may request a letter from your provider if the therapist needs more information.
• Somatic symptoms often affect the entire family unit. Some families choose to attend family therapy to address the needs of the whole family.
• If you are looking for both individual and family therapy, we recommend choosing two separate providers. This preserves privacy and provides your child with an independent space to build coping skills.

Children are most successful at overcoming difficult somatic symptoms when their families and healthcare providers are on the same page. Children with SSRDs must also actively participate in a symptom management plan. Your team will work with you to develop a plan that focuses on coping with symptoms. The goal is to return to normal activities at home and school.

We recommend that your child attend weekly psychotherapy. Although it may take time to find a psychotherapist, your child can start using coping techniques and strategies right away to help manage symptoms. These do not take the place of psychotherapy but may help your child start feeling better as you search for a psychotherapist.

Practice mindfulness

Mindfulness is a simple tool to include in a symptom management plan. Mindfulness means:

• being in control of your mind, rather than letting your mind be in control of you
• being aware of the present moment without trying to change it
• staying focused on one thing at a time and not multitasking

It’s natural to try to avoid painful sensations. However, focusing on the pain and discomfort that may come with SSRDs can become overwhelming. When you are mindful, you learn to observe and explore sensations and feelings, rather than react to them.

You can practice mindfulness anytime, anywhere, without anyone else knowing. For example, you can take a mindful walk, or focus on your breath, your surroundings or an activity. Mindfulness improves with practice. Practice mindfulness for 30 seconds and increase to longer periods when you are ready. With practice, mindfulness can give you more choices about how to respond to pain, tension and stress.

Model emotional awareness

Ignoring or avoiding difficult feelings can cause physical symptoms in the body over time. Emotional awareness means that we listen to what our bodies “tell us” by paying attention to strong emotions or stressful experiences associated with physical symptoms.

Parents can support their child’s emotional development through “reflective responding.” With this technique, parents try to understand what emotion their child is feeling and then offer it back to them; for example, “You seem disappointed.” This helps the child to identify, label, accept and express their emotions.

Reflective responding can be hard when children are experiencing strong emotions. A parent’s instinct may be to “fix” the problem and make their child feel better. However, when parents see things through their children’s eyes and reflect it back to them, their child feels heard and accepted. Children can become more comfortable sharing hard parts of their lives with parents. Most importantly, they can also feel empowered to make decisions about what to do with difficult emotions.

Communicate with empathy and optimism     

• Normalize somatic symptoms. Everyone experiences somatic symptoms like blushing, stomach butterflies and tears. Some people have more severe somatic symptoms like pain, nausea and weakness.
• Acknowledge your child’s physical and emotional pain. Some ways to validate their experience include, “It’s challenging when your symptoms are so strong,” “These symptoms have really affected your life,” and “It’s hard to do everyday activities that used to be easier.”
• Help your child focus on improved function. Parents can use language such as: We know that your symptoms are real, but they are not dangerous, and they are not causing harm to your body. Focusing on your symptoms may make them worse, so we are going to work on getting back to normal activities. This will help your mind and body heal. Eventually, your symptoms will improve.
• Build confidence in your child’s physical abilities. Encouraging words include: We will teach your mind and body to communicate better. This will help you gain strength and confidence to get back to your everyday activities.

Support your child’s healthy relationships during SSRD recovery

Forming relationships is part of healthy development. Experiencing somatic symptoms can get in the way of building or maintaining friendships, as children may have difficulty doing activities with their friends. Children and caregivers should look for opportunities, even in small steps, to expand healthy relationships.

Reaching back out to friends on the phone, by text or through social media can be a good start. Setting up play dates or hangouts with a friend can help children reconnect. Start with a structured activity like a movie, craft or event to reduce anxiety. Then move on to activities with more freedom as your child builds confidence.