Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client’s awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can be assumed that while medical doctors may certainly understand the benefit of treating medically based symptoms, they may choose to end their involvement at this point. A social worker is in a unique position to share the benefits of combining perspectives for the benefit of the client. Additionally, a social worker can advocate for their client by explaining these benefits and helping the client to explore available treatment modalities. As with any client, working with those diagnosed with somatic disorders, a social worker can employ advocacy skills on an ongoing basis, in an effort to achieve the most positive outcomes.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing.
Dimsdale, J. E., Patel, V., Xin, Y., & Kleinman, A. (2007). Somatic presentations—A challenge for
DSM-V. Psychosomatic Medicine, 69, 829.
Kirmayer, L. J., & Sartorius, N. (2007). Cultural models and somatic syndromes. Psychosomatic
Medicine, 69, 832–840.
Colleague 2: Pascha
Research indicates that somatic presentations are arguably present in virtually every psychiatric diagnosis (Dimsdale, Patel, Xin & Kleinman, 2007). Somatic symptoms are usually geared towards symptoms that include pain, discomfort and physical complaints. With illnesses that fall in this category, they typically occur before the age of 30 and the typical symptoms include headaches, dizziness, chest pain, abdominal and limb pain (Kirmayer & Sartorious, 2007). These disorders can often be difficult to differentiate from related disorders just like those of medical disorders.
The Somatic Symptom Disorder (F45.1) is noted in the DSM as: one or more somatic symptoms that are distressing or result in significant disruption of daily life, excessive thoughts or feelings relating to health concerns being manifested, persistent thoughts about the seriousness of one’s symptoms, high level of anxiety about health, excessive time and energy devoted to these symptoms or health concerns and lasting typically more than six months (APA, 20123). Social works should take a biopsychosocial approach when working with clients who have this somatic disorder because this perspective explains how some people are seemingly “healthy” can get mental illnesses and why some are more prone to mental illness than others. Using treatment plans and interventions for somatic disorders provides evidence that although someone can be mentally healthy at some point in their life, they can still experience mental illness is their biopsychosocial balance is disturbed (Dimsdale, Patel, Xin & Kleinman, 2007).
A multidisciplinary approach that is necessary when working with clients who have this disorder would consist of psychiatry, social work, medical, neurology, physical therapy, occupational therapy and speech and language pathology. Each of these team members would bring resources that would specialize in the various areas of somatic symptoms. The specialty that each team member could bring to the treatment plan includes practicing stress management, getting physically active, relaxation and de-stressing activities that include skills such as yoga and stretching. Teamwork and team effectiveness are higher in teams working with the interdisciplinary team approach. Therefore, the interdisciplinary approach can be recommended, particularly for clinics in the somatic indication field. Team development can help to move from the multidisciplinary to the interdisciplinary approach (Kirmayer & Sartorious, 2007).
Advocating for clients who suffer from somatic disorders would be important because of the stigma this disorder carries. These somatic disorders can be present when a client has experienced trauma, abuse or devastation (such as a natural disaster) and may not even know how to safely express the feelings they have inside. It is already far too easy and common for doctors to dismiss their client’s concerns about their physical symptoms with a spoken or unspoken, “it’s all in your head”. This is insulting, stigmatizing and risks missing specific medical and psychiatric conditions that need treatment. The importance of advocating for clients with this disorder is because the controversy continues between legitimate physical conditions (such as fibromyalgia) and that of mental somatic disorders. Many social workers have found that women and minorities are more likely to be diagnosed with somatic disorders because their health problems are not taken as seriously (Lee, Creed, Ma & McLeung, 2015). Many of the somatic disorders have symptoms that were previously associated with hysteria, a diagnosis primarily given to women. In this era of concern about our client’s health and mental health, it is clear that social workers who have been trained to make biopsychological assessments can play a prominent role (Barsky, Ettner, Horsky & Bates, 2001). The interaction of psyche (mind) and soma (body) is strong and the distress in one area affects the other. This is a prime example of the need for advocacy for interdisciplinary teams when working with somatic disorders.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American
Psychiatric Publishing.
Barsky, A. J., Ettner, S. L., Horsky, J., & Bates, D. W. (2001). Resource utilization of Patients with hypochondriacal health anxiety and
somatization. Medical Care, 39(7), 705-715.
Dimsdale, J.E., Patel, V., Xin, Y. & Kleinman, A. (2007). Somatic presentations – A challenge for DSM-V. Psychosomatic Medicine, 69,
829.
Kirmayer, L.J. & Sartorious, N. (2007). Cultural models and somatic syndromes. Psychosomatic Medicine, 69, 832-840.
Lee, S., Creed, F.H., Ma, Y., & McLeung, C. (2015). Somatic symptom burden and Health anxiety in the population and their correlates.
Journal of Psychosomatic Research, 78, 71-76.
