This Diagnosis Can Actually Hurt People With Chronic Illness
A Somatic Symptom Disorder diagnosis can perpetuate stigma and lead to mislabeling patients living with chronic illness.
If you have a chronic illness, at some point a doctor has probably told you ‘It’s all in your head’. You’ve likely been dismissed, your symptoms minimized and may have been made to feel as if your body is lying to you. When blood work or scans come back ‘normal’, pain and fatigue is often dismissed as being a manifestation of a psychological nature, and could be referred to a psychiatrist or therapist for support. Seeking Psychiatric or Therapeutic support is not a negative thing, but when mental health is used as a mean of dismissing a patients symptoms as ‘psychological’ is harmful and perpetuates stigma related to not only chronic illness, but mental health as well. If we don’t address these systemic practices, we will remain in a cycle of patients not getting the support they need.
Keep reading to learn how a diagnosis of Somatic Symptom Disorder can be harmful for chronic illness.
What Could Happen If I’m at the receiving end of this diagnosis?
The biggest downside of not addressing your physical symptoms is that the overall status of your illness can suffer and it could completely overshadow what’s really happening in your mind/ body.
When I was first diagnosed, my thoughts about the situation were all over the place:
‘What did I do to deserve this?’
‘Will I die from this?’
‘What if I can’t work?’
‘What if doctors don’t believe me?’
‘Will I ever be normal again?’
This list goes on….
Would this be considered excessive and characteristic of a Somatic Symptom Disorder? SURE! Most of us with chronic pain and illness could probably be diagnosed with this according to the DSM V, which lists criteria as:
A. One or more somatic (of the body) symptoms that are distressing or result in significant disruption of daily life
CHECK ✔️
B. Excessive thoughts, feelings or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms
- Persistently high level of anxiety about health or symptoms
- Excessive time and energy devoted to these symptoms or health concerns
CHECK, CHECK, CHECK ✔️
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)
CHECK ✔️
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There are also other diagnoses that fall under this category of illness related mental health disorders:
- Illness Anxiety Disorder
- Conversion Disorder
Both are characterized by a preoccupation with illness or symptoms and/ or a subjective incompatibility with medical test results and/ or disproportionate to ‘actual symptoms’.
The problem I have with this classification is complex:
- Who determines what is ‘out of proportion’? The able bodied person in a power position (ie doctor, clinician, etc)? Or the patient who’s actually having the vulnerable experience?
- It assumes there is no error on the doctor’s part and instantly assumes error on the part of the patient.
- It puts unwavering faith in any medical tests that have been run and doesn’t consider that maybe an illness just hasn’t been found yet (which happens more than doctors like to admit) OR a diagnosis was made and the patient is just having an understandably hard time coping with such a distressing experience, and this diagnosis only ADDS to the distress here.
- This diagnosis perpetuates stigma related to invisible disabilities and disproportionately affects women, chronic pain patients and other disadvantaged groups who are routinely dismissed by the healthcare system.
What Can This Diagnosis do for me?
Although this diagnosis is a mixed bag of mostly crap (there, I said it.), it does have some benefits.
- Any diagnosis can help you justify professional help to your insurance company for coverage. Let’s be honest here – any diagnosis we get in the mental health arena can be stigmatizing, but the important thing is that it’s what insurance companies need to justify paying for you to get support. The bottom line is, many people who are experiencing any lift transition that is distressing, may not fall under any other mental health diagnosis and this could be a way to have access support when you are most vulnerable.
- Viewed objectively, no diagnosis is inherently bad – it is our society and what they do with it that creates stigma and discrimination. People… am I right?
- I don’t think anyone would argue that having a chronic illness is a piece of cake to deal with. The emotional ups and downs and increased risk for depression and anxiety are very real. Getting support during the most difficult parts of this journey can put you in a better position to be able to advocate for your health needs and give you the confidence you just might need to tell that doctor exactly where to shove that ‘it’s all in your head’ assessment.
Therapy does have benefits for people with chronic illness (I know, I’m a therapist so I’m biased – but I also have a therapist! It helps.)
At Imagine Life Therapy, I help clients feel validated in their physical concerns, recognize the difficult emotions and grief that can come with chronic illness, manage stress, get a handle on their disease and more.
Here are some of the ways therapy can help if you have a chronic illness:
Therapeutic Alliance
- Therapy provides a solid alliance between you and your therapist – This means your therapist should show warmth, empathy, caring and competence while listening closely and carefully to ensure you feel understood. Therapy provides a safe, non judgmental space for you to process your illness experience.
Goal Oriented & Problem Focused
- Therapy encourages looking at problems through behavioral terms and setting goals for change that you and your therapist both share an accurate understanding of from your perspective. More importantly YOU choose your own wellness goals.
Therapy Can Help You Care For Your Disease Better
- When we go to the doctor, we’re lucky if we see them for all of 8 minutes, where they look at blood work, check on medications and then say ‘see you in another 3 months’, none of which focuses on the important aspects of disease management that no one ever teaches us. In therapy, you get a solid HOUR with the clinician to focus on whatever you want – and for therapists like me who specialize in this area, we work specifically on stress managements, disease management and self care practices. All of which can actually help your disease improve or at the very least, not get worse than it already is.
Therapy Can Help Ward Off Depression
- When illness triggers a loss of functioning, individuals may be prone to developing depression. Depression can worsen illness by making one less willing to provide self-care. This in turn can negatively impact your illness progression. Working in therapy to prevent depression and manage it when it does come up is going to have an overall positive impact on your health.
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