BCCHR's Ask an Expert Series

We asked two experts, Dr. Amrit Dhariwal and Dr. Katelynn Boerner, about 
Somatic Symptom or Related Disorder (SSRD), why it’s so poorly understood and why it’s so important we start talking about it.

Around one in ten teens in Canada will experience SSRD - which involves chronic, physical symptoms such as pain or fatigue. SSRD can be debilitating and isolating as the physical symptoms make it difficult to attend school or socialize with friends.

Dr. Amrit Dhariwal is an investigator and staff psychologist at BC Children’s Hospital as well as a Clinical Assistant Professor of Psychiatry at UBC. 

Dr. Katelynn Boerner is a post-doctoral researcher in both Dr. Dhariwal and Dr. Tim Oberlander’s research teams. She was recently awarded a Canadian Child Health Clinician Scientist Program (CCHCSP) grant, which is a transdisciplinary training program for the next generation of clinician-scientists in child and youth health research in Canada. 

Q: What is somatization and when does it become an SSRD?

Dr. Amrit Dhariwal
Dr. Amrit Dhariwal

Dr. Boerner: Somatization describes the process by which a person can experience a physical symptom of their emotional state. Everybody does somatize in some way, for example when you are sad you shed tears, or if you are nervous you can have an upset stomach. Essentially, what we feel physically relates to how we feel emotionally. 

Dr. Dhariwal:

We all somatize. It becomes a disorder when it prevents you from important tasks like going to school or work and seriously impairs your ability to enjoy life. 

An SSRD isn’t caused purely by stress or emotions. It is also related to your history of physical illnesses or injuries. For example, breaking an arm might sensitize that part of the body so that kids who’ve experienced this may feel pain there even after an injury has healed. Concussion is another example. You can continue having difficulty with cognition and attention even though the injury has resolved.  

Q: What are you trying to accomplish with your research?

Dr. Katelynn Boerner
Dr. Katelynn Boerner

Dr. Dhariwal: Our priority is to find better treatments and ways to care for teens with an SSRD. We are learning that the initial step is to normalize somatization and destigmatize it for families and health care professionals. People worry that somatization is “all in the head.” That is simply not true. We believe SSRDs and the suffering they cause should be taken very seriously. Those affected need us to closely listen to them.

Dr. Boerner:

Somatization is much more common than people realize, partly because we don't have a language for it.

If medical professionals can’t effectively describe it, then teens may not get a satisfactory answer as to why they feel the way they do. Not knowing can add to their sense of isolation and anxiety, which makes the symptoms even worse. 

Dr. Dhariwal:

We are working to normalize it so that we don’t have two different medical approaches for what happens above the neck versus what happens below.

Mental health should be part of care from the get go, as opposed to tacked on at the end because we have given up on the physical side.

Q: Why is language important?

Dr. Boerner: While studying somatization, one thing I’ve been struck by is the importance of language. For one thing, if symptoms are being described as “unexplained”, rather than using a term like “somatization”, the implication is that we do not know what the problem is or how to treat it. Understandably, this can be demoralizing for families. 

But language is also crucial for conducting research. If you can’t define a term you can’t measure it. For example, a study will say that it is measuring somatization, but in fact the researchers only measured physical symptoms without considering emotions. It also makes it difficult for researchers, health professionals, and families to find these studies if everyone is using different names.

Dr. Dhariwal: Fortunately, our team has been making a lot of progress and has gained recognition for demystifying somatization both within the medical community and the public. We now have many resources on the Kelty website, including a podcast, brochure, animation, graphic book, and more. As our approach to treating SSRDs at BC Children’s has evolved, it has influenced researchers and clinicians in other pediatric centers across Canada, who are utilizing our approach. I have a lot of hope and optimism for the future.  

Q. What does integrated mental and physical care look like?

Dr. Boerner: The important aspect of integrated medicine is team-based care. Psychiatrists and other mental health professionals should be available for consultation on medical teams alongside physicians so that patients can be diagnosed and treated by both working together. And, of course, an important part of team-based care is including the patient and their family on that team, and honouring the expertise they bring to the table about their body and their experience. At BC Children’s Hospital this approach is already being used to care for youths with SSRD. 

Dr. Dhariwal: Medical professionals have long studied how to treat physical symptoms, but are less familiar with what happens when these symptoms go on for a long time. Leaving these symptoms untreated can lead to less time at school or with friends. 

When we have pain, our usual response is to rest and let it heal. But if we ignore the mental health component, we may not realize that the physical symptoms are exacerbated by stress or isolation and that going out and seeing friends may be a better solution. We can only identify the best treatment if we ensure healthcare professionals are treating both the mind and body.