ONTARIO PSYCHIATRIC ASSOCIATION: PSYCHOTHERAPY DAY
Saturday October 15, 2022 , 1pm - 3pm EST
Virtual event
Psychotherapeutic Approaches to Somatic Symptom Disorders
Dr. Margaret Cheng Tuttle
Most of us have seen patients in our practices who are preoccupied with somatic symptoms such as pain, fatigue, GI distress, or limb weakness. When this preoccupation is the primary presentation, and when it causes clinically significant disruptions in functioning, we may find ourselves struggling first to establish a therapeutic relationship and come to agreement about a diagnosis. Even when there is buy-in from the patient regarding a diagnosis of somatic symptom disorder, the treatment course can be long and difficult.
In this presentation, I will first describe the evolution of the most recent diagnostic criteria for Somatic Symptom Disorder (SSD) in DSM-5 (2013). It is notable for removing the criterion of “medically unexplained symptoms” and for including positive psychological factors (cognitive, affective, and/or behavioral). It is hoped that this will remove some of the assumptions of a mind-body split that lead to stigmatization.
I will then present two evidence-based psychotherapeutic approaches to patients with SSD. These should be pursued concurrently with ongoing medical attention for the somatic symptoms. A time limited cognitive behavioral approach is described in “Overcoming Functional Neurological Symptoms: A Five Areas Approach” by Williams, Kent, et al. In addition to the familiar cognitive, affective, and behavioral factors, this approach includes the somatic symptoms and life circumstances as the fourth and fifth areas that interact with each other to perpetuate the symptoms. For some patients, it is useful to explore psychodynamic meanings to the somatic symptoms. Abbass and Schubiner, in “Hidden from View,” describe how to apply Intensive Short-Term Dynamic Psychotherapy (ISTDP) to SSD.
LEARNING OBJECTIVES
By the end of this presentation, participants will be able to…
- Understand DSM-5 diagnostic criteria for SSD and proposed revisions
- Understand the basics of one cognitive-behavioral approach to SSD
- Understand the basics of one psychodynamic approach to SSD
About the Speaker
Margaret Cheng Tuttle, MD, is a psychiatrist at Massachusetts General Hospital (MGH) in Boston, and Instructor of Psychiatry at Harvard Medical School.
Dr. Tuttle’s interest in Somatic Symptom Disorders (SSD) was sparked a few years ago by patients who challenged and intrigued her during her novice years as an attending psychiatrist.
She connected with David Perez, MD, Director of the MGH Functional Neurological Disorder (FND) Unit as she searched for expertise on patients with physical symptoms who spent much of their waking hours searching for relief or who had withdrawn from daily activities due to fear of experiencing a symptom. As a member of the FND Unit, she is learning novel approaches to conceptualizing and treating FND.
While FND and SSD share important features, they have different diagnostic criteria. Dr. Tuttle founded the MGH Somatic Symptom Disorders Interest Group with Albert Yeung, MD, to focus on SSD. This group is working to help primary care physicians understand the current conception of SSD, and ways to approach treatment with these often-misunderstood patients.
Dr. Tuttle is active as a member and leader of psychotherapy committees within the American Psychiatric Association, Massachusetts Psychiatric Society, and American Psychoanalytic Association. She has published peer-reviewed articles in the Harvard Review of Psychiatry, American Journal of Psychiatry, Seminars in Neurology, Journal of Infant, Child, and Adolescent Psychotherapy, and General Hospital Psychiatry.
Presentations relevant to SSD include:
- “Somatic Symptom Disorder: Conceptual Models, Patient Engagement, and Treatment Approaches,” with Albert Yeung, MD, and Allan Abbass, MD, at the American Psychiatric Association’s annual meeting in May 2022 and
- “Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide” published in Seminars in Neurology 2022, in which she contributed to the section on psychotherapies.
She completed psychiatry residency in 2016 at the University of Massachusetts Medical School, where she was Program Chief Resident. She earned her MD at UMass Medical School and holds master’s degrees from MIT (mathematics) and New England Conservatory of Music (piano performance), and a BA with highest distinction from the University of Nebraska-Lincoln. Before medical school, she had a full-time career as a classical pianist in the New England area.
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