By reference to what is arguably the psychiatrists’ Bible, DSM V*, a Somatic Symptom Disorder (SSD) – formerly known as a Somatoform Disorder – is diagnosed where somebody has an extreme focus on physical symptoms resulting in often serious functional and emotional problems. This can occur even where there has never been an underlying physical problem or where the original physical injury or condition has resolved but symptoms persist, even becoming worse.
A SSD can have a profoundly disabling effect on the sufferer who, understandably, will find it difficult (and in some cases impossible) to accept that their severe limitations are largely or even entirely psychological in origin.
Somatic Symptom Disorder Claims
We are approached regularly by people who have developed a SSD following an accident. In pretty much every case they will at best be frustrated, at worst extremely distressed. Comments such as “they must have missed something”, “nobody believes me” and “they think it’s all in my head” are common and this is of course entirely understandable.
Most people who contact us are having a very bad experience with another law firm, typically one of the large, impersonal factory operations who advertise in the media. Medical and other records will not have been obtained and/or reviewed, wholly unsatisfactory medical reports (often from the wrong type of medical experts) will have been obtained and those reports are commonly peppered with phrases such as “medically unexplained”, “psychological overlay”, “functional overlay” and “unreliable historian”.
From the lawyer’s perspective, in order to move forward with a claim involving a suspected SSD there are some basic ground rules.
Believe your client
Remember, most people in this situation have gone from living a normal, healthy and active life to one with an extremely limited outlook. Their symptoms will have inevitably affected their home and family life, their mobility, their ability to work, their social and leisure activities – the list goes on. Whatever the underlying cause of these restrictions, I would strongly suggest that it would be unusual in the extreme for somebody to take the conscious decision to turn their life upside down, purely in the hope of receiving some compensation. Remember, for most people, their condition affects not just them but also their loved ones. Would they really choose to also put them through the mill?
People will sense if you doubt their credibility, which is likely to swiftly undermine your professional relationship.
Is there really no other explanation?
It’s a fact; doctors can and do get it wrong.
A SSD is a diagnosis of exclusion. Is there any other possible explanation?
It’s imperative that the solicitor reviews all available records and depending upon the claimant’s background this will usually include (but is not limited to) GP records, hospital records, records from other treatment providers (eg physiotherapists, chiropractors, CBT practitioners, podiatrists – possibly even alternative therapy practitioners), employment records, DWP records, military records and in some cases even educational records.
The point is that anybody who has taken a contemporaneous note of their examination findings or has recorded what the claimant has reported to them, possibly even before the accident, may have preserved some vital piece of information. Yes, this can be extremely time consuming, but there are no shortcuts and it should not be delegated to junior staff.
It may well be that a full records review reveals evidence supportive of a possible SSD or similar condition, for example one or more previous episodes of medically unexplained symptoms.
Should this exercise raise any questions over diagnosis, particularly any suggestion of an organic cause, then the solicitor can work with the claimant to address these issues with those treating them and/or independent medical experts. In some cases this process leads to a referral for additional medical tests and/or input from an expert(s) in another specialism.
What if there really does not seem to be an organic explanation?
Should further investigation reveal no organic explanation for the claimant’s symptoms it doesn’t necessarily mean they are suffering a SSD. For example, they may instead have developed one of the conditions now grouped together under the tag ‘central sensitisation’, for example Fibromyalgia (FM), Coccydynia or Chronic Fatigue Syndrome (CFS). In such cases, a rheumatologist may be the next port of call.
Also, a SSD is only one of a number of psychiatric conditions which can manifest in otherwise unexplainable symptoms.
The issues of both diagnosis and causation of the claimant’s injuries/condition are fundamental in any claim, but never more so than where the claimant’s limitations are psychiatric in origin. Choice of medical expert is crucial to success. If a psychiatric diagnosis is likely or even if there is a need to exclude a psychiatric diagnosis, the claimant should be examined for the purpose of the claim by a psychiatrist with current clinical experience of SSD and similar conditions.
Of course, there are many branches of psychiatry and arguably most if not all psychiatrists in clinical practice should be qualified to diagnose a SSD. However, it is often felt that the best ‘type’ of psychiatrist for this purpose is what is known as a ‘liaison psychiatrist’. The Royal College of Psychiatrists define liaison psychiatry as:
“the sub-speciality which provides psychiatric treatment to patients attending general hospitals, whether they attend out-patient clinics, accident and emergency departments, or are admitted to in-patient wards – therefore it deals with the interface between physical and psychological health.”
As such, a liaison psychiatrist will have considerable experience of seeing and treating patients in a broad range of medical and surgical settings.
It goes without saying that a claimant with a SSD can expect to be treated by the defendant’s insurer and their representatives with, at best, considerable scepticism. They will the subject of the full gamut of personal intrusion. Covert surveillance and the monitoring of social media will be the absolute minimum the claimant should expect. These issues have been discussed in earlier articles.
Ultimately, however, claimants with a SSD or other psychiatrically mediated condition should not lose sight of the fact that, although their condition may not be organic in origin, they are certainly not ‘mad’ and their symptoms are entirely genuine.
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About the author
Leading Complex Regional Pain Syndrome (CRPS) solicitor Richard Lowes co-founded the first legal team in the UK specialising in representing people suffering CRPS and other debilitating chronic pain conditions. Richard is a popular speaker on the subject of chronic pain in litigation and remains an inveterate blogger. You may contact Richard direct at firstname.lastname@example.org
* The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association.