Page 30 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Somatic symptom disorders and aging

2.2. Misattribution to aging and perceived stigma judged or misunderstood. In medical settings, despite

Another diagnostic issue is that some older adults may high service utilization rates, some older adults may fear
misattribute symptoms of SSRDs to normal aging or being dismissed by medical providers, which puts them in
simply due to growing older. Under the “Development and a difficult position and may prevent them from effectively
Course” section of the DSM-5-TR for somatic symptom getting the care they seek and need.
disorder, it is noted that underdiagnosis is common among 2.3. Cognitive impairment
older adults because somatic symptoms are either seen as
a part of normal aging (and thus dismissed) or because Cognitive impairment and neurocognitive disorders are
high level of worry about illness is considered “normal” in common among older adults, as rates increase with advanced
older adults who are more likely to have medical illnesses age. 20,21 Indeed, estimates suggest that 22% of individuals
and take medications for them compared to younger 70 years and older have some form of mild cognitive
3
individuals. To the extent that physical symptoms such impairment and nearly 14% of individuals 70 years and
as pain, headaches, abdominal symptoms, and fatigue older have a formal diagnosis of a neurocognitive disorder
21
(all key physical symptoms associated with SSRDs) are (oftentimes referred to as dementia). Alzheimer’s disease,
attributed to normal aging by older adults themselves, they the most common form of major neurocognitive disorder,
will not report such issues to healthcare or mental health affects about 6.9 million people in the United States. 22
providers, which then prevents a full assessment of the Any degree of cognitive impairment on the part of
person’s responses to those physical symptoms. In short, older adult clients can adversely affect the detection and
this process can lead to an underdiagnosis of SSRDs. diagnosis of SSRDs. For proper diagnosis and assessment

Chronic or persistent pain is an especially common to be made, the client must have sufficient awareness and
problem, seen in 60 – 75% of older adults. However, pain insight to adequately report their symptoms. Older adults
symptoms are often incorrectly attributed to normal with cognitive impairment may commonly experience
aging rather than as part of a possible mental disorder. difficulty accurately reporting their somatic symptoms
10
One method of discerning whether pain or other somatic and especially their reactions to these symptoms. Making
symptoms are part of an SSRD is to assess whether temporal connections between physical symptoms and
the somatic symptoms cause significant and excessive the subsequent distressing or impairing psychological and
disruptions to functioning and whether they are clearly behavioral reactions is a challenge even among many with
associated with maladaptive and excessive emotional no cognitive deficits. Relatedly, older adults with cognitive
reactions, cognitions, and behaviors. 10 impairment commonly experience difficulty accurately
completing self-report screening and assessment tools
In addition to older adults misattributing their for SSRDs (these tools are described below). Cognitive
symptoms of SSRDs to aging itself, there is a strong stigma impairment has also been associated with the inability to
associated with SSRDs, perhaps more so than for most rate the intensity of symptoms on numerical scales. In
17
7
other categories of mental disorders. In a large survey sum, collecting reliable and valid information about SSRD
study in Germany, 17,18 SSRD stigma was actually more symptoms from older adults with cognitive impairment
pronounced among older people than younger people. can be convoluted and unreliable, further complicating the
In general, stigma in this category is due to the previous diagnosis of SSRDs.
understanding that the physical symptoms associated with
SSRDs must be medically unexplained, which led many 3. Assessment challenges
people with SSRDs to be (incorrectly) told that “it is all
in your head” or to be accused of being a fake. 10,12 Despite 3.1. Lack of age-specific screening and assessment
stigma, older adults with SSRDs are commonly encountered measures
in primary care and other medical settings. Unfortunately, To date, there are no assessment tools for SSRDs that have
3
older adults with SSRDs are less commonly encountered been specifically designed for older adults, which represent
in mental health settings, including psychiatric settings. a significant barrier to accurate screening and assessment.
3
Indeed, in medical settings, and especially in primary It is well established in professional geropsychology
care settings, patients with SSRDs are so common that that elder-specific assessment tools are preferable in
they have been called “heartsink patients” – patients most research and clinical contexts because such tools
who irritate and annoy their physicians and frequently are specifically validated for use with older adults and
come into their office. 12,19 The stigma about SSRDs likely designed with the unique contexts of later life in mind.
10
contributes to the reluctance for some older adults to seek However, several assessment measures for SSRDs are now
help in specialty mental health settings, for fear of being available for clinical and research use (Table 1 for a listing

Volume 3 Issue 4 (2025) 24 doi: 10.36922/JCBP025080013