Electroconvulsive Therapy in Severe and Refractory Somatic Symptom Disorder

Somatic Symptom Disorder (SSD) is characterized by persistent, distressing somatic symptoms accompanied by disproportionate health-related cognitions and behaviors. Electroconvulsive therapy (ECT) has no established indication in SSD; however, isolated case reports have suggested po\tential benefit in severe, refractory presentations. We report a 46-year-old postmenopausal woman with severe, refractory SSD who failed to respond to 4 months of combined pharmacotherapy and cognitive-behavioral therapy. Three sessions of bifrontotemporal ECT produced a striking symptomatic response, with her Somatic Symptom Scale-8 (SSS-8) score declining from 18 (severe) to 3 (minimal), a reduction sustained at follow-up. ECT was well tolerated. We discuss putative neurobiological mechanisms, including ECT-mediated changes in limbic and prefrontal circuits implicated in SSD pathophysiology. This case supports consideration of ECT in treatment-refractory SSD and highlights the need for systematic investigation of its efficacy and optimal parameters in this population.