OPA Psychotherapy Conference 2022

Organization: Ontario Psychiatric Association

Date: Saturday, October 15th, 2022
Time: 1pm - 3pm ET
Format: Virtual Event

This event will be recorded, and the recording will be available to the registrants following the event for 14 days after its distribution to registrants.

Topic: Psychotherapeutic Approaches to Somatic Symptom Disorders

Speaker: 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.

By the end of this presentation, participants will be able to…

  1. Understand DSM-5 diagnostic criteria for SSD and proposed revisions
  2. Understand the basics of one cognitive-behavioral approach to SSD
  3. Understand the basics of one psychodynamic approach to SSD



This event is an accredited group learning activity (SECTION 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Psychiatric Association (CPA).
This program is an accredited self-assessment program (SECTION 3) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada, and was approved by the Canadian Psychiatric Association. You may claim a maximum of 1.5 hours (credits are automatically calculated).
The specific opinions and content of this event are not necessarily those of the CPA, and are the responsibility of the organizer(s) alone.

La présente activité est une activité d'apprentissage collectif agréée (SECTION 1), au sens que lui donne le programme du Maintien du certificat du Collège royal des médecins et chirurgiens du Canada; elle a été approuvée par l'Association des psychiatres du Canada.
Les opinions et le contenu spécifiques de cette activité ne sont pas nécessairement ceux de l'APC, et sont la responsabilité exclusive de l'organisateur ou des organisateurs.


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:

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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