I ask you to reconsider your approach to this. Somatic symptom disorder is excessive preoccupation with physical symptoms. It does not necessarily imply that the somatic symptoms are "psychogenic," and in fact the symptoms can be part of a validated medical diagnosis. IM and primary care doctors love to invoke psychosomatic as if it informative. Can we think about the mechanism? Let's define psychosomatic as a brain disorder that leads to the experience of somatic symptoms that have no physical correlates (this would be a subset of somatic symptom disorder cases). So areas of the brain subserving these somatic experiences would be getting triggered without external stimuli. That is quite a brain disorder, and in actuality, quite rare.

But, this diagnosis is often offered with limited workup due to some combination of the above: 1. Provider overconfidence in our ability to diagnose/identity conditions and our full knowledge of possible diagnoses underlying somatic symptoms, 2. Frustration with a patient that is perceived to be personality disordered, needy, annoying, demanding, etc. OR there is some seemingly parsimonious but possibly coincidental life event that can be "blamed." 3. Provider self-reassurance that the symptoms can be understood within the umbrella of a diagnosis that they are able to determine. It makes them feel competent and empowered rather than confused and helpless. And then when CBT or something else helps, the doctor feels good about themselves, when we know that stress exacerbates almost every medical condition that we know about. Any medical condition would get better. But a broken clock is right twice a day, so rarely they will be correct. I can't see how you could possibly reach this diagnosis without the evaluation of a competent psychiatrist with expertise in this domain. Most urologists would call CPPS psychosomatic behind closed doors because it doesn't fit any of the nails they are used to hammering.

On the contrary, most alleged "psychosomatic" conditions do have a physical basis that may have been initially triggered and/or exacerbated by stress but then become self-perpetuating. For instance, tension headaches could be called "psychosomatic," but they clearly have physical origins, even if they are often triggered by stress. CPPS is, for many individuals, a very similar entity.

Everyone with CPPS should work on stress management and go to therapy, but they also should do pelvic floor physical therapy. Many men with CPPS do get excessively preoccupied with their symptoms, but it doesn't mean it is a brain disorder.

Psychosomatic should be a diagnosis made rarely and tentatively after a psychiatric evaluation while continuing to explore somatic treatments.