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PubMed2003

[Assessment and psychotherapeutic options of patients with somatoform disorders and a claim for invalidity pensioning].

Difficulties in the assessment of patients with somatoform disorders and a claim for social security benefits or invalidity pensioning pose a considerable challenge to the medical community. Within the process of delivering a medical expert's opinion, psychiatric and psychological factors often are underestimated. There are ample recommendations to apply specific criteria within the medical expert's report, but there are no empirical studies confirming that these criteria are really used and prognostically valuable. Especially, despite the growing numbers of psychosomatic in-patients and the thereby heightened socioeconomic importance, there are nearly no catamnestic studies which sufficiently evaluate the results of psychotherapy in the specific group of patients with somatoform disorders and a pending desire for financial compensation alone. The rare available data provides a nearly disastrous impression of psychotherapy results in this patient group. This review article highlights important problems of this special patient group and provides some suggestions concerning the further handling of the addressed issues.

Disability Evaluation↗

PubMed1996

Alexithymia in somatoform disorder and somatic disease: a comparative study.

BACKGROUND: The clinical validity of the newly developed 20-item Toronto Alexithymia Scale (TAS-20) with regard to the concept of somatization remains to be further established. This study attempts to determine the relationship between alexithymia and measures of psychopathology and illness severity in patients with somatoform disorders as compared to patients with chronic medical illness. METHODS: Forty inpatients with a DSM-III-R somatoform disorder and 29 inpatients with a chronic medical illness completed the German version of the TAS-20, SCL-90-R, Whiteley Index, and a global rating of the severity of current psychosocial impairment. RESULTS: Patients with a somatoform disorder scored significantly higher on the TAS-20 than the medically ill. As a result of stepwise multiple regression analysis, the SCL-90-R somatization scale emerged as a significant predictor of alexithymia in the somatizing patients, while the SCL-90-R depression scale and the severity of psychosocial impairment significantly predicted alexithymia in the medically ill. CONCLUSIONS: The results underline the clinical validity of the TAS-20 (German version) as well as the alexithymia construct.

Adolescent↗

PubMed2006

Somatoform disorders in DSM-IV: mental or physical disorders?

OBJECTIVE: To examine analytically the question of whether the characterization of somatoform disorders (SFDs) in Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) provides adequate grounds for classifying them as mental disorders rather than as physical disorders. METHODS: Analytical examination. RESULTS: There are prima facie grounds for classifying SFDs as physical disorders since they are characterized by physical symptoms. The characterization of SFDs in DSM-IV does not provide adequate grounds for classifying them as mental disorders. CONCLUSION: The spectrum of SFDs is drawn too widely in DSM-IV. At least some of the conditions now listed as SFDs in DSM-IV should be either given a dual diagnosis or classified simply as physical disorders.

Diagnosis, Differential↗

PubMed2001

[Diagnosis and treatment of somatoform disorders (functional physical complaints)].

In modern classification systems, unexplained physical symptoms without an organic origin are labelled "somatoform disorders". This syndrome is very frequent and causes a lot of treatment costs as well as indirect costs (such as workers' compensation and others). In the past, effective treatment strategies were lacking. However, consideration of modern scientific results has made it possible to develop treatment approaches which find the acceptance of the patients and which are highly effective. A hierarchical approach is presented suggesting the following steps: a) Primary care: The consideration of management rules in primary care can prevent the chronicity of somatoform symptoms. b) Brief psychological and psychopharmacological treatments: Modern cognitive-behavioural approaches can help to cope with the symptoms and to improve the subjective well-being. First results for pharmacological treatments are encouraging. c) Integrative inpatient treatment including intense psychotherapeutic and psychosomatic ingredients. Experts' judgements of course and prognosis in somatoform disorders should consider the following features: Duration and multiplicity of the complaints; comorbidity with other psychiatric and physical disorders; disability in different areas of life such as at work, family, leisure time; individual coping strategies; treatment approaches in the past.

Combined Modality Therapy↗

PubMed2002

The natural course of DSM-IV somatoform disorders and syndromes among adolescents and young adults: a prospective-longitudinal community study.

OBJECTIVE: Although somatoform disorders are assumed to be chronic clinical conditions, epidemiological knowledge on their natural course based on representative samples is not available. METHOD: Data come from a prospective epidemiologic study of adolescents and young adults in Munich, Germany. Respondents' diagnoses (N = 2548) at baseline and follow-up on average 42 months later are considered. The follow-up incidence, stability as well as selected baseline risk factors (sociodemographics, psychopathology, trauma exposure) for the incidence and stability of somatoform disorders and syndromes are prospectively examined. Diagnostic information was assessed by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). RESULTS: Over the follow-up period, incidence rate for any of the covered somatoform diagnoses was 25.7%. Stability for the overall group of any somatoform disorder/syndrome was 48%. Female gender, lower social class, the experience of any substance use, anxiety and affective disorder as well as the experience of traumatic sexual and physical threat events predicted new onsets of somatoform conditions, while stability was predicted by being female, prior existing substance use, affective and eating disorders as well as the experience of a serious accident. CONCLUSIONS: At least for a substantial proportion of individuals, the overall picture of somatization seems to be relatively stable, but with fluctuation in the symptom picture over time. Being female, the experience of substance use as well as anxiety disorder seem to constitute risk factors for the onset of new somatoform conditions as well as for a stable course over time.

Adolescent↗

PubMed1997

Somatoform disorders in Caucasian and Chinese Americans.

Somatization, broadly defined as the presentation of one or more medically unexplained somatic symptoms, refers both to the presentation of somatic symptoms in diagnosable psychiatric disorders such as major depression or anxiety as well as to the presentation of such symptoms in somatoform disorders. Although no comparative data exist, somatization is considered by many clinical investigators to be more common among Chinese than Caucasian patients, but it is unclear if this occurs because somatoform disorders are more prevalent among the Chinese or because Chinese patients with major depression or anxiety more often present with somatic complaints. We examined 85 consecutive Chinese American and 85 consecutive Caucasian American patients referred for psychiatric consultation and found the following: a) True somatization was significantly more common among Chinese American patients referred for psychiatric consultation; b) The somatoform symptom profiles of the two cohorts were different: Chinese American somatizers complained predominantly of cardiopulmonary and vestibular symptoms, whereas their Caucasian counterparts had symptoms that corresponded well with the categories listed in DSM-IV; c) In both cohorts of somatizers, a concurrent psychiatric disorder, most commonly major depression, was almost always present; and d) Among the Chinese American somatizers, pseudoneurological symptoms occurred most commonly in the form of abnormal sensations, whereas abnormal motor functions were more common among Caucasian Americans. Implications of the findings with respect to pathogenesis, treatment, and classification of somatization are discussed.

Adult↗

PubMedDate not supplied

Self-esteem and depressive symptomatology in children with somatoform disorders.

This study investigated levels of self-esteem and self-reported depressive symptomatology in a sample of children diagnosed with somatoform disorder. The somatoform sample, a sample of children with depressive disorders, and a sample of children with no DSM-III-R diagnosis differed significantly on measures of depression and self-esteem. Specifically, the somatoform group consistently scored between the depressed and no-diagnosis groups, although most of the statistically significant differences occurred between the depressed and no-diagnosis groups. Significant differences between the somatoform group and the other groups were found for behavioral self-esteem.

Adolescent↗

PubMed1989

Relative efficacy of the Sc-O, P-O, P-N, and Sc MMPI scales in differentiating brain-damaged, brain-damaged schizophrenic, schizophrenic, and somatoform disorders in an outpatient setting.

This study examined the efficacy of the Schizophrenic-Organicity (Sc-O), Psychiatric-Organic (P-O), the Pseudo-Neurological (P-N), and the Schizophrenia (Sc) MMPI subscales in differentiating the following four groups of outpatients: brain-damaged (n = 35), brain-damaged schizophrenics (n = 10), non-brain-damaged schizophrenics (n = 15), and somatoform disorders (n = 45). Both unmatched and matched samples were used in the analysis, and cut-off scores were obtained. In an unmatched sample, results suggested that the Sc scale was useful in differentiating brain-damaged schizophrenics from brain-damaged and somatoform disorders. With matched samples, the Sc differentiated brain-damaged schizophrenics well from other clinical groups, while the P-O scale differentiated the non-brain-damaged schizophrenics from brain-damaged and somatoform disorders. Furthermore, the P-N scale discriminated brain-damaged schizophrenics from non-brain-damaged schizophrenics, while the Sc-O scale was no longer significant. Results suggest that caution should be used in generalizing from previous studies (which used inpatient samples) to outpatient populations.

Adult↗

PubMed1990

Neurotic, stress-related and somatoform disorders (section F4) and physiological dysfunction associated with mental or behavioural factors (section F5): results of the ICD-10 field trial.

The results of the ICD-10 field trial in German-speaking countries relevant to sections F4 (neurotic, stress-related and somatoform disorders) and F5 (physiological dysfunction associated with mental or behavioural factors) show a comparatively low level of acceptance. Interrater-reliability in various diagnostic categories is not always adequate. In particular the allocation of some of the "old" diagnostic entities of ICD-9 to various sections of ICD-10, and in part unsatisfactory classificatory distinctions gave rise to certain problems.

Behavior↗

PubMed1995

[Relaxation therapy in patients with anxiety and somatoform disorders in primary care].

OBJECTIVE: To study the effect of relaxation therapy on the symptomology of patients with anxiety and somatoform disorders. DESIGN: An experimental prospective study, controlled through random assignation, using evaluation scales. SETTING: Mn. Jaume Soler Health Centre, Cornellà (Barcelona). PATIENTS: 31 patients (8 men and 23 women), diagnosed with anxiety or previously untreated somatoform disorders, for whom combined anti-depressive and relaxation therapy over a 5-month period was established. The results were compared with those of a control group (n = 17) with identical diagnoses, which only received antidepressive medication. MEASUREMENTS AND MAIN RESULTS: The STAI tests and two pain scales were administered at 0, 15, 30, 45, 60 and 150 days and the HRS and SCL-90-R at 0 and 150 days. The possible impact of the psychiatric diagnosis, age, gender, married status, existence of concomitant physical illness, SRE, present employment status and the presence of children or not were all considered. The results pointed to a significant improvement over the period in the analogue-visual scale of pain (p = .009) and in the HRS (p = .046) for the group comprised of those complying with the relaxation therapy independently of the psychiatric diagnosis. CONCLUSIONS: The benefit of relaxation in anxious and somatoform patients, when pain--and not anxiety--is the principal symptom, was confirmed. Depression improved when antidepressants were administered simultaneously, whereas anxiety varied little, at least during the time the trial lasted.

Adolescent↗

PubMed2006

Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: a randomized, controlled study.

OBJECTIVE: The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. METHOD: In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. RESULTS: According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. CONCLUSIONS: BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.

Adult↗

PubMed2004

Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia.

OBJECTIVE: To determine the role of undifferentiated and dysregulated affects in somatoform disorders by using a multimethod assessment approach of alexithymia. METHODS: Forty patients with ICD-10 somatoform disorders (SoD) and 20 healthy controls, matched for age, education and sex, were included in the study. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), the Affect Consciousness Interview (ACI), and the Levels of Emotional Awareness Scale (LEAS). All classifications were made blinded with regard to clinical status. RESULTS: Scores of the ACI and the TAS-20 showed that alexithymia is higher in SoD than in healthy controls. No differences were found on the LEAS. In terms of the multidimensionality of the alexithymia construct, our results indicate a specific positive association between SoD and a proneness to experience undifferentiated affects. The three subfactors of the TAS-20 were differentially related to non-self-report measures of alexithymia and to negative affectivity (NA). Only the cognitive facet of the TAS-20 (externally oriented thinking [EOT]) was related to the LEAS and the ACI. In contrast, the affective facets of the TAS-20-difficulties identifying feelings (DIF) and difficulties describing feelings (DDF)-were substantially related to NA. CONCLUSION: The findings highlight the important role of impaired affect regulation and NA in the process of somatization.

Adult↗

PubMed1993

[The somatoform disorders in the ICD-10].

ICD-10 criteria for the diagnosis of somatoform disorder, included in chapter F4 together with neurotic disorders and those associated with stressful situations, are examined and evaluated. Even when the term poses semantic difficulties, clinical conditions included are frequent and deserve attention by psychiatrists and general practitioners. The usefulness of standardization is supported by empirical data.

Female↗

PubMed2006

Can DSM-V facilitate productive research into the somatoform disorders?

OBJECTIVE: To highlight key research issues relevant to the diagnostic classification of somatoform disorders and assess whether DSM-V can facilitate research. METHODS: A selective review of recent research findings in relation to the diagnostic categories of somatization disorder and hypochondriasis. RESULTS: The DSM-IV criteria have been ignored by researchers as they were either too restrictive or too broad to study the associated features of somatization and hypochondriasis. In view of the linear relationship between number of bodily symptoms and impairment, the appropriate cutoff point has yet to be established. Ongoing research highlights the perceptual and cognitive aspects of these disorders, which need to be researched further in order to improve management. CONCLUSION: DSM-IV did not facilitate research. Its successor should enable longitudinal studies to further elucidate the causes and perpetuating factors of somatization and illness worry rather than limit such studies by producing artificial criteria that may not be supported by subsequent research.

Diagnostic and Statistical Manual of Mental Disord↗

PubMed2007

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition.

Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).

Adolescent↗

PubMed2003

[The 4-week prevalence of somatoform disorders and associated psychosocial impairment].

In the course of a WHO study,we report on the prevalence of somatoform disorders (SFD) and the associated psychosocial impairment in five western German primary care settings. In accordance with ICD-10 classification, a 4-week prevalence of 28.5% was found for SFD (number of patients in the age between 18 and 60 with an SFD in the last 28 days). The accumulation of SFD was higher in female patients than in males (RR 1.7), in particular when the number of children was >1 (RR 1.8). The female-male difference was more marked in persistent somatoform pain disorder (RR 2.1) and unspecific somatization disorder (RR 5.0). Concerning other psychiatric disorders, neurasthenia occurred most frequently,with a 4-week prevalence of 8.2%. The 4-week prevalence of concomitant occurrence of SFD and other psychiatric disorders was 7.7%. Working capability was most severely impaired, with 22.5 days of absence from work during the last month, in male patients with hypochondriacal disorder. In comparison, somatization disorder resulted in a severe level of psychosocial impairment, with 10.3 days of absence in work during the last month in female patients. The coexistence of SFS with other psychiatric disorders resulted in a greater extent of psychosocial impairment.

Adolescent↗

PubMed1997

How disabled are patients with somatoform disorders?

The purpose of this study was to evaluate the level and quality of psychosocial disabilities in patients suffering from somatoform disorders (SFD). Of 221 patients referred for psychiatric and cognitive-behavioral inpatient treatment, 37 were diagnosed according to DSM-IV as having SFD, 56 as pain disorder, 70 met the criteria for the subsyndromal form of SFD called the "Somatic Symptom Index" (SSI). The control group consisted of 58 patients with other mental disorders. All patients completed the Dysfunctional Analysis Questionnaire (DAQ) which measures social, vocational, personal, familial, and cognitive disabilities on psychometric scales. The results showed substantial disabilities in all somatoform subgroups; however, the levels and patterns of dysfunction in these patients were not statistically different from those in the control group. Impairment was generally more severe when patients had a comorbidity of somatoform and affective disorders. It is concluded that SFDs are associated with marked psychosocial disabilities similar to those seen in other mental disorders. The strongest predictor for psychosocial dysfunction is the comorbidity of somatoform with affective disorders, but not with anxiety disorders.

Adult↗

PubMed1995

Transcultural aspects of dissociative and somatoform disorders.

A brief review of the cross-cultural literature on dissociative and somatoform disorders with emphasis on US Hispanic populations has been provided. A brief description of the psychopathology of somatizing syndromes has been given as have some critiques of current nosologic systems. Cultural influences that may color the expression of somatic manifestations have been outlined. Although it is often difficult to disentangle the contribution of ethnicity from other demographic factors, and although there are plenty of methodologic shortcomings, most studies reinforce the view that culture exerts a powerful influence in shaping symptom presentation and determining health-related attitudes. Future work using instruments such as the Composite International Diagnostic Interview (CIDI) (Rubio-Stipec M: The somatization schedule of the Composite International Diagnostic Interview: The use of the probe in 17 different countries; unpublished manuscript) that include a more culturally congruent list of somatizing symptoms may shed new light on the international distribution and mechanisms at play in these symptom presentations.

Culture↗