Management of Somatoform Disorders

Evidence based treatment
The evidence for effective treatment of patients with chronic multiple symptoms are very sparse with less than 2 randomised controlled studied.

Management
Make the diagnosis: begin with a good assessment. 

  • Acknowledge the patient’s symptoms as real, be direct and honest about areas that you agree on and those that you don’t agree
  • Look out for sings rather than symptom, if necessary a brief physical examination
  • Use appropriate investigations to exclude physical cause, but discuss implications of negative test beforehand, avoid tests and procedures, unless indicated
  • Clarify psychological and mood factors
  • ‘Dry out’ physical symptoms
  • Identify patients illness beliefs, previous experience of doctors, understanding of test results
  • Identify psychosocial problems
  • Identify families perception and maladaptive responses
  • Reduce unnecessary drugs
  • Be proactive rather than reactive, set up brief regular scheduled visits (2-6 week interval) and avoid consultations on demand
  • Attempt to be the patient’s only physician and to minimise patient’s contact with other healthcare professionals
  • Apply a specific therapeutic technique if possible, i.e. reattribution model, CBT, brief psychotherapy, group psychotherapy
  • Understand worsening and new symptoms as an emotional communication rather than a manifestation of new disease
  • Build up a therapeutic alliance with the patient’s nearest relative by informing them of the management plan
  • Reduce expectation of cure, aim for damage limitations and containment instead
  • Inform your colleges of your management plan and have a contingency plan in case of crisis or emergencies

Specific psychotherapeutic treatment methods
Reattribution model: first stage is feeling understood, the second stage is broadening the agenda, the third stage is making a link. Download the Reattribution model for Somatoform Disorder PDF.

Cognitive behavioural therapy: dysfunctional automatic thoughts are identified and modified, thus breaking the vicious cycle of the symptoms and their consequences.

Brief psychotherapy: interpersonal psychotherapy has been found effective

Group therapy: several uncontrolled have proved that group therapy has been beneficial.

Family therapy

Biofeedback

Medication
Coexisting mood/anxiety/other mental illnesses are treated with psychotropic medications.