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