Somatoform disorders

Current Opinion in Psychiatry

Volumn 12, Issue 2, 1999, Pages 163-168

  Reid, Steven ^a   Wessely, Simon ^a  

^a KING'S COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIDEPRESSANT AGENT; SEROTONIN UPTAKE INHIBITOR;

ABDOMINAL PAIN; BEHAVIOR THERAPY; CHILDHOOD DISEASE; CHRONIC FATIGUE SYNDROME; CHRONIC PAIN; DISEASE CLASSIFICATION; HUMAN; HYPOCHONDRIASIS; IRRITABLE COLON; NEUROSIS; PSYCHOLOGICAL ASPECT; REVIEW;

EID: 0033025077     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-199903000-00004     Document Type: Review

References (72)

1. 1 Hotopf M, Mayou R, Wadsworth M, Wessely S. Temporal relationships between physical symptoms and psychiatric disorder. Br J Psychiatry 1998; 173:255-261
2. 2 Hickie IB, Scott EM, Davenport TA. Somatic distress: developing more integrated concepts. Curr Opin Psychiatry 1998; 11:153-158. This review to some extent makes the present review superfluous! It is readable if only for the elegant way in which the authors demonstrate that even Lancet editorialists have feet of clay.
3. 3 Robbins JM, Kirmayer LJ, Hemami S. Latent variable models of functional somatic distress. J Nerv Ment Dis 1997; 185:606-615. The authors attempt to confirm the validity of fibromyalgia, chronic fatigue and IBS. Their use of the Diagnostic Interview Schedule, however, which does not make definitive diagnoses of specific somatic syndromes, prevents any robust conclusions being drawn.
4. 4 Mayou R, Bass C, Sharpe M. Overview of epidemiology, classification, and aetiology. In: Mayou R, Bass C, Sharpe M (editors). Treatment of functional somatic symptoms. Oxford: Oxford University Press; 1995. pp. 42-65.
5. 5 Escobar JI, Gara M, Cohen Silver R, Waitzkin H, Holman A, Compton W. Somatisation disorder in primary care. Br J Psychiatry 1998; 173:262-266. This important paper demonstrates the failings of the current classification of somatoform disorders and restates the case for an alternative. Not surprisingly, the authors find little overlap between the diagnoses for somatization disorder (DSM-III-R, DSM-IV and ICD-10) in this population.
6. 6 Stern J, Murphy M, Bass C. Attitudes of British psychiatrists to the diagnosis of somatisation disorder. Br J Psychiatry 1993; 162:463-466.
7. 7 Escobar JI, Golding JM, Hough RL, Karno M, Burman MA, Wells KB. Somatisation in the community: relationship to disability and use of services. Am J Public Health 1987; 77:837-840.
8. 8 Kisely S, Goldberg D, Simon G. A comparison between somatic symptoms with and without clear organic cause: results of an international study. Psychol Med 1997; 27:1011-1019. This is a part of the large World Health Organization study evaluating somatoform disorders. The authors found that somatic symptoms, regardless of aetiology, were associated with increased psychological morbidity. Medically unexplained symptoms displayed a linear relationship with psychological morbidity, whereas in medically explainable symptoms there was a threshold effect with morbidity increasing sharply in patients with 11 or more symptoms.
9. 9 Guze SB. The validity and significance of the clinical diagnosis of hysteria (Briquet's syndrome). Am J Psychiatry 1975; 132:138-141.
10. 10 Regier DA, Boyd JH, Burke JD, Rae DS, Myers JK, Kramer M, et al. One-month prevalence of mental disorders in the United States: based on five epidemiologic catchment area sites. Arch Gen Psychiatry 1988; 45:977-986.
11. 11 Escobar JI. Developing practical indexes of somatization for use in primary care J Psychosom Res 1997; 42:323-328.
12. 12 Rief W, Hiller W. Somatization-future perspectives on a common phenomenon. J Psychosom Res 1998; 44:529-536.
13. 13 Kroenke K, Spitzer RL, deGruy FV, Hahn SR, Linzer M, Williams JBW, et at. Multisomatoform disorder. Arch Gen Psychiatry 1997; 54:352-358. A further attempt is made to develop a clinically useful alternative to the somatoform diagnoses currently in use. Three or more medically unexplained symptoms are required, plus a history of somatization; a prevalence of 8.2% was found in a primary care sample.
14. 14 Escobar JI, Waitzkin H, Cohen Silver R, Gara M, Holman A. Abridged somatization: a study in primary care. Psychosom Med 1998; 60:466-472.
15. 15 Hiller W, Rief W, Fichter M. How disabled are patients with somatoform disorders? Gen Hosp Psychiatry 1997; 19:432-438.
16. 16 Rief W, Shaw R, Fichter M. Elevated levels of psychophysiological arousal and cortisol in patients with somatization syndrome. Psychosom Med 1998; 60:198-203. This is an intriguing study examining psychological and biological processes in somatization. The authors found that patients with somatoform disorders had increased levels of physiological arousal, including higher heart rates and salivary cortisol concentration than did control individuals. Interestingly, the sample consists of patients with a diagnosis of abridged somatization rather than the more restrictive somatization disorder.
17. 17 Piccinelli M, Simon G. Gender and cross-cultural differences in somatic symptoms associated with emotional distress. An international study in primary care. Psychol Med 1997; 27:433-444.
18. 18 Gureje O, Simon G, Ustun TB, Goldberg D. Somatization in cross-cultural perspective: a World Health Organization study in primary care. Am J Psychiatry 1997; 154:989-995.
19. 19 Kirmayer L, Young A. Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosom Med 1998; 60:420-430. In this interesting theoretical paper, the authors conduct a thorough exploration of the idea of socialization as it relates to culture. They emphasize the need for a more sophisticated model of somatization than the reductionist mind-body view that is currently dominant.
20. 20 Rost KM, Smith GR Jr. Improving the effectiveness of routine care for somatization. J Psychosom Res 1997; 43:463-465.
21. 21 Sharpe M. Cognitive behavioural therapies in the treatment of functional somatic symptoms. In: Mayou R, Bass C, Sharpe M (editors). Treatment of functional somatic symptoms, vol 7. Oxford: Oxford University Press; 1995. pp. 122-143.
22. 22 Lidbeck J. Group therapy for somatization disorders in general practice: effectiveness of a short cognitive-behavioural treatment model. Acta Psychiatr Scand 1997; 96:14-24.
23. 23 Harrison S, Watson M, Feinmann C. Does short-term group therapy affect unexplained medical symptoms? J Psychosom Res 1997; 43:399-404.
24. 24 Kashner TM, Rost K, Cohen B, Anderson M, Smith GR Jr. Enhancing the health of somatization disorder patients. Psychosomatics 1995; 36:462-470.
25. 25 Smith GR, Monson RA, Ray DC. Psychiatric consultation in somatization disorder: a randomised controlled trial. N Engl J Med 1986; 314:1407-1413.
26. 26 Smith GR Jr, Rost K, Kashner TM. A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Arch Gen Psychiatry 1995; 52:238-243.
27. 27 Barsky AJ. A 37-year-old man with multiple somatic complaints. JAMA 1997; 278:673-678.
28. 28 Gureje O, Ustun TB, Simon G. The syndrome of hypochondriasis: a cross-national study in primary care. Psychol Med 1997; 27:1001-1010. This large international study provides measurements of the prevalence of hypochondriasis across 15 sites, with an emphasis on comorbidity and the impact on public health. Across sites the occurrence of ICD-10 hypochondriasis was 0.8%, but the authors make the point that this definition is too restrictive for primary care settings, ignoring a larger population who do not completely fulfil the criteria despite having equivalent levels of impairment.
29. 29 Escobar JI, Gara M, Waitzkin H, Cohen Silver R, Holman A, Compton W. DSM-IV hypochondriasis in primary care. Gen Hosp Psychiatry 1998; 20:155-159. In attempting to assess the prevalence and correlates of hypochondriasis in a large primary care sample in California, the authors found a prevalence of 3.4% using the DSM-IV criteria, although the study was flawed by a poor response rate.
30. 30 Fallon BA, Schneier FR, Marshall R, Campeas R, Vermes D, Goetz DG, Liebowitz MD. The pharmacotherapy of hypochondriasis. Psychopharmacol Bull 1996; 32:607-611.
31. 31 Clark DM, Salkovskis PM, Hackmann A, Wells A, Fennell M, Ludgate J, et al. Two psychological treatments for hypochondrias. Br J Psychiatry 1998; 173:218-225. This well-designed randomized controlled trial demonstrates both the usefulness and the specificity of cognitive-behavioural therapy as a treatment for hypochondriasis.
32. 32 Warwick HMC, Clark DM, Cobb AM, Salkovskis PM. A controlled trial of cognitive behavioural treatment of hypochondriasis. Br J Psychiatry 1996; 169:189-185.
33. 33 Avia MD, Ruiz MA, Olivares ME, Crespo M, Guisado AB, Sanchez A, Varela A. The meaning of psychological symptoms: effectiveness of a group intervention with hypochondriacal patients. Behav Res Ther 1998; 34:24-31.
34. 34 Neziroglu F, Yaryura-Tobias JA. A review of cognitive behavioral and pharmacological treatment of body dysmorphic disorder. Behav Modif 1997; 21:324-340.
35. 35 Veale D, Gournay K, Dryden W, Boocock A, Shah F, Willson R, Walburn J. Body dysmorphic disorder: a cognitive behavioural model and pilot randomized controlled trial. Behav Res Ther 1996; 34:717-729.
36. 36 Drossman DA. Presidential address: gastrointestinal illness and the biopsychosocial model. Psychosom Med 1998; 60:258-267. This is an excellent, very readable paper in which the author combines literature review with personal experience to demonstrate the importance of an integrated approach to somatoform disorders.
37. 37 Goldberg J, Davidson P. A biopsychosocial understanding of the irritable bowel syndrome: a review. Can J Psychiatry 1997; 42:835-840.
38. 38 Bennett EJ, Tennant CC, Piesse C, Badcock C-A, Kellow JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut 1998; 43:256-261. The extent to which life events contribute to the course of IBS continues to be debated. In this longitudinal study the authors examine the covariance of life stress and symptoms in IBS. The strength of their design enables them to demonstrate that 97% of the variance within individuals in symptom intensity was explained by recent life stress.
39. 39 Maunder RG. Panic disorder associated with gastrointestinal disease: review and hypotheses. J Psychosom Res 1998; 44:91-105.
40. 40 Dancey CP, Taghavi M, Fox RJ. The relationship between daily stress and symptoms of irritable bowel: a time-series approach. J Psychosom Res 1998; 44:537-545.
41. 41 Woodman CL, Breen K, Noyes R Jr, Moss C, Fagerholm R, Yagla SJ, Summers R. The relationship between irritable bowel syndrome and psychiatric illness. Psychosomatics 1998; 39:45-54.
42. 42 Gick ML, Thompson WG. Negative affect and the seeking of medical care in university students with irritable bowel syndrome. J Psychosom Res 1997; 43:535-540.
43. 43 Talley NJ, Boyce PM, Jones M. Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study. Gut 1998; 42:47-53. This is a large population-based study exploring the link between IBS and sexual abuse. After controlling for neuroticism and psychological morbidity the association between sexual abuse and IBS was lost.
44. 44 Vollmer A, Blanchard EB. Controlled comparison of individual versus group cognitive therapy for irritable bowel syndrome. Behav Ther 1998; 29:19-33.
45. 45 Lawrie SM. Is the chronic fatigue syndrome best understood as a primary disturbance of the sense of effort? Psychol Med 1997; 27:995-999.
46. 46 Sharpe M, Hawton K, Clements A, Cowen PJ. Increased brain serotonin function in men with chronic fatigue syndrome. Br Med J 1997; 315:164-165.
47. 47 Fry AM, Martin M. Fatigue in the chronic fatigue syndrome: a cognitive phenomenon? J Psychosom Res 1996; 41:414-426.
48. 48 Sharpe M, Wessely S. Putting the rest cure to rest-again. Br Med J 1998; 316:796-800. This brief editorial piously hopes we have seen the last of rest as a treatment for CFS.
49. 49 Deale A, Chalder T, Marks I, Wessely S. A randomised-controlled trial of cognitive behaviour versus relaxation therapy for chronic fatigue syndrome. Am J Psychiatry 1997; 154:408-414.
50. 50 Fulcher KY, White PD. A randomised controlled trial of graded exercise therapy in patients with the chronic fatigue syndrome. Br Med J 1996; 314:1647-1652.
51. 51 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive therapy for chronic fatigue syndrome: a randomized controlled trial. Br Med J 1996; 312:22-26.
52. 52 Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Q J Med 1997; 90:223-233. This is a review of outcome studies of CFS that identifies the risk factors for poor prognosis. The outcome appears poor, but, as most studies use subjects with long duration of illness seen in specialist care, this is hardly surprising.
53. 53 Kurtze N, Gundersen KT, Svebak S. The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients. Br J Med Psychol 1998; 71:185-194.
54. 54 Dwight MM, Arnold LM, O'Brien H, Metzger R, Morris-Park BA, Keck PE Jr. An open clinical trial of venlafaxine treatment of fibromyalgia. Psychosomatics 1998; 39:14-17.
55. 55 Bennett RM, Clark SC, Walczyk J. A randomised, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med 1998; 104:227-231. The authors observed that treatment with growth hormone improved overall symptoms, suggesting a disturbance of the hypothalamic-pituitary axis. They do note, however, that at a cost of $1500 per month its use is unlikely to become widespread.
56. 56 Pilowsky I. Acute and chronic pain: new understandings and treatment. Curr Opin Psychiatry 1997; 10:121-126.
57. 57 Lampe A, Söllner W, Kridmer M, Rumpold G, Kantner-Rumplmair W, Ogon M, Rathner G. The impact of stressful life events on exacerbation of chronic low-back pain. J Psychosom Res 1996; 44:555-563.
58. 58 Wallis B, Lord SM, Bogduk N. Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial. Pain 1997; 73:15-22.
59. 59 Kouyanou K, Pither CE, Rabe-Hesketh S, Wessely S. A comparative study of iatrogenesis, medication abuse, and psychiatric morbidity in chronic pain patients with and without medically unexplained symptoms. Pain 1998; 76:417-426. This paper highlights the role of the doctor-patient relationship in maintaining medically unexplained symptoms. Chronic pain patients who had no medically explained cause for their complaints were more likely to have had their symptoms treated as if they were imaginary, and then went on to receive excessive investigations and inappropriate prescribing.
60. 60 Jones DA, Rollman GB, Brooke RI. The cortisol response to psychological stress in temporomandibular dysfunction. Pain 1997; 72:171-182.
61. 61 Fishbain DA, Cutler RB, Rosomoff H, Rosomoff RS. Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis. Psychosom Med 1998; 60:503-509. The diagnoses somatoform pain disorder and psychogenic pain appear to have limited empirical justification. In this well-conducted meta-analysis the authors question both their validity and clinical usefulness. Antidepressants seem to be a good idea, however.
62. 62 Tait RC, Chibnall JT. Physician judgments of chronic pain patients. Soc Sci Med 1997; 45:1199-1205. Using clinical vignettes, physicians' ratings of pain and disability were lower if the patients' complaints were not supported by medical evidence, if the patient presented with a positive rather than negative affect and if the patient reported high levels of pain.
63. 63 Maruta T, Malinchoc M, Offord KP, Colligan RC. Status of patients with chronic pain 13 years after treatment in a pain management center. Pain 1998;74:199-204. This is a long-term follow-up study of 249 patients who attended a multidisciplinary pain clinic. Although the patients continued to complain of pain and had a reduced quality of life related to physical health, the sample had sustained an improvement both in employment status and in measures of emotional/mental health.
64. 64 Cott A, Anchel H, Goldberg WM, Fabich M, Parkinson W. Non-institutional treatment of chronic pain by field management: an outcome study with a comparison group. Pain 1990; 40:183-194.
65. 65 Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 1997; 73:77-85.
66. 66 McCracken LM. 'Attention' to pain in persons with chronic pain: a behavioural approach. Behav Ther 1997; 28:271-284.
67. 67 McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998; 74:21-27. Reducing 'attention' to pain and promoting acceptance are shown to lead to better adjustment although both this study and [66] were based on patient self-report and require verification using more direct methods of assessment or monitoring.
68. 68 Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997; 36:1329-1338. This is a thorough review with particular focus on syndromes common in childhood, such as recurrent abdominal pain.
69. 69 Hotopf M, Carr S, Mayou R, Wadsworth MEJ, Wessely S. Why do children have chronic abdominal pain, and what happens to them when they grow up? Br Med J 1998; 316:1196-1200. The authors, using a birth cohort study established in 1946, demonstrate that poor health and emotional disorder in parents is associated with recurrent abdominal pain in children and psychiatric disorder in adulthood.
70. 70 Shorter E. Multiple chemical sensitivity: pseudodisease in historical perspective. Scand J Work Environ Health 1997; 23(Suppl 3):35-42. This is a fascinating paper in which the author describes the emergence of a 'new' illness, highlighting the influence of medical culture on its development. He also gives an entertaining look at the peculiar lives of the early 'gurus' of 'clinical ecology'.
71. 71 Staudenmayer H. Multiple chemical sensitivities or idiopathic environmental intolerances: psychophysiologic foundation of knowledge for a psychogenic explanation. J Allergy Clin Immunol 1997; 99:434-437.
72. 72 Black DW. latrogenic (physician-induced) hypochondriasis. Psycnosomatics 1996; 37:390-393. As it seems likely that the label of multiple chemical sensitivity will be another product of US culture shortly to be exported to the rest of the world, this is a timely reminder of the importance of some doctors in spreading the concept of multiple chemical sensitivity, and the associated disability, Whether this is the result of arrogance, ignorance, naivety or greed is a moot point.