Managing somatoform disorders.

Abstract

The management of somatoform disorders is a confusing and difficult area. There are many iatrogenic complications, including unnecessary and repetitive investigations and surgery, drug dependence and "doctor shopping". Somatisation is a world wide phenomenon and a common presentation of psychological distress. Three main groups of patients are encountered in general practice: those with high levels of somatic symptoms, those with illness fear, and those with somatic presentations of other psychiatric illnesses. Management is straightforward for the acute cases and consists of trying to get the patient to accept a link between the psychosocial conflicts and the symptoms. Management is very difficult for chronic cases, where care, not cure, is the goal, as is an attempt to limit harm to the patient and limit the cost to the health system.