Diagnosis-Specific Management of Somatoform Disorders: Moving Beyond “Vague Complaints of Pain”

Anne Dohrenwend, PhD

University of Florida College of Dentistry
North Florida/South Georgia Veterans Health System
Gainesville, Florida

Characterized by unexplained somatic symptoms, often including pain amplification, somatoform disorders can be frustrating for clinicians to diagnosis and treat. In the United States, these patients use disproportionately high levels of medical resources and incur higher medical care–related costs. Deficiencies in management may stem from DSM-IV grouping in the somatoform category despite the at best weak etiologic homogeneity among the various disorders. This consequently leads to inappropriate generalizations when treating a disorder from this heterogeneous class. Appropriate diagnosis and optimized patient management requires an understanding of DSM-IV criteria for each of the seven individual disorders within this category. Patient-centered treatment of somatoform patients is based on assessment of such factors as affect, insight, and potential personality disorders. When somatic amplification is identified, clinicians should consider psychological testing and individualized multimodal therapy with a focus on functional outcomes.

References

Dohrenwend A, Skillings JL. Diagnosis-specific management of somatoform disorders: moving beyond "vague complaints of pain." J Pain. 2009;10:1128-1137.
Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903-910.
Strassnig M, Stowell KR, First MB, Pincus HA. General medical and psychiatric perspectives on somatoform disorders: separated by an uncommon language. Curr Opin Psychiatry. 2006;19:194-200.
Smith RC, Gardiner JC, Lyles JS, et al. Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosom Med. 2005;67:123-129.

Would you like to comment? , or in if you are already a member.

Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.

Buckley DI, Calvert JF, Lapidus JA, et al.
Ann Fam Med. 2010;8(3):237-44.
PURPOSE:...

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Beck JG, Clapp JD.
Psychol Trauma. 2011 Jun;3(2):101-108.
Many traumatic events leave...

The impact of enrollment in a specialized interdisciplinary neuropathic pain clinic

Garven A, Brady S, Wood S, Hatfield M, Bestard J, Korngut L, Toth C.
Pain Res Manag. 2011...

Association between urine drug test results and treatment outcome in high-risk chronic pain patients on opioids

Barth KS, Becker WC, Wiedemer NL, Mavandadi S, Oslin DW, Meghani SH, Gallagher RM.
J Addict...

The role of core strengthening for chronic low back pain.

Akuthota V, Standaert CJ, Chimes GP.
PM R. 2011 Jul;3(7):664-70.