Somatoform Disorders: Epidemiology, Treatment

Epidemiology

In view of the vicissitudes of diagnostic approaches and the re-cency of the current somatoform disorder grouping, it is not sur-prising that estimates of the frequency of this group of disorders in the general population as well as in clinical settings are incon-sistent if not nonexistent. Yet, existing data seem to indicate that such problems are indeed common and account for a major pro-portion of clinical services, especially in primary care settings.

Table 54.2 summarizes what is known about the epidemi-ology of these disorders.

In consideration of the substantial frequency of somato-form disorders in nonpsychiatric settings, instruments have been designed to aid primary care physicians in diagnosing psychiat-ric conditions. The Primary Care Evaluation of Mental Disorders (PRIME-MD) (Spitzer et al., 1994) includes somatoform items in its screening questionnaire and in its physician education guide. The DSM-IV Primary Care Edition (DSM-IV-PC) includes an “unex-plained physical symptoms” algorithm among the nine it included to address the most common psychiatric symptom groups presenting in primary care settings (American Psychiatric Association, 1995).

The epidemiology of the specific somatoform disorders is discussed individually in following sections.

Treatment

Whereas specific somatoform disorders indicate specific treat-ment approaches, some general guidelines apply to the somato-form disorders as a whole (Figure 54.2 and Table 54.2). Thera-peutic goals include 1) as an overriding goal, prevention of the adoption of the sick role and chronic invalidism; 2) minimiza-tion of unnecessary costs and complications by avoiding unwar-ranted hospitalizations, diagnostic and treatment procedures, and medications (especially those of an addictive potential); and 3) effective treatment of comorbid psychiatric disorders, such as depressive and anxiety syndromes. The three general treatment strategies include 1) consistent treatment, generally by the same physician, with careful coordination if multiple physicians are in-volved; 2) supportive office visits, scheduled at regular intervals rather than in response to symptoms; and 3) a gradual shift in focus from symptoms to an emphasis on personal and interper-sonal problems.