Somatoform Disorders

by

Karl Julian Looper, Laurence J. Kirmayer

• LAST REVIEWED: 22 April 2013
• LAST MODIFIED: 22 April 2013
• DOI: 10.1093/obo/9780199828340-0106

Introduction

Around the world, physical symptoms are the most common manifestation of psychological distress. This seeming contradiction presents a diagnostic challenge for health care professionals who are consulted to provide treatment and illness management. In many situations, it is difficult to clearly identify the psychological cause of physical symptoms, and, at times, it is equally difficult to exclude the possibility of an underlying biomedical process. This clinical challenge has led to the construction of the diagnostic category of somatoform disorders, a group of psychiatric disorders characterized by the presence of physical symptoms causing significant distress or functional impairment that cannot be fully explained by a general medical condition, substance use, or any other mental disorder. This category of disorders was established based on clinical utility and the need to exclude medical causes in health care settings rather than on a theoretical model of psychopathology or shared etiology. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association 2000, cited under Classification), the somatoform disorders include somatization disorder, hypochondriasis, body dysmorphic disorder, conversion disorder, pain disorder, undifferentiated somatoform disorder, and somatoform disorder not otherwise specified. Some authors prefer other terminology, including use of the terms medically unexplained symptoms, emphasizing the uncertainty about diagnosis, or functional somatic syndromes, suggesting that symptoms are due to disturbances in the function of psychophysiological systems rather than structural or anatomical pathology.

Reference Books

Most general textbooks on psychiatry and psychopathology have chapters on somatoform disorders. In recent years, several texts devoted to somatoform disorders have been published. Overviews of research and conceptual issues are provided in Maj, et al. 2005 and Dimsdale 2009. Creed, et al. 2011 and Johnson 2008 present reviews oriented to primary care and psychology, respectively. More specialized reviews approach the topic from the perspectives of neuropsychology (Lamberty 2008) and forensic psychiatry (Trimble 2010). Popular accounts of interest to professionals as well as clients address specific disorders such as Phillips 2009 on body dysmorphic disorder.

• Creed, Francis, Peter Henningsen, and Per Fink. 2011. Medically unexplained symptoms, somatisation, and bodily distress: Developing better clinical services. Cambridge, UK: Cambridge Univ. Press.

  DOI: 10.1017/CBO9780511977862

  A critical overview of current thinking on somatoform disorders by leading researchers.

• Dimsdale, Joel E. 2009. Somatic presentations of mental disorders: Refining the research agenda for DSM-V. Arlington, VA: American Psychiatric Association.

  Based on a workshop held in 2006, an international roster of contributors discuss research and conceptual issues needed to rethink the somatoform disorders for DSM-5.

• Johnson, Susan K. 2008. Medically unexplained illness: Gender and biopsychosocial implications. Washington, DC: American Psychological Association.

  DOI: 10.1037/11623-000

  An integrative biopsychosocial approach to somatoform disorders with an emphasis on gender issues.

• Lamberty, Gregory J. 2008. Understanding somatization in the practice of clinical neuropsychology. New York: Oxford Univ. Press.

  Directed to neuropsychologists, this book focuses on assessment and management of somatoform disorders.

• Maj, Mario, Hagop P. Akiskal, Juan Mezzich, and Ahmed Okasha, eds. 2005. Somatoform disorders. Chichester, UK: Wiley.

  A review of major categories of somatoform disorders organized in five sections (somatization and conversion disorders, pain disorder, hypochondriasis, body dysmorphic disorder, chronic fatigue and neurasthenia, and factitious physical disorders) with multiple commentaries by scholars from around the globe with interesting critical reflections and perspectives.

• Phillips, Katharine A. 2009. Understanding body dysmorphic disorder: An essential guide. Oxford: Oxford Univ. Press.

  Oriented toward body dysmorphic disorder (BDD) sufferers, families, and lay individuals, this volume presents up-to-date research as well as outlining effective approaches to treatment.

• Trimble, Michael R. 2010. Somatoform disorders: A medicolegal guide. Cambridge, UK: Cambridge Univ. Press.

  Addresses topics ranging from malingering to injury and disability relevant to legal and forensic settings.