Unexplained symptoms: somatoform disorders

Posted on 13th July 2015 by Ammar Sabouni

The issue

It never is easy when you feel something is wrong but don’t know what it is, so if you’re a patient you’ll visit the doctor. The real question is; what if even your doctor doesn’t know the cause of your symptoms?

These medically unexplained physical symptoms have been grouped together and given a name (as those in the medical profession do; give big, fancy names to this, that or the other) they’ve been called ‘Somatoform disorders’.

Somatoform disorders have a number of different types and diagnosis guidelines and are NOT the same as malingering, nor the same as physical symptoms of psychiatric disorders.

These unexplained symptoms range from pain, to vomiting, to seizures and are, as I’m sure you’d expect, the cause of considerable pain and suffering for patients and family members and the cause of much confusion for healthcare professionals who can’t figure out what’s wrong or how to treat.

Another name for these disorders is functional disorders; the older ‘Somatoform’ term is starting to go out of fashion.

The prevalence

Something like 1 in 3 people go to the doctor with symptoms that simply have no explanation; from digestive problems to sexual problems, and sometimes even with symptoms like memory loss and sensory loss, only to find the doctor is as confused as they are. A large number of these symptoms persist and 6 in 100 people suffer from them long-term.

Females of lower socioeconomic standing are more likely to develop such disorders but that is almost as far as you’ll get looking for risk factors that apply to all the Somatoform disorders.

The solution

Current guidelines recommend talking therapy alongside medication and many patients are treated with anxiety and depression medication based on NO evidence.

Cochrane has come to the rescue with two new systematic reviews on this subject under the titles of:

Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

and

Pharmacological interventions for somatoform disorders in adults

Well these two reviews looked at the pharmacological and non-pharmacological interventions available for Somatoform disorders and came to the conclusion that:

• New-generation antidepressants were used to successfully treat physical symptoms and anxiety witnessed in somatoform disorders.
• Natural remedies like St. John’s wort, managed to make the symptoms less severe. It was noted however that more people left the study on antidepressants than those on natural remedies stating that side effects or not noticing any improvement for the better on antidepressants.
• Like natural remedies, cognitive behaviour therapy,  a type of talk therapy, was able to reduce how severe the symptoms were, better than normal care but not better than enhanced care provided by the doctor.

Not sure how willing patients will be to undergo therapy for physical symptoms though.

The future

Well the quality of the evidence meant that a lot of the treatments were actually studied but nothing concrete could be concluded other than the above. That is NOT to say that all the treatments missing from here are not effective. But that these reviews weren’t able to conclude anything else based on the evidence they had available.

More research is needed into this disorder. It might also be that doctors should take these symptoms more seriously and provide optimal care for their patients which has been proved (as above) to be of better effect than traditional treatment.

References

van Dessel N, den Boeft M, van der Wouden JC, Kleinstäuber M, Leone SS, Terluin B, Numans ME, van der Horst HE, van Marwijk H. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD011142. DOI: 10.1002/14651858.CD011142.pub2.

Kleinstäuber M, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ. Pharmacological interventions for somatoform disorders in adults. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010628. DOI: 10.1002/14651858.CD010628.pub2.

Unexplained symptoms: somatoform disorders by Ammar Sabouni is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Based on a work at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011142.pub2/abstract. All images used within the blog are not available for reuse or republication as they are purchased for Students 4 Best Evidence from shutterstock.com.

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