Somatoform disorders

For a diagnosis of a somatoform disorder to be made, there should be continued presentation of physical symptoms together with persistent requests for medical investigations, despite negative findings of organic illness and reassurance by doctors that the symptoms have no physical basis. In some patients, physical disorders may have been present, but these do not explain the nature and extent of the present symptoms, or the distress and preoccupation of the patient.

Guidelines have been published on the management of patients with somatoform disorders who present in general hospitals,61,62 which include addressing psychological and psychiatric issues.

These disorders are frequent. In a recent survey of patients attending a general practice clinic in Holland, the prevalence of somatoform disorders was as high as 21.9 percent.63 Many of these patients are severely disabled, but it is only the minority that are likely to be assessed by clinical psychologists or psychiatrists, despite a recent recommendation advocating joint working between liaison psychiatrists and pain physicians.64

The value of the present classifications of these syndromes has been brought into question because of the imprecise categorization of such disorders and the fact that many patients fall into the category of undiffer-entiated somatoform disorder, a watered-down version of somatization disorder. Pain is only one of the symptoms that can occur in a somatoform disorder. Other symptoms include palpitations, breathlessness, cough, swallowing air, and frequency of micturition. Those somatoform disorders that are concerned with painful conditions are indicated below, together with their ICD-10 codes.

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