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

Abstract 

The DSM IV category, somatoform disorders, is composed of disorders that are characterized by symptom amplification—most typically, amplification of pain. Other than this commonality, there is considerable variability among the disorders in terms of etiology, course, comorbidities, and the presence or absence of insight. The heterogeneous nature of the somatoform group has led to calls to remove or radically alter the category in the next DSM revision. Despite these concerns, teaching articles addressing somatoform disorders tend to generalize across the category when making patient treatment recommendations. In this report, the authors encourage moving beyond catch phrases such as, “the somatic patient” and “vague complaints of pain,” and toward accurate differential diagnosis between somatoform disorders. They argue that accurate diagnosis of somatoform disorders is both achievable and necessary to provide optimal care for this diverse population of patients. Diagnosis and patient-centered management is contrasted with more generalized treatment recommendations.

Perspective

This article highlights the appropriate diagnosis and treatment of somatoform disorders for patients with pain. In contrast to the majority of literature on the subject, the authors emphasize the importance of differential diagnosis between somatoform disorders as well as patient-specific and diagnosis-specific treatment. The authors argue that there has been an incorrect tendency to overgeneralize across disorders, an error that is magnified by the exceptional weakness of the somatoform category.

Key words: Somatoform disorders, pain patient, medically unexplained symptoms, somatization, primary care, pain management