Somatoforme Störungen

Konzept, Klinik, Ätiopathogenese und Therapie

Somatoform disorders

Clinical evidence, etiology, pathogenesis, and therapy

Zusammenfassung

Patienten mit „medizinisch unerklärten Körpersymptomen“ stellen im medizinischen Versorgungssystem eine diagnostische und therapeutische Herausforderung dar. Eine psychiatrische Perspektive betont diagnostisch primäre psychische Störungen einerseits, somatoforme Störungen andererseits. In der klinisch-somatischen Medizin existiert eine eigenständige diagnostische Beschreibung von fachbezogen definierten funktionellen Körpersyndromen. Beide diagnostischen Systeme sind nicht deckungsgleich. Kritikpunkte an der derzeitigen Konzeptualisierung und Klassifikation von somatoformen Störungen werden dargestellt. Die in den aktuellen psychiatrischen Klassifikationssystemen aufgeführten somatoformen Störungen werden in ihren klinischen Charakteristika skizziert. Somatoforme Störungen werden ätiopathogenetisch vorteilhaft innerhalb eines multifaktoriellen Modells beschrieben, in dem psychosoziale und neurobiologische Einflüsse eigenständig bewertet werden müssen. Es lassen sich formale Behandlungsziele und allgemeine Behandlungsprinzipien beschreiben. Psychoedukative, psychopharmakologische, kognitiv-behaviorale, psychodynamische und rehabilitative Ansätze begründen eine multimodale Therapie der somatoformen Störungen. Das Management in der primärärztlichen Versorgung verdient eine besondere Beachtung.

Summary

Patients presenting with bodily symptoms and complaints that are not explained by organic pathology or well-known pathophysiological mechanisms comprise a major challenge to any medical care system. From a perspective of psychiatric classification, such medically unexplained somatic symptoms are diagnosed as depressive and anxiety disorders on the one hand or somatoform disorders on the other. In clinical physical medicine a quite different diagnostic approach is taken to conceptualize functional somatic syndromes. Concepts of somatoform disorders are outlined, critical issues regarding existing diagnostic systems are discussed, and possible alternative approaches for upcoming versions of DSM-V and ICD-11 are mentioned. The main somatoform disorders are described in their clinical characteristics. Etiopathogenetically, somatoform disorders may best be considered within a multifactorial model. Some pragmatic guidelines for multimodal treatment of somatoform disorders are outlined.

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Kapfhammer, H. Somatoforme Störungen. Nervenarzt 79, 99–117 (2008). https://doi.org/10.1007/s00115-007-2388-8

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Schlüsselwörter

  • Somatoforme Störungen
  • Funktionelle Körpersyndrome
  • Konzept
  • Kritik
  • Klinik
  • Ätiopathogenese
  • Therapie

Keywords

  • Clinical features
  • Concept
  • Critique
  • Etiopathogenesis
  • Functional somatic syndromes
  • Somatoform disorders
  • Treatment