Skip to main content

Somatoforme und funktionelle Störungen

Somatoform disorders and functional somatic syndromes

Zusammenfassung

Somatoforme Beschwerden zeichnen sich durch anhaltende und subjektiv beeinträchtigende Körperbeschwerden aus, für die auch nach angemessener somatischer Diagnostik keine ausreichende organmedizinische Erklärung gefunden werden kann. Die Prävalenzraten somatoformer Beschwerden und Störungen sind vor allem in der Primärversorgung beträchtlich. Der Verlauf der Störung ist typischerweise chronisch, die Remissionsraten sind niedrig. Die Genese und Aufrechterhaltung somatoformer Beschwerden sind als multifaktoriell anzusehen. Die Klassifikation somatoformer Störungen wird aktuell kontrovers diskutiert; es ist von einer deutlichen Änderung der Kategorie im künftigen DSM-V auszugehen. Hinsichtlich der Psychotherapie somatoformer Störungen liegt empirische Evidenz für die Wirksamkeit kognitiv-behavioraler sowie psychodynamischer Therapieansätze vor. Die Pharmakotherapie hat eine nachgeordnete Bedeutung, kann aber bei ausgeprägter Komorbidität von Angst- oder depressiven Störungen sinnvoll sein.

Summary

Somatoform symptoms occur in the absence of clear organic pathology. Typically, such symptoms are long-lasting and disabling. Somatoform symptoms and disorders are highly prevalent in primary care. The course of somatoform disorders is mostly chronic, and remission rates are low. Multiple factors influence the development and perpetuation of somatoform disorders. Currently, there is strong debate about the classification of somatoform disorders, and it is very likely that there will be significant changes in the classification of somatoform disorders in the upcoming DSM-V. With regard to the psychotherapeutic treatment of somatoform disorders, there is empirical evidence for the efficacy of cognitive-behavioral as well as psychodynamic-interpersonal strategies. Pharmacotherapy plays a minor role, but it can be useful mainly in cases of comorbid depression or anxiety.

This is a preview of subscription content, access via your institution.

Abb. 1

Literatur

  1. 1.

    Burbaum C, Stresing AM, Fritzsche K et al (2010) Medically unexplained symptoms as a threat to patients‘ identity? A conversation analysis of patients‘ reactions to psychosomatic attributions. Patient Educ Couns 79:207–217

    Article  PubMed  Google Scholar 

  2. 2.

    Chioqueta AP, Stiles TC (2004) Suicide risk in patients with somatization disorder. Crisis 25:3–7

    PubMed  Google Scholar 

  3. 3.

    Creed F, Barsky A (2004) A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 56:391–408

    Article  PubMed  Google Scholar 

  4. 4.

    Creed F, Guthrie E, Fink P et al (2010) Is there a better term than „medically unexplained symptoms“? J Psychosom Res 68:5–8

    Article  PubMed  Google Scholar 

  5. 5.

    Dimsdale J, Creed F on behalf of the DSM-V Workgroup on Somatic Symptom Disorder (2009) The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report. J Psychosom Res 66:473–476

    Article  PubMed  Google Scholar 

  6. 6.

    Fallon BA (2004) Pharmacotherapy of somatoform disorders. J Psychosom Res 56:455–460

    Article  PubMed  Google Scholar 

  7. 7.

    Fink P, Hansen MS, Oxhøj ML (2004) The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 56:413–418

    Article  PubMed  Google Scholar 

  8. 8.

    Fink P, Schröder A (2010) One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndrome and somatoform disorders. J Psychosom Res 68:415–425

    Article  PubMed  Google Scholar 

  9. 9.

    Fröhlich C, Jacobi F, Wittchen HU (2006) DSM-IV pain disorder in the general population. An exploration of the structure and threshold of medically unexplained pain symptoms. Eur Arch Psychiatry Clin Neurosci 256:187–196

    Article  PubMed  Google Scholar 

  10. 10.

    Garcia-Campayo J, Alda M, Sobradiel N et al (2007) Personality disorders in somatization disorder patients: a controlled study in Spain. J Psychosom Res 62:675–680

    Article  PubMed  Google Scholar 

  11. 11.

    Hasin D, Katz H (2007) Somatoform and substance use disorders. Psychosom Med 69:870–875

    Article  PubMed  Google Scholar 

  12. 12.

    Henningsen P, Fazekas C, Sharpe M (2010) Barriers to improving treatment. In: Creed F, Henningsen P, Fink P (Hrsg) Improving the management of medically unexplained symptoms, somatisation and bodily distress. Cambridge Univ Press, Cambridge (in press)

  13. 13.

    Henningsen P, Fink P, Rief W (2010) Terminology, classification and concepts, or: what exactly are we talking about? In: Creed F, Henningsen P, Fink P (Hrsg) Improving the management of medically unexplained symptoms, somatisation and bodily distress. Cambridge Univ Press, Cambridge(in press)

  14. 14.

    Henningsen P, Martin A (2008) Somatoforme Störungen. In: Herpertz SC, Caspar F, Mundt C (Hrsg) Störungsorientierte Psychotherapie. Urban & Fischer, München, S 541–559

  15. 15.

    Henningsen P, Sattel H, Gündel H et al (2010) Psychodynamic-interpersonal psychotherapy for patients with pain-predominant multisomatoform disorder: a randomized controlled trial. Manuscript submitted for publication

  16. 16.

    Henningsen P, Zimmermann T, Sattel H (2003) Medically unexplained physical symptoms, anxiety, depression: a meta-analytic review. Psychosom Med 65:528–533

    Article  PubMed  Google Scholar 

  17. 17.

    Henningsen P, Zipfel S, Herzog W (2007) Management of functional somatic syndromes. Lancet 369:946–955

    Article  PubMed  Google Scholar 

  18. 18.

    Kapfhammer HP (2008) Somatoforme Störungen. Konzept, Klinik, Ätiopathogenese und Therapie. Nervenarzt 79:99–117

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Kapfhammer HP (2008) Somatoform Störungen. In: Holsboer F, Gründer G, Benkert O (Hrsg) Handbuch der Psychopharmakotherapie. Springer, Heidelberg, S 949–962

  20. 20.

    Kroenke K (2006) Physical symptom disorder: a simpler diagnostic category for somatization-spectrum conditions. J Psychosom Res 60:335–339

    Article  PubMed  Google Scholar 

  21. 21.

    Lahmann C, Henningsen P, Noll-Hussong M, Dinkel A (2010) Somatoforme Störungen. Psychother Psychosom Med Psychol 60:227–236

    Article  PubMed  Google Scholar 

  22. 22.

    Lahmann C, Loew TH, Tritt K, Nickel M (2008) Efficacy of functional relaxation and patient education in the treatment of somatoform heart disorders: a randomized, controlled clinical investigation. Psychosomatics 49:378–385

    Article  PubMed  Google Scholar 

  23. 23.

    Lahmann C, Röhricht F, Sauer N et al (2010) Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial. J Altern Complement Med 16:47–52

    Article  PubMed  Google Scholar 

  24. 24.

    olde Hartmann TC, Borghuis MS, Lucassen PLBJ et al (2009) Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. J Psychosom Res 66:363–377

    Article  Google Scholar 

  25. 25.

    Rief W, Broadbent E (2007) Explaining medically unexplained symptoms – models and mechanisms. Clin Psychol Rev 27:821–841

    Article  PubMed  Google Scholar 

  26. 26.

    Rief W, Treede RD, Schweiger U et al (2009) Neue Schmerzdiagnose in der deutschen ICD-10-Version. Nervenarzt 80:340–342

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Smith RC, Gardiner JC, Lyles JS et al (2005) Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosom Med 67:123–129

    Article  PubMed  Google Scholar 

  28. 28.

    Sumathipala A (2007) What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med 69:889–900

    Article  PubMed  Google Scholar 

  29. 29.

    Thomassen R, Hemert AM van, Huyse FJ et al (2003) Somatoform disorders in consultation-liaison psychiatry: a comparison with other mental disorders. Gen Hosp Psychiatry 25:8–13

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    van der Feltz-Cornelis CM, Van Os TWDP, Van Marwijk HWJ, Leentjens AFG (2010) Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized controlled trials. J Psychosom Res 68:521–533

    Article  Google Scholar 

  31. 31.

    Voigt K, Nagel A, Meyer B et al (2010) Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification. J Psychosom Res 68:403–414

    Article  PubMed  Google Scholar 

  32. 32.

    Witthöft M, Hiller W (2010) Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol 6:257–283

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

Authors

Corresponding author

Correspondence to C. Lahmann.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lahmann, C., Henningsen, P. & Dinkel, A. Somatoforme und funktionelle Störungen. Nervenarzt 81, 1383–1396 (2010). https://doi.org/10.1007/s00115-010-3056-y

Download citation

Schlüsselwörter

  • Somatoforme Störungen
  • Funktionelle Syndrome
  • Klassifikation
  • Diagnostik
  • Therapie

Keywords

  • Somatoform disorders
  • Functional syndromes
  • Classification
  • Assessment
  • Therapy