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Somatoforme Störungen – somatoforme Belastungsstörung und verwandte Störungen

Living reference work entry
Part of the Springer Reference Medizin book series (SRM)

Zusammenfassung

Somatoforme Störungen umfassen eine Gruppe heterogener Störungen, denen als führende klinische Beschwerden körperliche Symptome ohne eine hinreichende organmedizinische Erklärung gemeinsam sind. Dass Konzept der „Somatisierung“ liegt den somatoformen Störungen, aber auch anderen primären psychischen Störungen zugrunde, die wie z. B. Depression oder Angst vorrangig in ihren integralen körperlichen Symptomen dargestellt werden. Ursache, Entstehung und Aufrechterhaltung von somatoformen Störungen werden multifaktoriell vermittelt. Akute und chronische psychosoziale Stressoren spielen eine wichtige Rolle. Es kommen unterschiedliche Schweregrade und Verlaufstypen vor. Zu beachten sind eine bedeutsame psychiatrische Komorbidität, eine häufige psychosoziale Behinderung sowie eine intensive Inanspruchnahme vielfältiger medizinischer Ressourcen. Nicht selten gestaltet sich die Arzt-Patient-Beziehung emotional konfliktträchtig. Es existieren differenzierte störungsbezogene psychotherapeutische Ansätze. Pharmakotherapeutische Interventionen sind v. a. bei koexistenten psychischen Störungen indiziert, besitzen aber auch unabhängig davon eine gewisse Evidenzbasierung. Das diagnostische Konzept der somatoformen Störungen spielt bisher für die ärztliche Versorgung nur eine untergeordnete Rolle. Die Herausforderungen hier sind in erster Linie in der hohen Anzahl von Patienten zu sehen, die entweder nur vereinzelte oder nur wenige körperliche Symptome ohne mögliche somatisch-medizinische Zuordnung präsentieren und daher häufig nur „Symptom-Diagnosen“ erhalten, oder aber bei denen meist auf einer fachärztlichen Ebene ein fachspezifisch definiertes „funktionelles Körpersyndrom“ diagnostiziert wird. Beide eigenständigen diagnostischen Zugangsweisen sind häufig nicht spannungsfrei und klinisch sinnvoll in das psychiatrische Diagnosesystem übersetzbar. Das DSM-5 hat eine Reihe von formalen und inhaltlichen Kritikpunkten an der früheren Diagnosegruppe der „somatoformen Störungen“ aufgenommen und schlägt nunmehr die Gruppe der „somatischen Belastungsstörung und verwandter Störungen“ vor. Es ist derzeit noch unklar, zu welchen Positionen und Bezeichnungen die für die nächsten Jahre angekündigte Revision von ICD-11 kommen wird.

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