Functional Somatic Symptoms

Abstract

on behalf of the guideline group "Functional Somatic Symptoms"* T he German clinical practice guideline on the management of patients with unspecific, functional, and somatoform physical symptoms (1, 2) expired in March 2017. Between November 2016 and July 2018, the guideline was updated and thoroughly revised by a group under the coordination of the German College of Psychosomatic Medicine (Deutsches Kollegium für Psychosomatische Medizin, DKPM) and the German Society of Psychosomatic Medicine and Medical Psychotherapy (Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie, DGPM) and in accordance with the requirements of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften, AWMF). Particular attention was paid to userfriendly language and relevance to daily practice. The long version of the guideline and the guideline methods report are available (in German) on the AWMF website (3). The patient guideline is currently undergoing revision. Characterization of the clinical pictureThe term "functional somatic symptoms" refers to a broad spectrum of symptom patterns of greatly varying severity (4-6):• Persistent unspecific symptoms that are burdensome enough for the patient to consult a doctor but are not classified as disease ("medically unexplained symptoms" or "persistent physical symptoms"). These can nevertheless discernibly impair the patient's everyday functioning.• Defined symptom clusters present over an extended period in the form of functional somatic syndromes (such as fibromyalgia syndrome or irritable bowel syndrome). These are mostly associated with a significant limitation of everyday functioning.• Conditions that fulfill the criteria of pronounced (multi)somatoform disorders and the newly defined somatic stress disorders. These presuppose considerable impairment of everyday functioning and are also associated with psychobehavioral symptoms. Functional somatic symptoms as outlined above are to be distinguished from the commonly occurring transitory indispositions that rarely prompt a visit to the doctor and affect everyday functioning only slightly for a limited time, if at all. These are of no medical significance.

Psychopathology and Somatic Complaints: A Cross-Sectional Study with Portuguese Adults

“…In terms of comorbidities, FSS are associated with psychiatric disorders, with high rates of depressive and anxiety symptoms [ 4 , 9 ], which was corroborated by the current study, which found a significant association between all psychopathological symptoms and the FSS severity, with anxiety symptoms having the highest correlation coefficient in both groups. In addition, a significant correlation ( p < 0.001) was found between the severity of somatic symptoms and obsessive-compulsive symptoms, psychoticism, and paranoid ideation, which is in accordance with previous studies that point out that personality disorders are associated with severe FSS [ 38 ].…”

“…Functional somatic symptoms (FSS) refer to persistent bodily symptoms that lead individuals to seek health care, and that no organic pathology is found that explains such symptoms [ 1 , 2 , 3 , 4 ]. FSS are common in medical practice and have frustrated doctors and patients as it is a diffuse condition, difficult to treat, and that can cause considerable disability [ 5 ].…”

Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data

“…For example, the provision of self-help information has been shown to improve the quality of life of IBS patients 32 , thus reducing the need for further consultation. Additionally, the Gemran FSS guideline advocates for restraint in diagnostic investigations when somatoform disorders are suspected 33 . Of those patients whose FSS diagnosis is confirmed in two quarters, there is a moderately high persistence, with between one third and two thirds of patients receiving the same diagnosis after five years.…”

Funktionelle Körperbeschwerden und somatische Belastungsstörungen – leitlinienbasiertes Management

“…Hierzu analysierte die Leitliniengruppe nach systematischer Literaturrecherche 3795 neue Originalarbeiten und 3345 systematische Reviews, von denen 358 Publikationen in die Aktualisierung Eingang fanden. Im fast durchgehend starken Konsensus wurden evidenzbasierte Empfehlungen, Hintergrundinformationen und klinische Entscheidungshilfen für Diagnostik und Therapie erarbeitet und so eine aktuelle, interdisziplinäre, evidenzbasierte, praxisnahe und anwenderfreundliche klinische Leitlinie erstellt [3,4]. Zusätzlich wurden für dieses narrative Review, basierend auf einer selektiven Literaturrecherche in PubMed/MEDLINE, einschlägige ältere Arbeiten herausgegriffen und besonders relevante neuere Arbeiten ergänzt, vor allem systematische Reviews und Meta-Analysen.…”