Intensive Multidisciplinary Treatment of Severe Somatoform Disorder

Abstract

Chronic severe somatoform disorder (SFD) is resistant to treatment. In a prospective observational study, we evaluated an intensive multidisciplinary treatment focusing on body-related mentalization and acceptance. Patients included in the study were 183 (146 women, 37 men) of 311 eligible patients with chronic severe SFD, referred consecutively to a specialized tertiary care center between 2002 and 2009. Primary outcome measures were somatic symptoms (SCL-90) and health-related quality of life (EuroQol 5-Dimensional [EQ-5D]). These measures were assessed four times before treatment (on intake, twice during an observation period, at start of treatment) and four times after treatment (during follow-up for 2 years). Multilevel analysis was used to separate effects of time (maturation) and treatment. Results revealed significant improvements in SCL-90 somatic symptoms (d = 0.51), EQ-5D index (d = 0.27), and EQ visual analogue scale (d = 0.56). Significant reductions were also observed in SCL-90 anxiety, depression, and overall psychopathology as well as in medical consumption associated with psychiatric illness (Trimbos/iMTA Questionnaire for Costs Associated With Psychiatric Illness). Large interindividual differences were found in treatment outcome. The long-term improvement seen in many patients suggests that intensive multidisciplinary tertiary care treatment is a useful approach to chronic severe SFD.

Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care

“…Finally, more outcome studies are needed on the long‐term effectiveness of interventions for somatoform disorders in secondary mental health care. After all, the treatment of DSM‐5 somatic symptoms disorders is still in its infancy (Sharma & Manjula, ) and chronic severe somatoform disorders are often treatment‐resistant (Houtveen et al, ). In line with our results, more recent treatment studies concerning somatoform disorders have stressed the importance of an additional treatment focus on co‐morbidity (Kaplan, ).…”

“…In line with our results, more recent treatment studies concerning somatoform disorders have stressed the importance of an additional treatment focus on co‐morbidity (Kaplan, ). Examples of other recent treatment studies regarding somatoform disorders are CBT enriched with emotion regulation strategies (Kleinstäuber, Gottschalk, Berking, Rau, & Rief, ), Group CBT (Yoshino et al, ), mindfulness‐based cognitive therapy (van Ravesteijn et al, ), and intensive multidisciplinary treatment (Houtveen et al, ).…”

“…Some authors assume an even higher prevalence for somatoform disorders as a result of changes in the DSM‐5 in relation to the diagnostic threshold (Voigt et al, ). In secondary mental health care, somatoform disorders tend to be persistent and chronic, difficult to treat, and with high functional impairment (Dirkzwager & Verhaak, ; Houtveen et al, ; Koelen et al, ; Steinbrecher & Hiller, ), resulting in high health care use, and high societal and economic costs (Houtveen et al, ; Konnopka et al, ; Sammet, Bohn, Schrauth, & Leibing, ).…”

“…Somatoform disorders are quite common, with an estimated prevalence of approximately 6% in the general population, 16% in primary care, and up to 52% in secondary care (Baumeister & Härter, 2007;Creed, Henningsen, & Fink, 2011;Fink, Hansen, & Oxhøj, 2004;van Hemert, Hengeveld, Bolk, Rooijmans, & Vandenbroucke, 1993;Houtveen, van Broeckhuysen-Kloth, Lintmeijer, Bühring, & Geenen, 2015;Steinbrecher, Koerber, Frieser, & Hiller, 2011;Waal de, Arnold, Eekhof, & van Hemert, 2004;Wittchen et al, 2010). Some authors assume an even higher prevalence for somatoform disorders as a result of changes in the DSM-5 in relation to the diagnostic threshold (Voigt et al, 2013).…”

Body image in patients with somatoform disorder

“…Overall, body image scores appear to be about similar to scores of a sample of patients with mixed mental disorders, with lower vitality scores as the most distinct main outstanding feature in patients with somatoform disorder, especially in patients with pain disorder and undifferentiated somatoform disorder. While body-oriented psychotherapy is considered important in both severe somatoform disorder [ 51 ] and other severe mental disorders [ 52 ], the current study adds that a focus on body image might be an important aspect of these therapies.…”