[Somatization -- conversion -- dissociation: strategies for behavior therapy]

Abstract

Modern cognitive behavioral approaches for the treatment of patients with medically unexplained somatic symptoms have been developed on the basis of the classification systems DSM-IV and ICD-10. These systems define somatoform disorders as a homogeneous clinical group. Behavior therapy has additionally developed vicious circle models specifying etiological, triggering and maintaining factors. Treatment goals and strategies can be derived directly from these models. The main components are: (1) motivation of patients to accept the psychotherapeutic approach; (2) introduction of alternative explanations of the symptoms on the basis of both biomedical as well as psychosocial mechanisms; (3) evaluation of the new explanations by patient and therapist; (4) reduction of avoidance and inadequate illness behaviour. Health economical aspects are particularly important because patients with somatoform disorders tend to overuse medical services and are thus considered an expensive problem group for the health system.