Non-specific, functional, and somatoform bodily complaints

Abstract

Background: 4-10% of the general population and 20% of primary care patients have what are called "non-specific, functional, and somatoform bodily complaints." These often take a chronic course, markedly impair the sufferers' quality of life, and give rise to high costs. They can be made worse by inappropriate behavior on the physician's part.

Methods: The new S3 guideline was formulated by representatives of 29 medical and psychological specialty societies and one patient representative. They analyzed more than 4000 publications retrieved by a systematic literature search and held two online Delphi rounds and three consensus conferences.

Results: Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality. A strong consensus was reached on most subjects. In the new guideline, it is recommended that physicians should establish a therapeutic alliance with the patient, adopt a symptom/coping-oriented attitude, and avoid stigmatizing comments. A biopsychosocial diagnostic evaluation, combined with sensitive discussion of signs of psychosocial stress, enables the early recognition of problems of this type, as well as of comorbid conditions, while lowering the risk of iatrogenic somatization. For mild, uncomplicated courses, the establishment of a biopsychosocial explanatory model and physical/social activation are recommended. More severe, complicated courses call for collaborative, coordinated management, including regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse), graded activation, and psychotherapy; the latter may involve cognitive behavioral therapy or a psychodynamic-interpersonal or hypnotherapeutic/imaginative approach. The comprehensive treatment plan may be multimodal, potentially including body-oriented/non-verbal therapies, relaxation training, and time-limited pharmacotherapy.

Conclusion: A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. The appropriate treatment depends on the severity of the condition. Effective treatment requires the patient's active cooperation and the collaboration of all treating health professionals under the overall management of the patient's primary-care physician.

Figure 1

Systematic literature search and selection of relevant publications. FSS, functional somatic syndrome

Figure 2

Diagnostic algorithm: Stepped simultaneous diagnostic assessment depending on symptom severity (modified from 2, 4); PTSD, post-traumatic stress disorder

Figure 3

Therapeutic algorithm: Stepped, collaborative, and coordinated care model according to severity level (modified from 2, 4)

eFigure

Association between evidence level (EL) and recommendation grade (RG) (from e4); ^*1evidence level according to Oxford Centre of Evidence-Based Medicine (etable 2); ^*2recommendation grade in the Program for National Care Guidelines (Programm für Nationale Versorgungsleitlinien); ^*3clinical consensus point, by analogy to the National Care Guideline for Unipolar Depression (e5)