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.
This review describes the conceptual and clinical relations between irritable bowel syndrome (IBS), other functional, somatoform, and mental disorders, and points to appropriate future conceptualizations. IBS is considered to be a functional somatic syndrome (FSS) with a considerable symptom overlap with other FSSs like chronic fatigue syndrome or fibromyalgia syndrome. IBS patients show an increased prevalence of psychiatric symptoms and disorders, especially depression and anxiety. IBS is largely congruent with the concepts of somatoform and somatic symptom disorders. Roughly 50% of IBS patients complain of gastrointestinal symptoms only and have no psychiatric comorbidity. IBS concepts, treatment approaches, as well as health care structures should acknowledge its variability and multidimensionality by: (1) awareness of additional extraintestinal and psychobehavioral symptoms in patients with IBS; (2) general and collaborative care rather than specialist and separated care; and (3) implementation of "interface disorders" to abandon the dualistic classification of purely organic or purely mental disorders.
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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.