Somatoform disorders are characterised by persistent physical symptoms that suggest the presence of a medical condition, but are not explained fully by that condition or by the direct effects of substance misuse or mental disorder (DSM-IV).1 The prevalence of somatoform disorders is estimated at 6% in the general population.2 Patients with such disorders usually have high functional impairment, 3,4 are difficult to treat, 5,6 and show high utilisation of medical care. 7 Moreover, it typically takes years before they are referred to mental healthcare. 6,8,9 A strictly somatic approach and unnecessary diagnostic examinations may increase somatising behaviours, 10 and lead to chronic symptoms and high medical costs: 7,11,12 these findings emphasise the need for early intervention.13 Psychotherapy may be a viable treatment option given the role of behavioural, cognitive and emotional processes in these disorders and their high degree of comorbidity with mental disorders.14-16 Some reviews and meta-analyses suggest that psychotherapy may be effective in patients with somatoform disorder. [17][18][19] However, these reviews were restricted to psychodynamic psychotherapy only, 17 or predominantly involved groups with less severe disorder, with functional neurological or conversion disorder generally being excluded. 18 Hypochondriasis and body dysmorphic disorder were typically included in these reviews, 19 although it is still a matter of debate whether these conditions should be classified as somatoform disorder.14, 20 The results of previous reviews cannot always be generalised to patients with strictly defined somatoform disorder in secondary and tertiary care, as these patients are generally more impaired than those seen in primary care. 21 Finally, previous meta-analyses typically included only randomised trials, often excluding effectiveness studies, [22][23][24] whereas the inclusion of both randomised and non-randomised studies allows the meta-analytic comparison of effect sizes between these designs.The aim of our meta-analysis therefore was to examine the effectiveness of psychotherapy for patients with strictly defined, severe somatoform disorder treated in secondary and tertiary care. To that aim, we compared effect sizes from pre-to post-treatment and from post-treatment to follow-up of psychotherapy and treatment as usual, excluding waiting-list control groups. This study focused on pre-to post-treatment contrasts, and not on between-group contrasts, given the limited number of controlled treatment studies in this context. Given the small number of studies included, moderators of treatment effect were examined only exploratively. We examined methodological quality of the studies, 25 intervention characteristics (type, modality, frequency and length), 26 and whether treatment was offered in tertiary (multimodal and integrative) or secondary care settings, 18 as potential factors influencing treatment effectiveness. MethodA multiple-phase search was conducted in March 2010 to retrieve as many studies as pos...

BackgroundAlthough body-related problems are common in patients with somatoform disorder, research focusing on how patients with somatoform disorder perceive and evaluate their body is scarce. The present study compared differences in body image between patients with somatoform disorder and respondents from a general population sample. It also examined differences within the somatoform disorder group between men and women and between the diagnostic subgroups conversion disorder, pain disorder and undifferentiated somatoform disorder.MethodsData were obtained from 657 patients (67.5% female) with somatoform disorder (DSM-IV-TR 300.7, 300.11, 300.81, 300.82) and 761 participants (58.6% female) from the general population. The Dresden Body Image Questionnaire (DBIQ) was used to assess body image in five domains: body acceptance, vitality, physical contact, sexual fulfilment, and self-aggrandizement. Confirmatory factor analysis and analyses of variance were performed. Since differences in age and sex were found between the somatoform disorder sample and the comparison sample, analyses were done with two samples of 560 patients with somatoform disorder and 351 individuals from the comparison sample matched on proportion of men and women and age.ResultsPatients scored significantly lower than the comparison sample on all DBIQ domains. Men scored higher than women. Patients with conversion disorder scored significantly higher on vitality and body acceptance than patients with undifferentiated somatoform disorder and pain disorder.ConclusionsThe mostly large differences in body image between patients with somatoform disorder and the comparison sample as well as differences between diagnostic subgroups underline that body image is an important feature in patients with somatoform disorder. The results indicate the usefulness of assessing body image and treating negative body image in patients with somatoform or somatic symptom disorder.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1928-z) contains supplementary material, which is available to authorized users.

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Social cognition and its association with level of personality organization (PO) were examined in 163 patients with severe somatoform disorders (SFDs) and 151 psychiatric (PSA) control patients. Social cognition was measured with the Social Cognition and Object Relations Scale, which assessed both affective and cognitive facets of social cognition. Levels of PO were assessed using theory-driven profiles of the Dutch Short Form of the Minnesota Multiphasic Personality Inventory (MMPI). The SFD patients exhibited impairments in the cognitive facets of social cognition but not more so than the PSA controls. The results for the affective aspects indicated that the SFD patients exhibited lower levels of emotional investment yet higher affect tone in interactions than the PSA controls. In contrast to the control group, level of PO was not associated with social cognition in SFD. Together, the results indicated that impairments in complexity of mental representations are not specific to SFD patients, yet impairments in emotional investment may be specific to SFD.

Background Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors. Aims To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups. Method The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered. Results The six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value. Conclusions The Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.