Health Care Utilization and Poor Reassurance: Potential Predictors of Somatoform Disorders

Abstract

Objective Somatoform disorders are common conditions, but the current diagnostic criteria are considered to be unreliable, based largely on medically unexplained symptoms. DSM-5 is considering other possible characteristics of somatizers including high utilization, dissatisfaction with care, and poor response to reassurance. This paper reviews the available literature for evidence to support these criteria, and evaluates if distinctive aspects of these characteristics exist in somatizers. Methods The Pubmed database was searched combining terms such as “somatoform disorder” with “reassurance,” “satisfaction,” and “utilization.” Articles were individually inspected. Results Many studies report a deficit in long-term response to reassurance in somatizers; there was some evidence that patients respond initially to reassurance, followed by return of anxiety, leading to further reassurance seeking. There was insufficient evidence to support poor satisfaction with care as a characteristic of somatizers. While there is no standard criterion for high utilization, regardless of definition, evidence was found to support over-utilization, particularly in outpatient visits. However, no unique pattern of utilization was found that could identify somatizers within a broader group of high utilizers. Conclusions This review revealed evidence of over-utilization in many areas of healthcare, as well as poor long term response to reassurance in somatizers. Dissatisfaction with care, though, was not a consistent finding. It is difficult to study alternative diagnostic criteria for somatoform patients when the current criteria rest on so many problematic assumptions. Future research should attempt to validate criteria empirically in patient groups, with selection not based on medically unexplained symptoms.

Exploring the Role of Neuroticism and Insecure Attachment in Health Anxiety, Safety-Seeking Behavior Engagement, and Medical Services Utilization

“…Contrary to what was hypothesized based on the IMHA, reassurance-seeking did not lead to alienation. This inconsistency may be due to the fact that the items used to measure reassurance-seeking reflect a more passive desire for health-related reassuranceseeking, which stands in contrast to the active, incessant, and aversive reassurance-seeking, as it is conceptualized by the IMHA and other theories (Puri & Dimsdale, 2011). Taking account of the perceptual factor (absorption) in our analysis, results showed that absorption was positively related to worry and reassurance-seeking.…”

Frequent attendance in family practice and common mental disorders in an open access health care system

“…However, the association between somatoform disorders and FA is in keeping with a large body of evidence from elsewhere [20][21][22]. In fact it has recently been suggested that a redrawing of the diagnostic criteria for the category somatoform disorders is needed, focusing on its main attributes: somatic symptoms, excess concern with symptoms and illness and abnormal health care utilization [34].…”

My mind is made up: Cancer concern and women’s preferences for contralateral prophylactic mastectomy

“…This revealed differences across women in terms of the importance to them of achieving reductions in cancer risk—those who were concerned over cancer recurrence had stronger preferences for management strategies associated with lower ongoing risks. Previous research has found high levels of healthcare utilisation among patients who exhibit high levels of concern about disease symptoms or illness (Barsky, Orav, & Bates, ; Bermingham, Cohen, Hague, & Parsonage, ; Mewton & Andrews, ; Puri & Dimsdale, ). It is plausible that women who are concerned about cancer recurrence following breast cancer treatment might use more healthcare services than those who are not similarly concerned.…”

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