Management of Functional Somatic Syndromes and Bodily Distress

Abstract

Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

“…As mentioned in the Introduction, AD is a debated diagnosis [e.g., 14,16] and ED has limited international recognition. Indeed, it is challenging to fit the complexity of chronic stress, which comprises both biological, psychological and social factors, into customary taxonomies of medical disease [13,18]. In the face of this complexity and the lack of previous research, we consider it a strength of the study to use clinical diagnoses defined by DSM-5 and ICD-10 as a means of operationalizing clinically significant symptoms associated with chronic stress.…”

“…There is a lack of international consistency regarding how to define and classify clinically significant reactions to chronic stress [2,13]. We operationalized symptoms using diagnostic criteria for adjustment disorder (AD) and exhaustion disorder (ED).…”

The Need to Distinguish between Bodily Distress Disorder and Somatic Symptom Disorder

“…We read the article entitled "Management of Functional Somatic Syndromes and Bodily Distress" by Henningsen et al [1] with great interest. The authors state that they intend to develop a unifying perspective on the understanding and management of functional somatic syndromes and bodily distress, while also providing an update on current concepts and their aetiologies as well as evidence-based recommendations for treatment, thereby concentrating on developments in the last decade.…”

“…Hence, only a proportion of patients with FSS show characteristics of SSD. Moreover, as Henningsen et al [1] mention themselves, the number of bodily symptoms is a strong predictor of disability and health care use, but with health anxiety being an additional and independent predictor.…”

Potential effects of multimodal psychosomatic inpatient treatment for patients with functional vertigo and dizziness symptoms – A pilot trial

“…A systematic review provided some preliminary evidence that outpatient cognitive‐behavioural psychotherapy (CBT) may be effective in reducing vertigo‐related handicap; however, the review was unable to determine the long‐term efficacy of these interventions since follow‐up evaluations were and still are rare (Schmid, Henningsen, Dieterich, Sattel, & Lahmann, ). CBT has also been proven effective in specific somatoform disorders and functional complaints such as irritable bowel syndrome, fibromyalgia, or chronic fatigue syndrome (Henningsen, Zipfel, Sattel, & Creed, ). In addition, there is some evidence that psychodynamic interpersonal therapy can reduce somatization and improve physical quality of life (Sattel et al ., ).…”