Somatoform disorders are presentations where physical symptoms worry a patient, there is no organic pathology to explain them, but reassurance fails. They represent a murky borderland between medicine and psychiatry and understanding has not been helped by the plethora of terms used in this area. A typical scenario would be a 68-year-old woman who was recently widowed complaining to a general practitioner of headache, trouble sleeping, tiredness and muscle pain. Blood tests are negative but the patient says “there must be something wrong”. Faced with uncertainty, clinicians may easily fall back on a fruitless path of investigations and referrals. There is plenty of knowledge regarding somatoform disorders among younger people (who have fewer physical illnesses), but much less regarding older people. This article focuses on what is known about these disorders in older people, a practical way forward and what may develop in the future.