The simple answer is "yes, anyone can help." People with Somatization Disorder tend to respond well to caring, concerned clinicians. It is important that there be a "stable" primary clinician, someone they can count on to be there when they start becoming symptomatic again. We don't usually expect permanent "cure," but we can greatly reduce the severity and frequency of symptoms, reduce medical costs, etc. Taking the suffering seriously without getting trapped in a quest for physical causes; gently redirecting the conversation toward life/relationship issues; providing encouragement and subtle suggestions of improvement - these are the keys. No specific orientation is required: you can be psychodynamic, humanistic, or cognitive-behavioral. You can even be a physician (placebos work well, if backed up by caring).

Intensive Short Term Dynamic Psychotherapy is the treatment of choice. For more information, look at papers by Allan Abbass and Habib Davanloo. Abbass runs the psychiatric education program at Dalhousie University, where ISTDP is taught to all training psychiatrists. Hope this is helpful. Dianna Kenny

I'm inclined to agree with Dianna Kenny, with one caveat: many somatoform disorder patients are somewhat alexithymic. They have difficulty identifying and labeling their emotional states. (That's partly why they develop somatic symptoms in the first place.) And alexithymia makes short-term dynamic work challenging. Not impossible, but more difficult. (In fact, it was in the course of developing an early form of short-term dynamic therapy that alexithymia was first described by Peter Sifneos - it was considered to be one of the major obstacles to doing intensive work over the short haul.)

Thanks for that excellent observation, Stephen. Yes, for people with alexithymia, the first challenge is to help them tolerate the experience of their own emotions. This is achieved within ISTDP with a process called restructuring, which aims to bring into awareness the resistances that are employed to prevent this from occurring and then to name and express the feelings once they have come into awareness. It is slow but important work and is integral to this form of therapy.

Thanks Stephen Joy and Dianna Kenny for this insightful responses

YES. As a Family Physician and a Psychological counsellor i approach such patients on following manner.

Mainly 3 principles.

1. Establish a firm theraputic rapport with the patient.

It is important to acknowledge the patient's pain and suffering to communicate that the physician is caring, compassionate and interested in providing help.

2. Educate the patient regarding the manifestations of somatization disorder.

Tell the patient that he/she is suffering from medically recognized illnessand that the condition will not lead to chronic mental or physical, deterioration or death.

3. Provide consistant reassurence.

Althought patient already in anxiety and depressive symptoms i have to minimally prescribe medications and carefully monitored.

Thanks Fernando. You mean psycho-education works. How much are the chances of full recovery?

A review of randomized controlled trails by Kroenke (2007) (efficacy of treatment for somatoform disorders. Psychosomatic Medicine) indicates that CBT is the best established psychological treatment for somatoform disorders

Thanks Fernandez, i will see it

Hi everyone, I have been following this discussion with great interest. I work in a Pain Management Service, and I am wondering if anyone is aware of a validated assessment tool for somatization disorder?

I agree with Susan Longley; somatization disorder involving complaints across multiple somatic systems and with an onset before age 30 is very different from somatoform disorders, be they pain, undifferentiated, conversion, etc. A validated assessment tool from which one can infer the presence of a somatoform disorder, of what ever flavor, is the MMPI-2-RF. In particular the somatic-cognitive scales and RC1 measure somatic complaints. What is every helpful is that two validity scales assess the credibility of responses in that domain. The Fs scale measures the probability of non-credible reporting of somatic symptoms, and the RBS (response bias scale) measures the probability of non-credible cognitive complaints. Particularly useful is the fact that comparable group distributions are displayed for each scale; e.g. means and distributions are graphically depicted for male and female forensic disability claimants respectively, as well as any oter group one might choose.

In response to Isabela Caramlau's query about assessment: Somatization Disorder is a bit of a nightmare, diagnostically speaking. Dr. Williams is correct in stating that the MMPI-2 is useful, but it is not going to provide you with a definitive diagnosis. Rather, certain MMPI profiles may either help to confirm your clinical diagnosis or suggest that somatoform disorders are worth investigating. And now that Somatization Disorder has been removed from the DSM (despite a clinical and research history dating from Briquet's 19th century work) it is unlikely that anyone will be working on a new method for diagnosing it.

In order to make a diagnosis of Somatization Disorder, of course, you need to have a history of multiple somatic complaints that cannot adequately be explained by medical causes. This entails taking a detailed history of the patient's medical problems in all of the domains (pain, GI, sexual, and neurological), including what their physicians were able to ascertain. Unless you have all of those medical records ready to hand, you'll need to rely on the patient. And many people with this disorder are poor historians, inclined to be vague/impressionistic and to shift away from potentially painful topics. For what it is worth, the SCID-IV is probably the single best structured interview to use, but it will be time-consuming and sometimes frustrating.

There is also a brief self-report measure called the PHQ-15 (part of the Patient health Questionnaire). Developed by Kroenke, Spitzer, and Williams and first published in 2002, it has some value as a screening test. Patients rate their symptomatic distress for 15 symptoms on a 0 - 2 scale; those with 3 or more 2-point responses are flagged for further study. If you start with a group of medical patients who have persistent unexplained symptoms, and exclude those with known depression or psychosis, the PHQ-15 will be about 75% accurate. More important, it will be highly specific. Although only about a third of those testing positive will end up diagnosed with Somatization Disorder, only 3% of those testing negative would have been diagnosed. So it is a quick, easy way to initiate the assessment. But I don't think anyone has checked out the false positive rate among patients with other psychiatric disorders, notably depression.

I have a degree in Physiology and Psychology. I have a great problem with the entire concept of somatisation. How can anyone guarantee that the symptoms are not due to an organic disease? There are many rare illnesses during which the patient deteriorates slowly over many years and experiences many symptoms and which require specific tests for diagnosis. Examples include Addison's Disease and many autoimmune conditions. In addition there are many rare illnesses that we do not yet know about but do exist.

Is it ethical to treat a patient as having a somatisation disorder especially as the "cure rate" is negligible? In my opinion it is highly irresponsible of physicians, psychologists and psychyatrists to stop looking for an organic cause and taking the chance of treatment away from the patient, especially as at the end a patient may  even die. However, as this could occur years down the track and the cause would appear unrelated, no one would think that the diagnosis of somatisation disorder in fact stopped the patient from receiving adequate medical care.

In conditions like Addison's disease and in autoimmune conditions where a lot of conditions overlap the patient presents with numerous complaints that can be explained once a diagnosis is found.

I especially despair for the patients who do suffer from psychological and/or psychyatric complaints as they will never get the benefit of a proper work up.

I think it is time to re-think whether somatisation really exists and it is also crucial to address how such a diagnosis impacts on the patient psychologically and socially. In my opinion the patient will never get a proper work up as it would be easier for the doctor to go along with the somatisation diagnosis especially if they are worried about being ridiculed for believing that the patient indeed has an organic illness. 

I really would like someone to explain to me how a limited number of tests, especially non-specific tests for a condition can exclude an organic cause for the patient's symptoms. 14 years ago I was diagnosed with Addison's disease, polymyositis and vasculitis and with many allergies and I had practically every symptom possible before my diagnosis that took about a year only because of my knowledge of physiology and  supportive doctors. Now I have small airways and almost died a year ago because due to ignorance and arrogance it was easier for the attending doctor to put the hyperventilation down to psychological causes and not considering neuromuscular, lung and heart causes (neuromuscular patients can hyperventilate due to various organic causes). And this is my point exactly. Why should patients suffer just because certain doctors etc think that they know everything. I think with complicated medical cases the results should be reviewed by researchers who studied physiology and see how the puzzle pieces fit together.

The comment by Stephen Joy "And now that Somatization Disorder has been removed from the DSM (despite a clinical and research history dating from Briquet's 19th century work)" rally worries me. I would hope that medical science came a long way from the time of Briquet. If we get stuck in the past, the patient certainly has no chance. Just because his concept was resurrected in 1071 without scientific evidence means nothing. Many symptoms of an impending diabetic hypo could be put down to hysteria. Also, to my knowledge unfortunately somatisation disorder was not taken off DSM but was renamed. Somatisation disorder really has no scientific basis.

 Aniko Huizer-Pajkos or Pajkos    -  You seemed to have had a terrible experience that is a cautionary tale for doctors who dismiss illnesses (and their patients) because it seemed psychosomatic.  But is this different from my sister who is blind, not due to the glaucoma the doctors diagnosed , but due to the brain tumor they failed to identify?  Doctors misdiagnose often, let the patient beware.   

As for psycho-somatic illness I think you are overgeneralizing your experience.  From my perspective it is far more likely that people will receive endless ineffective treatments and operation for illness that  are either caused by psychological factors, or are exacerbated by them.   Suggesting something can be improved through psychological treatment is indeed dangerous ground.  There is a great deal of evidence for psychosomatic illness, if you are interested you could read Gabor Mate's "when the Body Says No."  Also the work of Allan Abbass,  and this slideshow from Dalhousie university.  http://fmf.cfpc.ca/wp-content/uploads/2016/11/S136668_Medically-Unexplained-Symptoms_The-emotional-processes-involved-for-patients-and-healthcare-professionals.pdf