Eric K. Mason
According to Arnold, De Waal, Eekhof, and Van Hemert somatoform disorders are among the most common mental disorders found in primary care settings (2006). In a recent study conducted by Arnold, et al., the prevalence of somatoform disorders in primary care settings was measured at 16.1% (2006). Some studies have reported the prevalence of somatoform disorders to be as high as 30% (Arnold, 2006).
Somatoform disorders are characterized a by the presence of multiple physical symptoms that cannot be explained by a “real” physical illness (Millon, Blaney, & Davis, 1999). Several disorders fall under the general heading of somatoform disorders. For example, somatization disorder, undifferentiated somatoform disorder, conversion disorder, pain disorder, hypochondriasis, body dysmorphic disorder, and somatoform disorder NOS are all subtypes of somatoform disorder (American Psychiatric Association, 2000).
Undifferentiated somatoform disorder appears to be the most common (Arnold, 2006). People with undifferentiated somatoform disorder often have physical complaints, “such as fatigue, headache, or gastrointestinal symptoms [which cause] clinically significant impairment for at least 6 months” (Arnold, 2006). These physical complaints must be “below the threshold for a diagnosis of Somatization Disorder” (American Psychiatric Association, 2000). Physical symptoms, such as those described above, must be experienced by the client for several years before a diagnosis of somatization disorder can be given (American Psychiatric Association, 2000).
Somatoform disorders present health care professionals with a unique dilemma. For people with somatoform disorders, there is no “real” cause for their physical complaints. However, they generally dislike it when others psychologize what they see as real physical complaints. In other words, they don’t like hearing that it’s all in their heads. People with somatoform disorders, therefore, may be reluctant to seek out help from mental professionals (Arnold, 2006).
In “Somatoform Disorder in Primary Care: Course and the Need for Cognitive-Behavioral Treatment,” Arnold and colleagues address the use of cognitive-behavioral therapy as a treatment option in primary care settings for somatoform disorders (2006). In order to determine the viability of cognitive-behavioral therapy as a treatment option for somatoform disorders, Arnold, et al. randomly recruited 1,778 patients from primary care settings. Out of the randomly selected group, it was determined that 119 patients could be diagnosed with a somatoform disorder. Other exclusionary factors, such as pervious psychological treatment, psychosis, serious somatic diseases, the abating of symptoms associated with somatoform disorder within six months, etc., were used to narrow down the patients to those for whom cognitive-behavioral therapy was considered suitable. There were 49 patients deemed suitable for cognitive-behavioral therapy (Arnold, 2006).
Out of the 49 patients mentioned above, 26 were interested in receiving cognitive-behavioral therapy as a treatment for their somatic complaints. According to the authors of this study, these 26 patients amount to a 4.8% weighted prevalence rate in the original population of randomly selected patients. The authors, therefore, conclude that there are sufficient numbers of individuals with somatoform disorders for whom cognitive-behavioral therapy would be suitable. Perhaps, more importantly there also appears to be a significant number of people with somatoform disorder who were interested in receiving cognitive-behavioral therapy (Arnold, 2006).
Arnold, I.A., et al. (2006). Somatoform disorder in primary care: Course and the need for cognitive-behavioral treatment. Psychosomatics, 47, 498-503.
Million, T., Blaney, P.H., & Davis, R.D. (Eds.). (1999). Oxford Textbook of Psychopathology. New York: Oxford University Press.